A doctor has told an inquest into the death at Our Lady’s Hospital Navan of a 65-year-old woman at the height of the Covid-19 epidemic that on the night she was admitted he had to notify superiors of the “short staffing level” on duty at the hospital. The inquest, conducted at Trim Courthouse by Coroner for Co Meath Nathaniel Lacy, enquired into the death of Maura Murphy, Phillinstown, Trim but who had also lived at Crumlin Dublin. Ms Murphy, wife of David and mother of two children had been chairperson of Transfusion Positive, a voluntary organisation catering for people infected with the Hepatitis C virus having received contaminated blood or blood products administered within the State.
The inquest heard evidence on 24th June last from a Garda, and also Ms Murphy’s husband, four doctors, and a nurse. The family was represented at the inquest by senior counsel Ciaran Craven, instructed by solicitor David Murphy while the hospital was represented by barrister Caoimhe Daly instructed by solicitor Jane O’Neill. The inquest had been adjourned from June and a verdict was issued by the coroner this week.
Dr Kanchana Ratnayake told the inquest that said he was the medical registrar on duty at the hospital on 11th July 2022. There was supposed to be two medical registrars rostered to be working that night. Because of the Covid outbreak the emergency department was divided into Covid and non-Covid areas. The Covid area handled all patients with cough or fever and the non-Covid area covered those without those symptoms. On the night in question the registrar who was supposed to covered the non-Covid ED was “absent” and “I was the only medical registrar for the evening and had to cover both EDs”. He also had to review acutely unwell in all the wards including intensive care unit and coronary care unit, he said Because of the increased patient load that night he had had to text the consultant on call Dr Anwar Mallik, his line manager, to inform him of the “short staffing level”. When he started his shift at 9pm there were already six patients waiting to be seen in non-Covid ED with only one senior house officer doing the admissions. “While I had to foresee the admissions and give clinical guidance from both non-Covid and Covid ED which was also extremely busy”.
The late Maura Murphy.
Ms Murphy was brought to the hospital by ambulance at 11.36pm and was seen by a triage nurse at 12.01am. The patient had symptoms of feeling unwell and shivering, high temperature of 39 degrees, nausea, vomiting and back and flank pain. She was assessed by ED registrar Dr Zakaria Bakhshi because of her high blood pressure (88/60) and pulse rate (128bpm). These met the criteria for sepsis and she was seen as soon as possible at 12.20am. According to the ED registrar’s assessment the most likely differential diagnosis was meningitis and Ms Murphy was handed over to the medical team for a review., Dr Ratnyake said. At 12.30am he had started reviewing Ms Murphy after seeing other patients in the non-Covid area “which was getting busy as well at that time”. He had gone through her symptoms with her. She did not complain of any abdominal pain. She described her lifestyle of regular exercise and swimming (25 laps three days a week).
He was convinced that meningitis was not the cause of her problems but that she may have been suffering from gastroenteritis He was looking after other patients throughout the night and was not called to review Ms Murphy after leaving the ED. At 7.20am he received a call from ED saying Ms Murphy had become very unwell since about 6.45am. He reviewed the patient and found she was cold and clammy and had low blood pressure. He then brought the consultant on duty Dr Mallik. He deemed there could be some intra-abdominal pathology more than just a simple viral gastroenteritis. The nursing staff were asked to give Ms Murphy intravenous drug to combat low pressure. Other doctors were asked to call the surgical team for an urgent review and to perform
abdominal CT scan. Dr Ratnayake said that after Dr Anwar had reviewed the patient he handed over the other night admissions to him and finished his shift. It was only when he arrived for work next day that he was informed Ms Murphy had gone into cardiac arrest and had passed away.
Cross-examined by Mr Craven who asked if there had been any response from his line manager when he told him that there was a shortage of staff Dr Ratnayake replied that he was told “do the best you can.”
The inquest was told that blood samples had been taken from Ms Murphy but these had been inconclusive. A medical registrar had instructed that blood tests should be repeated but the inquest was told that this had not been done. Consultant pathologist Professor Muna Sabah who performed a post mortem said that death was due to septic shock in the context of ischemic bowel disease. In reply to a question from Mr Craven she said that for the entire length of the aorta there was evidence of severe arteriosclerosis. She also said that most of the small bowel was infarcted (injury or death of tissue). The pathologist said she
was aware that the late Ms Murphy had had hepatitis C and had chronic liver disease as a consequence of that. However, the liver disease had not contributed to her death. Garda Inspector Alan Rougneen read into the record a statement by Ms Murphy’s husband David in which he gave formal evidence of identity. He said he would have said his wife was in good health prior to her death. They had just been in Wales for a week with their three grandchildren and they
had been very active with them.
Delivering his narrative verdict the coroner said that that death was due to septic shock in the context of chronic ischemic bowel disease. He said that Ms Murphy had been admitted to the hospital by ambulance at 11.36 on 11th July 2022, was assessed by the emergency department and commenced on the hospital’s “sepsis pathway”. Her initial serum lactate was elevated. He noted that the medical registrar’s instruction to take second blood samples had not been carried out and no further action was taken. Ms Murphy’s condition had deteriorated in the early hours, she had suffered a heart attack and had died at 11.41am.
