The family of a retired teacher who died on the day before his 50th wedding anniversary at Tallaght hospital were frustrated that concerns they repeatedly raised about his deteriorating health were not adequately addressed by medical staff, an inquest has heard.
Declan Sweeney (78) of Langton Park, Newbridge, Co Kildare, died in the hospital on December 27th, 2018, a week after he had been admitted over concerns about shortness of breath.
Counsel for Sweeney’s family, Roger Murray SC, claimed there was no evidence that the care of the patient — a father of five who was acting principal of Synge Street CBS on his retirement — had been escalated until the day of his death, despite an early warning system indicating it was warranted over several previous days.
The coroner, Cróna Gallagher, also said she had found it difficult to establish who was responsible for the patient’s care over the Christmas holidays when he was seen by a large number of doctors.
Sweeney’s daughter, Michelle Eastley, told a sitting of Dublin District Coroner’s Court on Monday that she had asked several times for her father to be seen by a senior doctor and to be transferred to an intensive care unit (ICU) after his condition had started to deteriorate on Christmas Eve — three days before his death.
On Christmas Day, Ms Eastley said her father, who was confused, sweating profusely and lacking energy, was not seen by a medical intern until 10pm after a nurse had already advised his family to go home.
She recalled that the doctor, who did not carry out any physical examination of her father, claimed his shaking, laboured breathing and dark-coloured urine were normal for someone with pneumonia.
On returning to the hospital the following day, Ms Eastley said they were informed that her father had collapsed while being taken out of bed, while his family believed his condition was worsening.
She said a doctor had reassured them that he was “not dying”.
Ms Eastley said she directly approached a registrar later on December 26th, 2018, to examine her father but he would only look at the patient’s file and refused to transfer him to the hospital’s intensive care unit as he was “not sick enough”.
She claimed her family were also “aghast” to be only informed by a nurse that evening that their father had been hallucinating on several nights that he was at home and that his house was being broken into.
She said the family had asked for him to be reviewed again by a registrar later that night but were told there was only one covering the whole hospital and he was too busy to come to the ward.
On December 27th, Ms Eastley said a senior registrar informed them at 10am that their father was doing well and said his lungs were “as healthy as yours or mine”. However, his vital signs started to deteriorate shortly afterwards and they were told he was critically sick and might die.
Ms Eastley said two ICU doctors reviewed him at 4pm but did not believe he should be transferred for intensive care as he did not have any organ failure, despite the family highlighting that he was under severe stress and in a lot of pain. However, she said her father’s condition continued to worsen and he started shaking uncontrollably before becoming unresponsive at about 8pm. He died shortly afterwards.
She added: “It hurts that he was so afraid and we didn’t get to say goodbye properly.”
In reply to questions from the coroner, Ms Eastley said she felt doctors treating her father over the period were not familiar with him and were not members of the primary care team meant to be overseeing him.
Edward Moloney, a consultant in respiratory medicine at Tallaght hospital, said he had not seen Sweeney when he was readmitted on December 20th, 2018, after he had been discharged earlier that month for treatment of chronic lymphocytic leukaemia (CLL).
Prof Moloney said the patient had several medical conditions including CLL, Parkinson’s disease, recurrent chest infections and likely chronic obstructive pulmonary disease given his history as a smoker.
Although Sweeney was nominally under his care, Prof Moloney said he had not seen the patient after his readmission as he was on leave from December 22nd, 2018, onwards.
The consultant said he only became aware of Sweeney’s readmission when he got a call at 9.15pm on December 27th for emergency advice about treatment of the patient. But Prof Moloney said he recommended that any further intervention would be futile after being informed that 55 minutes had already been spent trying to resuscitate the patient.
The coroner noted that Sweeney had been seen by a large number of doctors over the course of a week but it was “not clear” who was responsible for his care at Tallaght hospital.
Dr Gallagher said it was also difficult to know which doctor should have been responsible for escalating Sweeney’s care when the early warning system appeared to warrant it.
Evidence was heard of arrangements of how consultants provided cover for each other when one was taking holidays.
Prof Moloney told the coroner that he would not have expected at the time to know Sweeney had been placed back in his care unless he had been informed by one of his registrars.
However, the consultant said several changes had since been made at Tallaght hospital in relation to the handover of care of patients including a “Friday evening huddle” where patients who needed to be reviewed by consultants over a weekend were identified.
Prof Moloney said patients were now triaged to the most appropriate speciality rather than the care team they might have been with during previous hospital admissions.
He said there was also a new critical care outreach service to ensure the continuity of care of patients after they were discharged from high-dependency units to other wards. But Prof Moloney also noted that care in high-dependency units was inappropriate for all patients as it would “not make a change to the outcome”, as in Sweeney’s case.
“In certain cases, it prolongs death rather than prolonging life,” said Prof Moloney.
Another consultant in respiratory medicine, Stephen Lane, who provided cover for Prof Moloney’s patients while he was on leave, said he had not seen the patient at any time.
Prof Lane said he would have expected to have been called about Sweeney’s condition on December 27th even if a decision had been taken to transfer him to the hospital’s ICU.
He told the coroner that the quality of care in Tallaght hospital was “much better than it was 10 years ago” with increased staffing levels.
The inquest continues on Tuesday.