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Desperately ill but discharged


SADLY MISSED Anne Marie O’Brien died in Mayo University Hospital on October 2, 2016.

‘I will never have peace of mind again’ – dead woman’s daughter

Edwin McGreal

The daughter of a Castlebar woman who died two days after being released from Mayo University Hospital despite ‘off the wall’ test results has said how her mother’s passing haunts her.
An inquest yesterday (Monday) into the death of Anne Marie O’Brien (48) of Windsor, Castlebar, recorded a verdict of misadventure after the inquest heard that Ms O’Brien was discharged from hospital against her will two days before she died.
Speaking at the inquest, her daughter, Laura O’Brien, said she cannot comprehend why her mother was discharged in the early hours of Friday, September 30, 2016.
‘Agonising pain’
Anne Marie O’Brien died in Mayo University Hospital on October 2, 2016, after she suffered a cardiac arrest in her home earlier that day. Her postmortem found that she died as a result of pneumonia with a background of chronic obstructive pulmonary disease (COPD).
“I don’t understand why the doctors thought it would be okay to discharge her from hospital … I’m haunted by what happened and I feel that in some way I am to blame because I did not insist that my mother be kept in the hospital on the 29th [of September]. I will never have peace of mind again,” an emotional Laura O’Brien told the inquest.
The HSE has apologised for the standard of care Anne Marie O’Brien received.
In her evidence, Laura O’Brien said that on September 24, 2016, her mother told her she had a terrible pain in her back. The following day she brought her mother to Mayo University Hospital. She was prescribed with Diazepam and discharged later that day.
However, the pain got worse, and on Thursday afternoon, September 29, an ambulance was called, as her mother was in ‘such agony’.
Ms O’Brien said her mother was put on a trolley in the hospital. She said she was in ‘agonising pain on the trolley’ and was left ‘unattended for a significant period of time’.
“At that stage the only way I can describe my mother is that she was in bits. Nobody was taking her seriously,” Ms O’Brien told the inquest.

‘I was horrified’
Anne Marie O’Brien’s sister, Margaret Whelan, spent the night in the hospital with her. Ms Whelan told the inquest that one doctor checked Anne Marie’s chest and appeared to look concerned. She said a row then erupted between this doctor and a second doctor.
“The other doctor was shouting at him and appeared to be dismissing his concerns,” she said. “Then they walked away. I will never forget my sister’s face and the state of despair she was in. She said to me, ‘They don’t believe me Margaret’.”
Ms Whelan said she could not believe when Anne Marie was told she was being discharged.
“I was horrified. Anne Marie could not stand, and they were looking for a way to send her home. It was an absolute disgrace the way she was treated. She should never have been allowed to leave the hospital that morning … She was treated more like an animal than a human.”
Laura O’Brien said she was extremely worried on the evening of October 1 about her mother and was in ‘complete disbelief’ that she had been discharged.
“I felt I had nobody to turn to, bearing in mind the way she had been treated at the hospital had been so appalling. They just did not seem to have any regard for her,” she said.

Medical evidence
Yesterday’s inquest heard evidence from six doctors who were working in the hospital at the time. The inquest was part heard last May, when other reports, including the postmortem, were given.
Dr Babatunde Ayeni was the senior house officer working in thr emergency department on the night in question. He examined Ms O’Brien and ordered various tests. Ms O’Brien’s C-reactive protein (CRP) showed it raised to 183. CRP is a blood test marker for inflammation and infection in the body, the inquest was told.
In response to a question from Mr Tansey asking him if the CRP reading of 183 was ‘off the wall’, Dr Ayeni said it was.
Dr Ayeni said he twice raised his concerns, with Dr Awais Khan, the senior house officer with the medical department on the night, about Ms O’Brien’s shortness of breath, high CRP and ‘the need for admission for further medical management’.
He was asked if he was disappointed that Ms O’Brien was not admitted.
“As a doctor if something I recommended wasn’t carried through, I would be disappointed,” said Dr Ayeni.
Dr Awais Khan said he identified the problem as being orthopaedic, and not medical.
Damien Tansey, solicitor for the O’Brien family, asked Dr Khan how a CRP reading of 183 – combined with Ms O’Brien’s history of obesity, mild heart disease and COPD and her  breathing problems at the time – could lead him to think the problem was simply back pain.
Dr Khan said it was because Ms O’Brien was complaining about back pain. Mr Tansey described Dr Khan’s assertion that the problem was orthopaedic and not medical as ‘foolishness’.
Dr Khan said it was not his decision to discharge Ms O’Brien, and that he had intended to further examine her for back problems.
Dr Omotunde Oludayo Sanni was a locum Registrar in Emergency Medicine at the hospital on the night in question, and it was he who ultimately discharged Ms O’Brien. He said initially he advised Dr Ayeni to refer the case to the medical team on call.
He said that after seeing Ms O’Brien earlier during the night he felt she was ‘too ill’ to be let home, as ‘she could not even get out of the trolley’. He said he did not want her to be discharged, but the decision had been taken by the medical team, led by Dr Khan, not to admit her. There ‘is a limit to what I can do’, he said.  

‘Unreserved apology’
Coroner Pat O’Connor said that it should be ‘a cause for concern’ in medicine that often times a person is not examined holistically. They may be admitted with one condition but background and underlying factors need to always be taken into account.
He recorded a verdict of misadventure.
After the verdict was given, Sasha Gayer, Senior Counsel for the HSE, read out a letter written by Catherine Donohoe, General Manager at Mayo University Hospital, apologising for the standard of care on the night in question.
“On behalf of the hospital, I wish to make an unreserved apology to you and all of the members of your family for the standard of care delivered to your late mother, Mrs Anne Marie O’Brien, during her attendance at the hospital on the 29th, going into the 30th of September, which was not to the standard our hospital would believe was appropriate,” she wrote.
Damien Tansey said this case ‘clearly [fell] between a number of stools and a number of departments in the hospital, with devastating consequences’.
Speaking afterwards outside Castlebar Courthouse, Mr Tansey criticised the medical staff at the hospital for their ‘failure and neglect’, arguing that they should have had much greater regard for blood tests that ‘clearly indicated’ there was an evolving pneumonia.
A civil action by the O’Brien family against the HSE is also underway.