With a clear deficit in the regulation of alternative practitioners, the message to patients is 'buyer beware', writes Dr Muiris Houston, Medical Correspondent
You could have heard a pin drop during the inquest on Paul Howie, a 49-year-old man with cancer who died suddenly in April 2003 from suffocation while under the care of an alternative practitioner.
The evidence of his wife, Michelle, painted a picture more reminiscent of the Middle Ages than a modern European State. The care given to Paul Howie by a self-styled "natural health therapist" had little in common with modern scientific practice.
Paul Howie noticed a lump in his neck in May 2002. The therapist, Mineke Kamper, supplied remedies for his condition. Despite this, the lump grew and Mr Howie began to complain of tiredness. By early 2003, his lump was "big and angry", his wife told the coroner.
She said her husband had made an appointment at a laser surgery clinic in Dublin in February 2003. However, following a conversation with Ms Kamper, he cancelled it.
He continued to take various remedies, which according to the evidence of Dr Sean McDermott of the State forensic laboratory, contained no active ingredient. The lump on his neck changed shape and blistered. It subsequently started to bleed. Ms Kamper apparently interpreted this as a good sign, even when there was substantial bleeding.
By this time, the deceased had difficulty swallowing and in opening his mouth fully. But perhaps the most poignant evidence of all was Michelle Howie's description of a consultation that took place at the practitioner's house on April 16th, 2003.
"He [ Paul] was very weak. He had a bleed that morning. Paul was lying down in the car . . . When we got to Mulranny, Mineke came to the car. I had to help Paul. We linked him. In the house Paul went down on the floor. She gave him something and then Paul crawled to the settee."
Paul Howie continued to deteriorate after this consultation. Late on the night of April 21st he developed breathing difficulties. His wife rang the doctor on duty. However, before the GP arrived Mr Howie stopped breathing. His wife tried to resuscitate him, but to no avail and he was pronounced dead early on April 22nd.
The court heard that Ms Kamper, a Dutch woman, is a trained nurse. She practised as a nurse for 25 years. Despite this professional training and practice, she allegedly told Mr Howie, in the words of his wife, "we had a choice but if we did get medical attention that Paul would die and that she, Ms Kamper, could and would cure him".
The professional evidence of Dr Iqdam Tobbia, consultant pathologist at Mayo General Hospital was unequivocal. Mr Howie had died of suffocation due to a tumour of the tonsil that had extended to block his airway.
The inquest was told that the patient had a squamous cell cancer of the oropharynx (the area of the back of the throat).
Such tumours are relatively rare, but curable. Caught early and with modern treatment, one would expect 90 per cent of patients to be alive and well five years after diagnosis.
It is clear that Ms Kamper missed several glaring signs that her patient had cancer. Difficulty swallowing is a "red flag" symptom that must always be investigated. And when a skin lesion begins to expand and bleed, it must be biopsied.
According to her own statement, read to the inquest, she made a diagnosis of haemochromatosis. This is a condition, affecting the liver and other organs, caused by an overload of iron in the body. None of the signs and symptoms described to the court would have led a doctor to this particular conclusion.
Yesterday's case illustrates two clear failings in our legal and health systems. The inability of the jury, under the 1962 Coroners Act, to deliver a verdict of death by neglect is a sign that long-promised legislation in this area is well overdue.
And the lack of an up-to-date Medical Practitioners' Act, to include a section dealing with those who would regard themselves as diagnostic practitioners, is a glaring deficit.
While no legislation can offer a fail-safe solution, these measures would afford a considerable level of protection. In the meantime the message to patients is: caveat emptor.