Inquest told car dealer may have been misdiagnosed

The inquiry into the unexpected death of a well-known car dealer heard that he may have been misdiagnosed in a private hospital, which could ultimately have reduced his chances of survival.

The late JJ Fleming (60), of Blackrock, Salthill, walked into the Galway Clinic on November 6 2013 complaining of numbness in his legs, but died in Bon Secours Hospital on December 8 – where he had been transferred, at the request of his wife.

“If he’d seen a neurologist straight away, and had the appropriate treatment, we would not need an inquest,” Maria Fleming told the inquiry at Galway Courthouse on Thursday. “Why did it take nine days for them (Galway Clinic) to seek a neurologist’s opinion?”

The father of four had been on holidays in Spain in November 2013 when he began to feel unwell. He went home early to attend an out-patient’s appointment with consultant urologist, Dr David Boucher Hayes, in the Galway Clinic, as he was heading away himself the following day.

His wife said that he had an uncomfortable night at home on November 5, however, and was advised to pack an overnight bag so that he could be admitted to the Clinic for routine tests.

He walked in the following day, and was told that he did not have prostate or urological problems – as he had been told by his GP and hospital staff in Spain – but rather five trapped nerves in his back.

“I arrived back on November 9, and was alarmed to hear that he needed surgery,” Mrs Fleming said.

Urgent decompression was required, she was told, as his condition was deteriorating daily, his legs were weakening, and he now walked with a limp.

She questioned why the surgery was not performed until November 13 – a full week after being admitted. And, she said that his condition actually got worse after the operation.

Her husband complained all day after the surgery of a burning sensation in his legs, but was told that it was normal.

She said that it was not until a year later, when she received a claim form from the VHI, that she found out he had been brought back to the operating theatre the following day as an MRI had confirmed a bleed.

“Nine days after surgery he was essentially paralysed… He questioned his care, and voiced his concern,” she said.

He was seen by Dr Michael Hennessy, a consultant neurologist visiting from the Bon Secours Hospital, and diagnosed with mononeuritis multiplex, which is damage to one or more peripheral nerves – the nerves outside the brain and spinal cord.

On Dr Hennessy’s advice, and on the requests of Mrs Fleming, her husband was transferred to Bons Secours Hospital on November 25, where he was admitted under a new team, put on steroids, and a marked improvement followed.

“There was a total transformation, and his mood improved greatly – they were all so much more positive about his recovery,” she said.

Their daughter had set a date for her wedding in August 2014, and Mr Fleming was determined that he would be able to walk her up the aisle.

“It gave us great hope,” his wife said. “I was advised to make changes to our home, as he would be coming home in a wheelchair.”

However, his condition deteriorated in the early hours of December 5, and he became unresponsive.

“When I arrived, he was motionless in the bed, the neurologist said that he had suffered a major brain haemorrhage… he looked like he was asleep,” Mrs Fleming recalled.

He passed away on December 8 and, when his wife called to the Bons Secours Hospital in March 2014 for the results of the post-mortem examination, she was told by the consultant that her husband may have been initially mis-diagnosed; that the inflammation of his spinal nerve roots could only have been detected by a neurologist.

“He said that he had not required the initial treatments (operations), that it would have been steroids (treatment) – which is what he had in the Bons,” she said.

“I was shocked that he’d had two surgeries in the Clinic that he had not required.”

However, Dr John Burke, an orthopaedic surgeon at the Galway Clinic told the inquiry that Mr Fleming’s symptoms “fitted with Cauda Equina Syndrome (CES)…”

This condition affects the nerve roots in the lower end of the spinal cord, and needs to be dealt with urgently, as it would have worsened with time. He added that compressed nerves were discovered when Mr Fleming went under the knife.

However, he acknowledged that this may not have been a correct diagnosis. “When he began to worsen, I knew it was another factor, and called in Dr Michael Hennessy,” he said.

This initial diagnosis was shared by other consultants, who had assessed Mr Fleming while he was a patient in the Galway Clinic – among them, Dr Ronan Kavanagh, an expert in the area of inflammatory diseases, and Mr Fleming’s rheumatologist since 2010.

Former Consultant Neuropathologist at Beaumont Hospital, Professor Michael Farrell, carried a post-mortem examination on the brain, and submitted a report to the Inquest, which was read into the record.

He concluded that death was due to a stroke, most likely caused by “extreme” arteriolar sclerosis, which is common in diabetics, from which Mr Fleming suffered for 30 years.

His findings in relation to what caused the initial complaints, while on holidays, were at odds with some of the other medical evidence given on the day, and Mrs Fleming’s legal team requested that Prof. Farrell would attend the Inquest at an adjourned date in September.