Tuesday 12 December 2017

Pensioner died on trolley in busy A&E 10 hours after being admitted with chest pains

Cork University Hospital
Cork University Hospital
Ralph Riegel

Ralph Riegel

A PENSIONER died on a hospital trolley in a busy emergency department 10 hours after being admitted with severe chest pains.

James 'Jimmy' Holland (79) was being kept in the emergency department at Cork University Hospital (CUH) overnight because there was no bed available in the specialist cardiology unit.

Mr Holland of Glyntown, Glanmire, Co Cork was on a cardiac monitor in the emergency department but its alarm never sounded because he had suffered a type of cardiac incident which cannot be detected by such equipment.

In CUH's emergency department, nursing staff are dependent on such audio alarms from cardiac monitors.

When nursing staff routinely checked on Mr Holland at 12.45am on April 11, he was unresponsive.

He had been fine when checked at 12.10am.

While he apparently still had a cardiac electrical read, his heart had stopped pumping blood around his body.

Despite desperate efforts to revive Mr Holland, he was pronounced dead at 1.24am.

In the specialist cardiology unit, the feeds from all such monitors are constantly checked by a cardiology nurse in the ward and staff are not totally reliant on audio alarms.

CUH cardiologist, Dr Ronan Curtin, said Mr Holland had apparently suffered a Pulseless Electrical Activity (PEA) type cardiac arrest.

"There is no technology that can monitor for a PEA arrest," he said.

"This type of cardiac arrest won't be detected by a monitor of any description."

Such PEA incidents can occur in just a fraction of a second.

Father of five Mr Holland had awoken at 1am on April 10 last with a severe pain in his chest.

He had suffered a heart attack 20 years before and had unstable angina.

He later went to an out of hours GP service and they referred him to CUH.

Mr Holland attended CUH's emergency department at 3.22pm and was placed on a trolley.

He was formally admitted to CUH at 8.30pm and placed in a cubicle in the emergency department because there was no bed available in the cardiology unit which was full.

It was planned to conduct an angiogram on Mr Holland the following day and secure a bed for him in the cardiology unit.

Doctors stressed that Mr Holland did not exhibit any of the symptoms of requiring an emergency angiogram.

"He was a priority patient. He was awaiting a cardiology bed," Dr Heather Cronin said.

Another attending doctor, Dr Susan Harkin, said she cannot recall if CUH was busier than normal that night.

"The emergency department in CUH is generally very busy," she said.

Assistant State Pathologist Dr Margaret Bolster found that Mr Holland suffered a sudden cardiac death due to coronary heart disease and a thrombosis against a background of lung and renal problems.

Coroner Philip Comyn returned a verdict of death due to natural causes.

The coroner declined a request by the Holland family for the inquest to be adjourned to allow for a more detailed examination of the monitors in CUH's emergency department.

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