Friday 20 April 2018

Coroner delivers open verdict at inquest of woman found collapsed in bedroom

The Coroner's Court in Dublin
The Coroner's Court in Dublin

An open verdict was returned at the inquest of a woman whose death was investigated by gardaí as a possible assault.

Jane Devitt (33) from Carrigmore Way in Tallaght, Dublin 24, died on April 8, 2012, from a hypoxic brain injury four days after her mother discovered her collapsed in her bedroom.

Gardaí investigated her death after former deputy state pathologist Dr Khalid Jaber’s initial post-mortem indicated a blunt force trauma to the head.

However, at Dublin Coroner’s Court, Dr Jaber said that while there was a small bruise at the base of her skull, it is not possible to definitively say what caused the injury.

The inquest heard that that Ms Devitt took a paracetamol overdose four days prior to her collapse which could also have led to her death.  

Dublin Coroner’s Court previously heard that Ms Devitt was a recovering alcoholic who relapsed.

She had several collapses prior to her final admission, attending A&E in both Tallaght Hospital and St James’s Hospital, and had been involved in an altercation with her ex-partner John Connolly on March 26.

He denied striking Ms Devitt during the altercation at her home and told the inquest that he did not see her fall or bang her head.

On the final day of the inquest, the jury heard that Ms Devitt was admitted to Tallaght A&E on the evening of March 31. She told junior doctor Dr Eilis Dunning she had taken 44 paracetamol tablets along with some lager at approximately 5pm.

An initial blood test confirmed the paracetamol. The inquest heard that paracetamol levels cannot be confirmed until four hours after it has been taken. Dr Dunning took a second blood test with the samples going to the lab at 10.28pm, according to labelling.

An issue arose around the timing of this sample with no note made in the medical records, however, Dr Dunning said she would have taken the specimen in the previous 15 minutes. The result of the second test showed a paracetamol level of 154 microgrammes. Dr Dunning said that she “plotted” the level on a graph comparing the time the test is taken and level of paracetamol found which is used to indicate if a patient requires an antidote. There is a high risk and normal risk line on the graph. Dr Dunning assessed Ms Devitt using the normal risk line and the antidote was not administered.

The court heard that excessive alcohol use is one of the factors that renders a patient high risk. Dr Dunning said that the dead woman told her that she had been off alcohol for months. She was not aware that Ms Devitt had recently attended Tallaght Hospital and St James’s Hospital with alcohol intoxication, she added. Ms Devitt’s mother Deirdre Connolly said that she made Dr Dunning aware of this in a phone call, however, Dr Dunning said she could not recall it being discussed.

Professor Patrick Plunkett, clinical professor of emergency medicine, said that in his view Ms Devitt was high risk. When the paracetamol was taken was unclear and unless you have “rock solid” times, "you treat", he said. The graph used to determine risk in Ireland was simplified in January 2013 with a lower threshold now in place. Prof Plunkett said that in his view the hypoxic brain injury was due to hepatorenal failure cause by paracetamol toxicity.

The inquest heard that gardaí initially did not treat the death as suspicious but launched an investigation following a report from Dr Jaber. A person was interviewed and a file sent to DPP who directed that no prosecution would follow.

Dr Jaber, giving evidence from the US via Skype, said that he found a small contusion or bruise on the brain but could not say whether it was caused by a trauma, the paracetamol overdose or alcohol dependency.

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