Respite centre apologises to Dublin couple over son’s care

A couple whose young son died shortly after falling unconscious while in respite care at a centre in Dún Laoghaire have secured an apology in the High Court under a settlement of their action over his care at the centre.

Tristan Neiland, who had various medical conditions including epilepsy, was rushed to hospital after being found unconscious in his room at the Carmona Respite Services Centre in Dún Laoghaire on January 6th, 2013.

He was pronounced dead shortly afterwards.

His parents alleged Tristan, aged almost seven, died as a result of the failure by the centre to use an oxygen saturation monitor despite a care protocol providing for that and instructions from his mother to do so.

The claims were denied and the case settled on Thursday on terms including an apology from the services.

Tristan's mother Angela was upset as she showed Mr Justice Kevin Cross a photograph of her son who she said went into the centre as a happy boy on a Friday afternoon and returned on a Monday afternoon "in a white coffin".

‘Came home lifeless’

“He left our house running and laughing and he came home lifeless, ” she said.

After investigations, the terms neglect and abuse had been used to describe the care received by Tristan and those “are words we live with”, she said.

She hoped other families who seek respite “are aware and vigilant of the care and lack of care that are provided by institutions”. An external investigation had described this as the “worst case of lack of governance” in an institution they had ever seen, she said.

“Tristan died unnoticed, he died alone and we have only an estimation as to his time of death, he died with equipment and medication that was part of his medical protocol only feet away.”

Mrs Neiland said attempts by staff to “conceal the facts of what happened on the night and subsequently to deflect blame on the family was reprehensible as borne out by an investigation commissioned by St John of Gods”.

She hoped her son’s death has made the Carmona services “a safer place” but he “had paid for that with his life” and the family were also paying in having to live our lives “without our precious Tristan”.

Andrew and Angela Neiland sued St John Of God Community Services clg over the death of Tristan at the Carmona Respite Services Centre on January 6th, 2013. Tristan had various medical conditions, including epilepsy associated with cyanosis (a condition caused by lack of oxygen in the blood), autism, mitochondrial disorder, global developmental delay and asthma.

His parents, of Cabinteely Park, Cabinteely, Dublin, sued for damages over personal injuries and mental distress sustained by them as a result of his death. The case was also on behalf of Tristan's three siblings.

‘Shortcomings’

On Thursday, Mr Justice Kevin Cross was told it had settled on terms including an apology read by Luán ó Braonáin SC, for the defendants. It said: “Saint John of God Community Services clg apologise for the shortcomings in the care of Tristan at the time of his death. The service acknowledges that this is a cause of great stress and anguish for Tristan’s family. We also acknowledge that Tristan’s mother did nothing to cause or contribute to his death.”

Bruce Antioniotti SC, for the parents, said the death of Tristan was particularly traumatic for the family. While Tristan suffered from epilepsy, he was attending school at the time of his death, was healthy, happy and able to run and play and was much loved by parents and siblings.

He had had some overnight respite in 2012 and the parents on January 4th, 2013, placed him in respite as they wanted to take a weekend off. His mother had provided a detailed care plan and in particular stated once he fell asleep he had to have a monitor attached to his big toe because when he suffered a serious epileptic seizure he became cyanotic and required oxygen very quickly and the only way to check that was to have him monitored.

On the second night, Tristan went to bed at about 8.30pm and was found dead in the room about 10.56pm, counsel said. It was “not a nice scene”. “What happened was they had not attached his monitor and had not checked it,” he said.

Regulations required Tristan should be checked every 15 minutes but an internal inquiry by defendants showed he was not checked for either 60 or 88 minutes and he died from a seizure. The parents’ case was, had the monitor been attached, death would not have occurred.

Denied causation of death

The defendants made certain admissions but denied causation of death and exhibited a report saying Tristan may have suffered his most severe seizure ever and could have died even with a monitor. The parents’ renowned paediatric expert argued otherwise.

Counsel said “disturbing aspects” of this matter, including falsification of notes and falsification of time of death, came out in the internal inquiry and, in fairness to the services, they had admitted certain notes were not correct.

Having heard from Mrs Neiland, the judge praised her courage, sympathised with her and said he hoped she was correct in having said lessons had been learned.

The parents claimed their son had been in the care of the Carmona services since about 2006 and it was at all times aware of his medical conditions.

They claimed their distress over his death was aggravated because the defendants allegedly created a risk assessment after Tristan’s death dated October 8th, 2012, and wrongly alleged Mrs Neiland had told them it was acceptable not to use the saturations monitor.