An inquest into the death of a 43-year-old resident of Navan 17 months ago has been told that the woman had died at her home some hours after she had spent three hours at Our Lady’s Hospital Navan and had been discharged. The inquest into the death of Máirín Lydon O’Hora], The Crescent, Glenveigh, Navan on 12th September 2023 conducted by Coroner for Co Meath Nathaniel Lacy at Trim Courthouse opened on 20th January and adjourned and the coroner’s verdict was delivered electronically by the coroner this week.
At the inquest barrister Aoife Nolan instructed by solicitor Michael Boylan represented the family and barrister Rory White instructed by Mason, Hayes and Curran solicitors represented Our Lady’s Hospital. Ms Lydon O’Hora’s husband Michael told the inquest that he arrived home from work at 6.47pm. He put on dinner and brought it up to Máirín in bed. She said she was very tired. She had been in Navan
hospital for about three hours and had been discharged and was home by 4pm. She had gone in with “very bad abdominal pain” on the advice of her GP Dr Niall Maguire. In the hospital her pain was very severe and “the staff wondered how she had managed it”. After he brought the dinner to her she ate a small bit of it but lurched over suddenly in pain onto her left side. He said he rang 999 and was told there was “no ambulance available” but to stay on the line.
Stopped breathing
His wife told him she could not feel her face and had a red rash on her stomach. “She said to me she thought she was going to die. I was trying to figure out if I could take her to the hospital myself. I rang her brother and some neighbours. I looked at Máirín and she had stopped breathing. Her eyes were open and there was no pulse. I started CPR on her”. Her brother arrived and he dialled 999. A first responder arrived and continued CPR but without success. At 10.10pm he formally identified Mairin’s remains to Sergeant Charley McNulty. In reply to the coroner Mr O’Hora said that his wife had some pain about 9pm on the night of 11th September.
He said she had never had such a severe episode of pain as the one on the 12th . In reply to Ms Nolan, Mr O’Hora said his wife had been given a diagnosis of “muscle spasm” arising from a game of tennis she had played some days previously. He said he was present at the game three days before Máirín’s death. It was a very relaxed game. She did not injure herself and had not complained to him afterwards. They went for a few drinks with friends and Máirín did not complain afterwards.
When she went to the hospital she had remained in touch and had told him the staff were going to do a scan. In one text message to him she wrote “I’m in A&E, they gave me a shot, the pain is very bad, they don’t know how I managed”. She sent a text at 15.03 saying she was going home. A text said that the pain was very bad, her bloods were clear but she said she was not convinced. When she got home she said she had blood tests but “she was just utterly exhausted, she hadn’t slept the night before and the following day”.
Dialled 999
In reply to questions from the barrister for the hospital, Mr O’Hora said he had brought dinner to his wife at about 7pm and when she collapsed he dialled 999. He described his wife’s condition over the phone and said he needed an ambulance. Mr White said that one of the doctors giving evidence at the inquest would say that the pain came on two days beforehand “which would fit in with the tennis game”. Mr O’Hora said that they were able to go for a few drinks. “If I had been in agony with a pain in the stomach I know I wouldn’t have been going for drinks”.
Mr White put it to Mr O’Hora that he (Mr O’Hora) had been “a bit off” the next day. However, Mr O’Hora replied that this was due to a “bad ankle, I wasn’t used to running on concrete”. Mr White said the doctor would say that the pain had come on “two days before” and that she had been playing tennis “two days before”. Mr O’Hora said that was the first he had heard of that. She had no pain following the tennis – “this is the first time I heard of this”
Sergeant Charley McNulty told the inquest that Mr O’Hora had identified the remains of Ms Lydon O’Hora to him.
Blood and blood clots
Consultant Pathologist Professor Muna Sabah gave evidence of having carried out a post mortem on Ms Lydon O’Hora’s body on 13th September. She said that behind the abdominal organ there was a large amount of blood and blood clots, about 2.5 litres and in the pelvic area. There was no evidence of abdominal aneurysm. She said she had been informed that Ms Lydon O’Hara had had three consecutive miscarriages. The pathologist concluded that there was no evidence to the right side of the abdomen. She suspected that the deceased may have had a tendency towards clotting factors.
She said that in post mortem examination she could not find the site of a haemorrhage and suspected a small blood vessel. She added that such a spontaneous retroperitoneal haematoma was “highly unusual and critical”
In reply to a question from the coroner Professor Sabah said that that amount of blood shouldn’t have been at the site of the body where it was found. She said it would appear that there was a leak from blood vessels. Mr White put it to Professor Sabah that the collection of blood was not the cause of death, rather it was from hypovolemic shock (caused by severe dehydration or blood loss with secondary
dysfunctions of the organs of the body).
In reply to Ms Nolan, the professor said that if a CT scan was done, it would show up that level of blood collection.
Doctor’s evidence
Dr Ankit Singhania started his evidence by extending his condolences to the family of the deceased and stating that he worked at the Navan hospital between July 2021 and July 2024. He first became aware of Ms Lydon O’Hora’s presence by a staff nurse. He was told that the patient suffered from nausea and increased intensity of pain. Two things came to his mind, possible gallstones or gastritis. He directed intravenous medication, analgesic. He also directed baseline bloods to be sent, coagulation profile, inflammatory biochemistry. A urinal sample analysis had a 2+ blood value, raising the question of a renal element. She was continually monitored for vitals. When he spoke to
the patient she told him that a pain had started two days beforehand, cramping pain and associated nausea. He had asked her to try to remember what happened two days before “and she declared she had been playing tennis and she had a lot of twisting and pulling”. There was no element of doubt but that she was deeply uncomfortable. A possible diagnosis of musculoskeletal pain came to his mind. When the patient was asked for a “pain score” she replied that it was four out of ten.
In his practice he did not rely solely on numerical pain scales but also observed for non-verbal pain scale and corroborated. A physical examination of the stomach did not reveal any abnormality in movement, colour, and palpations did not reveal any pain. Specific organ tests were all negative and affirmed a possible diagnosis of gastritis, gall bladder stones, kidney stones or any other intra- abdominal pathologies. He had leaned towards musculoskeletal s, having ruled out gastritis, he prescribed anti-inflammatory analgesic intravenously in addition to a muscle relaxant. He left Ms Lydon in a cubicle continuously monitored and established to review her later. That cubicle was directly facing the nurses’ station so there was direct vision of Ms Lydon’s bed. Blood tests revealed that nothing intra-abdominal was causing the pain and that the pain was no doubt muscular in origin, not one single value out of the normal range. There was general improvement following the analgesics.
Asked to go home
At one stage Ms Lydon asked for his attention and asked him if she could go home, that she was not in pain anymore. He offered her a pain killer prescription but she said there was no need, she could get it over the counter. He said he told her he had concluded the pain was musculoskeletal, “most likely due to the tennis playing”. He advised rest for a couple of days and advised she come back to the hospital if the pain worsened. He had no single reasonable doubt that Ms Lydon was leaving the hospital pain-free and that she was happy to go home. In reply to questions from Ms Nolan he said there was full staffing on duty on that day. He was not aware there was any short staffing.
He made a statement on about the 15th when a review of Ms Lydon’s treatment was carried out by the hospital. He said he had initially prescribed paracetamol for the patient. He agreed that in the “triage notes” Ms Lydon had been upgraded from Category 3 to Category 2. Apart from the triage, when he observed her her vitals were stable. He agreed that the patient had a history of gastric sleeve surgery.
He agreed she was given medicine intravenously at 12.20 and 12.25 and that took place before his first assessment of her. He was aware that Ms Lydon had had miscarriages and gastric band surgery.
Pain 4 of 10
While Ms Lydon O’Hora said his recollection was that she said her pain level was four out of 10, if the pain had been 10 out of 10 he would have given her morphine. The physical examination did not produce any abnormalities and there was no pain in her abdomen when he touched it, he said. He had done all the investigations necessary and he could not find anything else other than musculoskeletal issues.
Asked if the advice he had given the patient to return to Navan hospital if her condition escalated was the right one, the doctor replied that according to his assessment and his findings he always advised that if a patient has any concerns they “could always come back to me and I am happy to help”.
Replying to the barrister for the hospital, the doctor said that he had prescribed low-potency analgesia and also stronger analgesic. She did not require any analgesic when the patient was leaving the hospital but he gave her a note for her employer if she did not feel able to work. No imaging by way of CT scan was deemed necessary or carried out.
Pain intermittent
Nurse Caoimhe Donoghue said that on the day in question Ms Lydon O’Hora walked into her department and sat down in a chair. Initially, she said that her pain was intermittent, coming and going. Her medical history was checked with her, her blood pressure was taken, she was asked if she had any allergies. Her blood pressure was “slightly elevated”, quite common when people were being triaged. When the patient went to stand up “she got a wave of pain” and she knew at that stage she would have to take her blood pressure. When she got the wave of pain she was changed from Category 3 patient to Category 2 patient.
In final submissions made to the coroner Ms Nolan said the appropriate verdict was “medical misadventure”. Mr White disagreed and said the verdict should be one of natural causes. In a verdict delivered last week Mr Lacy returned a verdict that death resulted from hypovolemic shock in the context of spontaneous retroperitoneal haematoma.
