A VERDICT of death by natural causes after a misadventure was returned by an inquest jury yesterday in the case of a young woman who died after an operation to remove two tumours which proved not to exist.
Dr Brian Farrell, the Dublin City Coroner, said that relatives of Ms Beatrice Hartnett (30), of St Patrick's Park, Dunboyne, Co Meath, had expressed great concern about the unfortunate incorrect diagnosis of tumours.
He said also that there was an unfortunate problem in communications between the deceased woman's sisters and some doctors and nurses in St Vincent's Hospital, Dublin. He hoped that proper cognisance would be taken at the hospital of the family's concerns.
At yesterday's hearing in the Dublin Coroner's Court, Mrs Mary Hartnett Flood told of her family's shock and upset at being told that her sister had a tumour "half the size of a cauliflower" by a doctor at St Vincent's Hospital.
She later met Dr Isweri Pillay a senior medical house officer at St Vincent's, on October 30th, 1994, and was told that this tumour, which was half the size of a cauliflower, also had "shoots coming out of it". She was also told that Ms Hartnett had a black spot close to her bowel.
"Dr Pillay explained to us that there was really no treatment and that surgery would be the only way to gee rid of it. She said it was a type of cancer that was rapid and silent and Ms Hartnett would not suffer. Dr Pillay also said that it did not go into the bones.
"We then asked her if the removal of the tumour would improve Beatrice's chances and she said that she could not say, as they don't always know how bad it is until they operate. The only cure was removal by surgery," said Mrs Hartnett Flood.
After expressing great upset at Ms Hartnett's deteriorating condition following her operation on November 3rd, Mrs Hartnett Flood met Mr Enda McDermott, the consultant surgeon, who had discovered that Ms Hartnett had no tumours.
He told the family that he had some good news, as Ms Hartnett only had lymph glands, some larger than others. He said these glands would dissolve and that it would be surprising if Ms Hartnett's biopsy, which had been sent for tests, showed up anything.
"We asked him if Beatrice would need another operation. He said No. It was then that he looked shocked when we mentioned about the tumours."
Dr Pillay said the deceased was admitted to the hospital on October 24th after complaining of intermittent pains, constipation and lower stomach cramps.
She was aware of her history. A cat scan showed two introabdominal masses consistent with metastatic melanoma in the bowel wall. After a surgical opinion was sought, they proceeded with an exploratory laparotomy.
Dr Pillay said that afterwards Ms Hartnett complained of abdominal pain. She informed her that her biopsy had been sent away and the results would come shortly.
Under cross examination, Dr Pillay denied specifically telling the deceased woman's sisters that Ms Hartnett had a cauliflower type tumour. It was not a term she normally used.
However, she agreed that she might have used it when speaking at some stage to family members.
Dr Pillay stressed that the deceased woman's type of eye melanoma, which had been diagnosed in 1993, had a propensity for recurrence in the bowel. She referred to this as secondary cancer and called it metastatic melanoma.
Prof John Horgan, a consultant cardiologist, said that Ms Hartnett had been referred to him at the Richmond Hospital from the age of 15 for "a minor defect of the aortic valve." But she had no dysfunction of her heart, or complications, for 11 years.
There was nothing, he said, to suggest that her "leaking heart valve" had resulted in her death.
Dr Susan Kennedy, a pathologist, said that the cause of death was acute bleeding into the lungs, probably caused by pulmonary embolism, or blood clotting.