The issue of checking patients for medication that they might bring with them when admitted to hospital has been highlighted by a coroner at the inquest of a man who took his own life when he overdosed on painkillers that he brought to hospital with him.
Cork City Coroner, Dr Myra Cullinane noted that Cork University Hospital did not appear to have any protocols regarding patients being allowed retain medications that may have been prescribed elsewhere before their admission to the hospital.
Dr Cullinane said she was not making any formal recommendation regarding the practice but she wished to highlight it as a feature of the inquest into the death of Raymond Kelleher who took his own life on March 6th by overdosing on medication he brought with him to CUH.
The inquest heard that Mr Kelleher (53), a father of six from Meadowgrove, Blackrock in Cork city, had been treated for depression for several years by a psychiatrist but had given up taking anti-depressants some six months prior to his death and was doing well.
Mr Kelleher’s widow, Jacqueline told the inquest how her husband took ill when he began complaining of severe and debilitating headaches on February 17th last and was prescribed some analgesic medication but the problem continued.
He had been receiving treatment from Bon Secours Consultant Neurologist, Dr Peter Kinirons for a facial spasm and when initial tests in CUH found no evidence of any physical problems which might cause the headaches, he was referred back to Dr Kinirons for further assessment.
Consultant in Emergency Medicine at CUH, Dr Iomhar O'Sullivan, who saw Mr Kelleher in the Clinical Decision Unit and referred him back to Dr Kinirons, told the inquest that he had also referred him to pain specialist at CUH, Dr John Browne for treatment for the headaches.
Dr Browne prescribed analgesics, Lyrica and Ixprim for Mr Kelleher who was discharged from hospital on February 26th and he obtained them at a pharmacy in Cork before returning to Dr Browne on February 28th for an analgesic injection but it did not bring any relief.
Mr Kelleher was re-admitted to CUH on March 1st and was seen again on March 3rd by Dr O’Sullivan who felt his complaint of headaches varied somewhat from his earlier complaints so he checked with Dr Browne and learned of Mr Kelleher’s history of depression.
Dr O’Sullivan told the inquest that he prescribed anti-depressants for Mr Kelleher and also asked for him to be seen by a psychiatrist at CUH as various scans had shown no evidence of any physical issues and he was safe to discharge from a physical point of view.
Psychiatrist, Dr Attiya Suhail saw Mr Kelleher on March 4th and although Mr Kelleher told her he had had suicidal thoughts the day before, he had spoken of how his love of his family would prevent him from self harming and she did not believe that he was depressed at that point.
The inquest heard that Mr Kelleher was referred back to the CDU and nurses, Helena Lilley and Wenona McBride told the inquest that they were told that Mr Kelleher was of no risk to himself or others when they took over in the CDU at 8pm on March 5th.
Mr Kelleher had also been seen by neurologist, Dr Sean O’Sullivan who recommended that he go for a lumbar puncture to see if his headaches might be due to a rare condition called idiopathic cranial hypertension and he was quite stressed about going for the procedure.
Prof Stephen Cusack, who knew Mr Kelleher personally for a number of years, said he met Mr Kelleher with his registrar on the night of March 5th before he was due to have the lumbar puncture and Mr Kelleher was clearly unhappy about having the procedure.
Prof Cusack agreed to defer the lumbar puncture until the next morning and said he would discuss its necessity with Dr O’Sullivan given Mr Kelleher’s great stress over it. “His last words to me were ‘Ok, I’ll see you in the morning,” said Prof Cusack.
Ms Lilley told the inquest Mr Kelleher was on pain medication which was logged on a drug cardex and when he called to the nurses’ station looking for more painkillers at 2.40am on March 6th, she explained to him that he could not get any more painkillers until 6am.
Jacqueline Kelleher had told the inquest her husband had brought his own painkillers with him when he was admitted on March 1st and she had seen them on his locker on March 3rd but both Ms Lilley and Ms McBride said they never saw any painkillers in his cubicle.
Both Ms Lilley and Ms McBride said that Mr Kelleher could not sleep in the early hours of March 6th and frequently passed by the nurses’ station to go to the main emergency department to get a drink of water or to go outside of the hospital for a smoke.
Ms Lilley said she was not alarmed when she checked his bed at 5.15am and found he was not there as he frequently went for a smoke but when she checked at 6.15am and found he was not in his bed, she raised the alarm and hospital security and gardaí were alerted
Garda Aisling Murphy told how when she checked CCTV footage, she saw Mr Kelleher going to the water cooler in the emergency department repeatedly while she also found up to 20 clips of him taking something from his pocket and putting it in his mouth.
She also found footage of him going into a suite of offices adjacent to the CDU at 3.55am but when searched these offices, she could find no trace of him although she did find empty blister packs of Lyrica and Ixprim in a flip bin beside his bed in his room.
Prof Cusack said he went into his office adjacent to the CDU at 6.30am and noticed a smell of cigarettes but didn’t think anymore of it before attending a meeting when he learned that Mr Kelleher was missing and he went on his rounds to check on his patients.
He returned to his office at 9.55am and went to sit down at his desk to ring his wife when he discovered Mr Kelleher’s body under his desk, said Prof Cusack. He had not locked his office when he left at 10.30pm the previous night, he added.
The inquest heard that gardaí found a note in Mr Kelleher’s pocket along with his mobile phone and Ms Kelleher had earlier told how she received a text message which her husband had sent her at 3.57am but which she did not discover until 7.30am.
Assistant state pathologist, Dr Margaret Bolster told the inquest that she found no evidence of any significant brain pathology which would have caused Mr Kelleher's death and that blood tests showed he had lethal levels of both paracetamol and tramadol in his system.
Dr Bolster said that Mr Kelleher died from an overdose of a combination of both paracetamol and tramadol and that the levels of the latter that he had in his system were such that the outcome was irreversible even if he had been discovered earlier.
Dr Cullinane asked Prof Cusack if there had been any changes in CUH since the tragedy and he said a swipe card system had been introduced so that no one could now access the suite of offices adjacent to the CDU without a swipe card.
Asked by Dr Cullinane if there were any protocols in placing governing patients being checked for medication they bring with them, Prof Cusack said he was not aware of any such protocols as patients were only given medications that they were prescribed in the hospital.
“People often come in with bags of medication - in my experience, I don’t tell them to do anything with the medication, they usually give it to family and put it in a locker,” said Prof Cusack, adding that all medications given in hospital were logged on a drug cardex system.
On occasion, a patient might have some medication that the hospital does not have in its pharmacy and it is administered to them for their condition and is written up on the drug cardex but such instances were rare, he said.
Prof Cusack said he assumed that there was a nursing policy in terms of handling people’s possessions when they are admitted to hospital but medical staff did not have the right to search people’s bags or belongings.
Returning a verdict of suicide, Dr Cullinane highlighted the issue of checking patients for medications that they might bring with them to hospital before extending her sympathies to the family of Mr Kelleher on their tragic loss.
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