Hospitals should assess all the needs of vulnerable patients when they are being discharged, a coroner has recommended following an inquest into the death of a man at the Midland Regional Hospital in Portlaoise.
Christopher Marianayagam died in the hospital in June 2011, several weeks after he fell near the front door just after being discharged from the emergency department.
Mr Marianayagam (71), who had a history of diabetes and recurrent falls, suffered a 16cm fracture and his condition deteriorated sharply afterwards.
The inquest heard evidence from a staff nurse that two doctors having their lunch at the time of the fall refused to come to his assistance because they “were not on call”.
Mr Marianayagam, an ethnic Tamil, fled persecution in Sri Lanka and sought asylum in Ireland in 2008. He was granted refugee status but his daughter, son-in-law and grandson have not received a final decision.
As a result, he lived alone in a flat in Portlaoise while the rest of his family are in direct provision. The inquest heard he wanted to move back in with his family, at the former Montague Hotel near Portlaoise, where conditions have been heavily criticised by human rights groups.
Appropriateness of discharge
Lawyers for his family argued it was inappropriate for the hospital to have discharged him when no member of his family was there to pick him up. Dr Seán O’Rourke, emergency medicine consultant at Portlaoise, said Mr Marianayagam was discharged as there was no indication for emergency investigation.
Asked if it was appropriate to discharge a patient with his medical history, Dr O’Rourke said there should have been a family member present.
Laois county coroner Eugene O’Connor returned the cause of death as a large intracerebral haemorrhage, with a skull fracture, “consistent with the history of a fall”. The coroner said he would add a rider to his written verdict, highlighting the need for the Health Service Executive to assess the requirements of patients on discharge, particularly those who were vulnerable, young, old or had mental health issues.
Such an assessment needed to be holistic and not just deal with medical issues, he said.
In a second note, he called for hospitals to employ a specific method of transmitting information about patients with head injuries when communicating with the State's sole centre of excellence in neurology in Beaumont Hospital.
