Tallaght hospital a 'dangerous place', says city coroner


A CORONER has said Tallaght hospital sounds like a “very dangerous” place.

Questioning whether it would be safer for ill or injured people to stay at home rather than go to the hospital, Dublin county coroner Dr Kieran Geraghty said the hospital “sounds like a very dangerous place to be for anybody, let alone a sick patient”.

He was responding to comments by Dr James Gray about conditions in the hospital at the inquest into the death of Thomas Walsh.

Mr Walsh (65), of Elmcastle Park, Kilnamanagh, Tallaght, died at the hospital on March 2nd this year. He had been admitted to the hospital in an ambulance the previous day with severe ankle pain and was in a “virtual ward” when he died.

A virtual ward is another name for hospital corridors and alcoves where patients are left while awaiting a bed in a ward, the inquest heard.

Giving an opinion at the inquest, Dr Gray, a consultant in emergency medicine at the hospital, said the corridor where Mr Walsh was left was not a designated area for patients. A lack of facilities such as oxygen outlets, monitors and equipment made it unsuitable for any patient.

Dr Gray said there were “appallingly poor standards of sanitation” with no dedicated toilet or sink on the corridors, where up to 59 patients have been known to be placed at any one time.

“There is no isolation facility and poor infection control on the corridors,” he said, adding that at one stage three people with the contagious bacterial infection TB were left in the corridor.

He agreed it was unacceptable for a patient like Mr Walsh to wait nearly six hours before being seen by an emergency doctor.

He told the inquest the Health and Safety Authority had issued the hospital with an improvement notice warning it to stop putting trolleys in front of the fire exit.

He said he and his colleagues had complained about these conditions to the Human Rights Commission, the Health Service Executive, the Health Information and Quality Authority and the Medical Council, but that overcrowding continued.

Mr Walsh should have been more closely monitored, Dr Gray said, adding “a detailed nursing plan was not in place for Mr Walsh and this might have uncovered he was on Cpap [continuous positive airway pressure]”.

Dr Michael Crockett, a second-year senior house officer at Tallaght, told the inquest earlier that at no stage was the hospital informed Mr Walsh used Cpap for sleep apnoea.

He added that it was common practice to leave patients on trolleys in corridors due to a shortage of beds.

The inquest heard that Mr Walsh was one of 38 patients in the virtual ward on the day of his death. Two of these patients had been in the virtual ward for longer than 24 hours.

Mr Walsh’s condition deteriorated during this time and he was pronounced dead at about 4am.

A postmortem supervised by consultant histopathologist Dr Michael Jeffers found Mr Walsh had died of cardiac arrhythmia secondary to bronchopneumonia.

Anne Donovan, director of nursing at the hospital, said nobody could say a corridor was an appropriate place for patients, and agreed there were issues regarding patients’ dignity and safety. However, she said the corridors were the safest place for patients to be when there were no alternatives.

John O’Connell, acting chief executive of the hospital told the inquest its catchment area was supposed to be 350,000 but in reality was closer to half a million.

“We’re seeing more patients than we’re meant to,” he told the court, adding “there is no out-of-hours GP in this community, which would relieve some pressure off us”.

He said the hospital was unhappy with patients being left in corridors, but that things were changing. “There has been up to 59 patients in corridors in the past. This will never happen again as there is a cap of 25,” he said.

Extending his deepest sympathies to the family, Dr Geraghty recorded an open verdict. He said had it been a cardiac arrhythmia, he would have recorded a verdict of death by natural causes. Had a lack of oxygen caused the cardiac event, he would have given a verdict of medical misadventure. But because “we can’t be certain either way”, an open verdict was being recorded.

Speaking after the inquest, Kay Walsh, wife of the deceased, said she was disappointed with the verdict as she felt there was some fault on the part of the hospital.

“The conditions were dreadful when he was in there. There were loads of people around him and he was on a chair the whole time – he didn’t even get a trolley,” she said.