Doctors query findings into death of patient

A second pathologist will have to review the file of a 60 years old man, who died almost a year ago in the Galway Clinic, as the two consultants who had attended him could not accept that he had died from pneumonia.

Dr Ciaran MacLoughlin, the Coroner for West Galway, made the unusual move after hearing two hours of evidence at Galway Courthouse. The pathologist who had carried out the post mortem examination was no longer living in Ireland, and could not be called-on to back-up his findings.

“If it is pneumonia, I will return a verdict of bronchial pneumonia and medical misadventure, as he was not given the appropriate treatment at that time,” Dr MacLoughlin said.

“The pathologist is an independent professional hired by myself – once the opinion is challenged, I feel the integrity of the court is challenged, and the integrity of the court has to be above all suspicion.”

Patrick Kelly of Lifford, Co Clare, underwent surgery at the Galway Clinic on January 8 last, to treat a large rectal polyp.

The surgery had been postponed from the previous month as his surgeon, Professor William Joyce, was of the opinion that a low platelet count could lead to post-op bleeding.

By the following month, Mr Kelly had followed recommendations, was in better shape, and was anxious to proceed with the surgery.

Professor Joyce described his patient’s post-op recovery as “excellent” and when he performed an examination on January 14, he said that Mr Kelly was “incredibly well.” He died the following afternoon, however.

Professor Joyce said that in almost 30 years of practice he had rarely seen such a progressive death, in the absence of cardiac disease or sepsis.

He could not accept, either, the findings of the consultant pathologist, Dr Frans Colesky, that his patient had died from pneumonia.

“In my own mind, I’m still unclear as to what exactly the cause of death was,” he said.

He further reiterated that the surgery had been successful, and that Mr Kelly had developed no complications ‘locally’ as a result of the polypectomy – the post mortem examination confirmed this.

However, barrister for the Kelly family, Patrick Whyms, referred to the nursing notes which stated that staff had voiced their concerns on two occasions to senior colleagues.

He further said that Mr Kelly had been complaining of a worsening distended abdomen – his son compared it to a woman expecting twins – from January 12 up until his death on the afternoon of January 15.

Doctors on call were not concerned, however, as he was not vomiting, his abdomen was not tender, and bowel movements were normal.

When asked, Professor Joyce said that the distention was common after this type of surgery, while the bowel gets back to normal. He said that a chest x-ray on the afternoon of January 14 and the early morning of January 15 showed no signs of abnormalities, such as pleural effusions.

He further said if the Consultant pathologist’s findings were to be accepted, that Mr Kelly did indeed suffer from bronchial pneumonia, it was “an unusual presentation.”

However, Dr MacLoughlin said he would have to give precedence to the microscopic diagnosis made by Dr Colesky, rather than to Prof. Joyce’s clinical opinion.

Surgeon, Mr Osama El Sadig, also questioned the conclusions drawn by the pathologist, and said that he was also at a loss as to what had caused the death.

Mr Kelly’s son, Brian, said that his father’s health had visibily disimproved in the days following his surgery.

“(On the 14th) he looked worse than when I’d seen him in the ICU a few days before,” he recalled.

“He had no energy to shake my hand, he was very weak. He didn’t want us to see him like this, after such a high in ICU to this low.”

Dr Frans Colesky’s report, which was read into the record by Dr MacLoughlin concluded that the cause of death was pneumonia in a post-operative setting.

For the first time in his 30 year career as Coroner, Dr MacLoughlin made the unusual move to have a second pathologist examine the file.

“I’m doing it out of fairness to the doctors, who find it hard to understand how the sequence of events occurred . . . although it is a very well-recognised condition, but thankfully does not occur very frequently because of the intervention of early diagnosis and antibiotic treatment,” he said.