A 20-month-old child found unresponsive on the floor of his bedroom died of toxicity from fentanyl, a powerful opioid used for pain relief, a coroner has found.
The death of Christopher McDonagh-Mashall, an otherwise healthy child, is believed to have been the first of its kind from fentanyl toxicity here. Lawyers for his mother, Leanne Marshall, said that with appropriate instructions and warnings, “it could so easily have been avoided”.
An inquest at Portlaoise Coroner’s Court on Friday was told Ms Marshall and her extended family believe Christopher’s sudden death on November 22nd, 2023, arose from exposure to fentanyl patches worn for pain relief purposes by his then terminally ill uncle, Joe Marshall.
A postmortem found toxicology results from the child’s blood samples showed the presence of fentanyl at what consultant histopathologist Dr John O’Neill said was a “very high” level, 10 times above the therapeutic level for adults, and “which would certainly be associated with toxicity and death in adults and children”.
RM Block
In a narrative verdict, which describes the circumstances of a death, Laois County Coroner Eugene O’Connor found the cause of the child’s death was fentanyl toxicity and said he will issue specific recommendations in due course for appropriate warnings to be issued concerning use, storage and disposal of fentanyl patches.
The inquest heard Joe Marshall, along with Leanne and Christopher and other family members, was living at the time in their mother Kelly Marshall’s home at Ashbury View, Roscrea, Co Tipperary.
A distraught Leanne Marshall, who held a framed photo of her son throughout the inquest, attended by many of her family and extended family, said the day of his death was “the day my world fell apart”.
Ms Marshall, who was estranged from Christopher’s birth father Richard McDonagh, from Tullamore, said Joe was “like a father” to her son and the two were very close. Christopher would often fall asleep on Joe’s chest, and they watched TV and played together, the inquest heard.
In submissions for Ms Marshall, barrister John Sweetman, instructed by solicitor Mark Tiernan, said the child’s death was “a tragedy of extreme circumstances”, compounded by Joe Marshall’s death, aged 33, in January 2024, followed by the death by suicide of the child’s birth father in August 2024.
The family’s wish was that no other family would experience such a tragedy, they hoped there would be learning from Christopher’s death and that the coroner would make recommendations to help avoid any similar tragedy, he said.
It seemed clear Christopher’s death was a result of exposure to fentanyl patches and what was “so extremely sad about it is that it could so easily have been avoided”, counsel said.
Had there been any sort of warning or instructions to any of those involved, especially to family, “it would not have happened”.
In this case, there was a “massive systems failure”, he said, nobody was aware of the seriousness and dangers of this medication, it was “an accident waiting to happen” and it could happen again.
In his ruling, the coroner said the cause of death was fentanyl toxicity and it was beyond doubt that was from the patch, “whether it fell on the ground or whatever occurred”, he said.
Fentanyl patches are very useful slow-release pain-relieving medication that enable a person with terminal illness to remain at home, and that facility should be available, he said.
He would recommend that verbal instructions and a “simple” document understandable by non-medical people to convey the risk should be given to every family and patient dealing with such medication. The material should note a patch can and will fall off, set out what to do about that, and explain how to dispose of it and the fact the patch is a particular danger to small children – who would have no awareness of the danger involved and be likely to pick up everything and examine it.
Earlier, the inquest heard that, on November 22nd, 2023, the extended family was preparing for an early Christmas because they feared Mr Marshall might not survive until then.
When Christopher was found unconscious that evening, and pronounced dead, the early Christmas was cancelled and the child’s presents and Christmas pyjamas remained untouched. His grandmother Kelly said his room remains today as it was.
