A coroner has identified shortcomings in the record-keeping of doctors at Portiuncula Hospital in Ballinasloe but said he didn't think there was any lapse in their treatment of a woman who died hours after being discharged.
Co Westmeath coroner Dr Wilfrid Hoover accused the hospital of "dilly-dallying" in carrying out an internal review into the death of Co Westmeath woman Ellen Devery-Allen in December 2013. "They're taking their own sweet time about it," he said at the inquest into her death at Mullingar courthouse.
Ms Devery-Allen (33) died in her mother Maria Devery’s house in Athlone on December 21st, 2013, after suffering a heart attack caused by a massive pulmonary embolism.
She had been discharged from the hospital about five hours earlier after being diagnosed with suspected deep vein thrombosis in her leg.
The doctor who treated her has left the country and did not give evidence at the inquest. Dr Rizwan Asim has given a statement to the internal review, but the HSE has refused to make it available while the inquiry is ongoing.
Ms Devery-Allen was brought to the hospital by ambulance that morning complaining of leg pain and swelling for some days. She had also suffered back pain since giving birth six months earlier and had a history of intercranial hypertension.
She died despite the prompt arrival of an ambulance and intensive and prolonged administration of CPR by his aunt and mother's neighbour, Bernie Costello, who is a trained paramedic.
Mrs Devery said she accompanied her daughter to the hospital on the morning of December 21st. Her daughter was very upset but was adamant she wouldn’t be staying in hospital. She said her daughter told her: “There’s no way I’m staying here. If I have to, I’ll walk home”, even though she was unable to walk at the time.
Ms Devery-Allen was discharged after a few hours, given pain relief and told to come back for an ultrasound on the Monday. Mrs Devery said her daughter seemed happier upon returning to her house. She sat in a chair in the sittingroom and ate her dinner. However, about 10.30pm she found Ms Devery-Allen lying back in the chair, unresponsive.
Ms Costello, who was called in from her home next door, said there was pandemonium in the house when she was summoned to it. She could see that Ms Devery-Allen was dying but started on CPR anyway. She gave her a few rescue breaths and thought for a while she was getting somewhere but Ms Devery-Allen did not respond. She was pronounced dead at 11pm after all efforts to resuscitate her were unsuccessful.
Emergency medicine consultant Dr Orla Smithwick, who was not personally involved in the care of the patient, gave evidence on behalf of the hospital. Dr Asim stopped working at Portiuncula in January 2014, the inquest heard. He is in the US and is not available to give evidence to the inquest.
Dr Smithwick told Co Westmeath coroner Dr Wilfrid Hoover two consultants worked at Portiuncula. No consultants worked in the hospital in the evenings or at weekends, and there were no oncall arrangements. While no ultrasound was available in the hospital over the weekend, it wouldn't have been available then at University Hospital Galway either.
She agreed with the coroner that Dr Asim should have completed a Wells scorecard for assessing the risk of deep vein thrombosis. This would have been good practice. The guidelines had not been followed in this respect and this was a lapse.
However, the guidelines did not require a junior doctor to consult with a register in cases of suspected DVT and most patients with this condition were treated as outpatients pending tests, she said.
Dr Smithwick said it was possible Ms Smithwick had an asymptomatic pulmonary embolism. However, she had none of the signs that one would expect and it would have been an unusual diagnosis in someone so young.
Dr Hoover said the pulmonary embolism seemed to have occurred after Ms Devery-Allen went to her mother’s house. While there was a lapse in the recording of her symptoms, he didn’t see any lapse in terms of her treatment.
He said he couldn’t see the value of introducing Dr Asim’s unsigned, unsworn statement into the proceedings. However, he agreed to adjourn the inquest so that evidence could be taken from another junior doctor involved in the decision to discharge Ms Allen-Devery, who is still working at the hospital .