A CONSULTANT neurosurgeon at Beaumont Hospital yesterday apologised to a family at an inquest for a "breakdown in communication" which meant that arrangements for a second brain scan on a 64-year-old man were not made.
Mr Steven Young expressed his regrets to the family of Mr Francis Heslin. He said new procedures for transmitting information to other hospitals were introduced after the communication failure.
A letter was initially sent from Beaumont Hospital to Dundalk Hospital stating that the first brain scan had shown no abnormalities. However, a reassessment the following day indicated that there were bilateral chronic subdural haematomas present and it was decided the patient should return in a month for a further scan.
This information, however, was not conveyed to Dundalk Hospital, and Mr Heslin was only referred for a second scan when his condition deteriorated. He died on August 29th, 1996, after spending 12 weeks in a coma.
The City Coroner, Dr Brian Farrell, adjourned the inquest to allow further investigation of an incident in which Mr Heslin is suspected of hitting his head on the roof of a bus just weeks before he first became ill.
Mr Heslin, a bus-driver, of Castletown Road, Dundalk, was admitted to Dundalk Hospital on May 14th, 1996, complaining of severe head pains over a three- week period. These symptoms had followed what appeared to be a mild head injury, according to the deposition of a consultant general surgeon, Dr Ursula Mulcahy.
A brain scan was conducted at Beaumont Hospital the following day, and he was then sent back to Dundalk Hospital.
Dr Mulcahy saw the patient on June 4th and asked for an appointment for Mr Heslin with a neurosurgeon. She was told, however, that there was a long waiting list.
Mr Heslin's condition deteriorated between June 11th and 12th and a second brain scan was carried out at Beaumont Hospital. It was discovered that haematomas had been present on the original scan, and the second scan revealed significant increase in chronic subdural haematomas".
Mr Young said he became involved on the day after the first scan. On reassessment it was suspected there could have been bi-lateral chronic subdural haematomas, although he did not feel this merited surgery.
"Having consulted with Dr Paul Brennan, the radiologist, and having seen the scans myself, I wished Dundalk Hospital to be informed that there might be an abnormality and that we might not consider it to be too important, but we wanted it followed up in a month's time."
However, Dundalk Hospital was not informed of this and he apologised to Mr Heslin's family for this breakdown in communication".
"As chairman of the department of neurosurgery, and in discussion with my neurosurgical and neurological colleagues, a new protocol has been adopted in conjunction with the hospital authorities to ensure that in the future such failures of communication do not occur again."
These changes were:
. The introduction of a system that ensures that X-ray reports on patients assessed but not admitted to Beaumont Hospital are sent to the referring consultants in other hospitals.
. Stating clearly on letters accompanying patients returning after their normal working hours that their scans may not yet have been reported by a consultant.
. The introduction of a rule that all telephoned advice to referring hospitals is also sent in writing by Fax or post.
Dr A. Shah, a senior house officer at Beaumont Hospital, said Mr Heslin's hospital notes suggested that he had suffered a mild head injury. Mr Heslin told him that he had banged his head on the roof of the bus.
Dr Francesca Brett, consultant neuropathologist, said death was due to bronchopneumonia, caused by repeated chest infections in a man who had been unconscious.