A WOMAN who died at home from cancer was given a “massive” dose of a morphine-like drug shortly before she died, an inquest heard yesterday. However, a verdict of death from natural causes was recorded.
Dr Stephen Higgins, a consultant in palliative medicine from Our Lady’s Hospice in Dublin, told the Dublin county coroner the 65-year-old patient received “a 48-hour dose within one hour”.
The inquest into the circumstances surrounding the death of Teresa Keeley of Bawnville Road, Tallaght, last July, was told by the deceased’s son, John, that a locum doctor who had been called by the family because their mother was extremely distressed said that he, the doctor, could “hasten things” with the family’s consent.
However, Dr Mohamed Karim of the Contactor’s Medical Bureau strongly rejected this assertion in his evidence, saying he was certain he had “administered an appropriate dose to ease the woman’s pain”.
A postmortem, ordered by coroner Dr Kieran Geraghty after he was made aware of the concerns of medical professionals, found no evidence of opiate drugs such as morphine in Mrs Keeley’s body, although, because she had been embalmed beforehand, it was not possible to recover a blood sample from the deceased.
A pathologist, Dr Fanzie Taher, of Tallaght hospital, told the court samples of vitreous humour – a type of fluid present in the eye – had shown no trace of morphine. The samples were analysed in the toxicology laboratory of Beaumont Hospital, with the results confirmed by the State laboratory.
The inquest heard that Mrs Keeley had been diagnosed with breast cancer in 1999 and had made an initial recovery. However the cancer recurred, with secondary growths in her bone, liver and lungs.
She had been admitted to Tallaght hospital some weeks before her death in order to have a cancer-related accumulation of fluid removed from her abdomen.
Mrs Keeley was discharged home to her daughter’s house for palliative care from her GP, public health nurses and the home care team from Our Lady’s Hospice.
Although not in acute pain, she deteriorated on July 20th, 2008, and Áine Legg, clinical nurse specialist in palliative care, gave evidence of commencing a syringe driver.
Morphine in the form of the drug Oxynorm at a dose of 15mg and 5mg of the sedative Midazolam were included to infuse under the skin over a 24-hour period.
It is standard practice in palliative care to include both these drugs within a syringe driver which is used when a patient with terminal cancer has difficulty taking medication orally.
The inquest was told the home care team had left an “emergency pack” of injectable drugs along with prescribing guidance notes with Mrs Keeley’s family, so that any problems could be dealt with by a visiting doctor or nurse.
Dr Karim gave evidence of being asked to see a patient who was in severe pain on the night of July 21st last year.
When he arrived, he found Mrs Keeley in “severe distress“. She was a patient who, in his professional opinion, needed large and immediate doses of a pain medication.
“This was an explosion of pain with the severest respiratory distress. I had no alternative but to do what I did.”
He said he was not shown any hospice letter and he administered three vials of Oxynorm (30mg) and Midazolam(30mg) intramuscularly at intervals to Mrs Keeley.
However, Dr Higgins said the hospice team became concerned the following day when they noted a “significant” amount of medication from the emergency pack had been used. In his opinion, the emergency dose of morphine should be between one-sixth and one-tenth of the 24-hour dose. A dose of Oxynorm 3mg was the dose advised in the letter accompanying the pack.
Dr Geraghty concluded Mrs Keeley died of natural causes. Based on the pathologist’s evidence he stated she had died from metastatic (disseminated) cancer secondary to breast cancer.
There was no evidence that morphine was involved as a cause of death.