Mystery remains Sacred Heart patient’s rib fractures

Mystery remains as to how Sacred Heart Hospital patient received three rib fractures


Anton McNulty
antonmcnulty@mayonews.ie

AN INQUEST into the death of an 80-year old male patient heard on Monday that it remained ‘a mystery’ how he sustained three fractured ribs without staff becoming aware of it.
John Ruane late of Carralavin, Bonniconlon, Ballina died on April 29, 2012 in Mayo General Hospital three days after he was admitted with severe swelling around the neck and chest. He was diagnosed with surgical emphysema which is when air from the lungs becomes trapped under the skin.
A subsequent CT scan of the thorax on Mr Ruane revealed that he had three rib fractures which had not been detected by the hospital staff and staff at the Scared Heart Hospital were not aware of. He died in Intensive Care in Mayo General and the post mortem found he died from acute bronchial pneumonia due to the fracture of three ribs on his left side.
Mr Ruane, who suffered from Alzheimers and Dementia, was a patient in the St Anne’s Unit of the Sacred Heart Hospital and staff explained that in the hours before he fell ill, he did not suffer from any pain and was not in distress. There had been no recordings of a fall taking place or any other incident which could lead to the injuries.
Mr Eugene McCormack, the acting Assistant Director of Nursing at St Anne’s Unit carried out a review of the incident of Mr Ruane’s death and took statements from the staff who cared for him in the hours up until his admittance into Mayo General.

UNABLE TO IDENTIFY
The conclusion of the review were outlined at Mr Ruane’s inquest which was held yesterday in Castlebar and found that they were unable to identify any causal factors to explain how the ribs came to be fractured.
When questioned by Mr Cathal Deasy, solicitor for Mr Ruane’s family how this could have happened, Mr McCormack described it as a ‘mystery’.
“I’m afraid I have to agree with you and speaking personally and for the staff it is a mystery as to how this happened. If he was found on the ground or if there was bruising on his chest area I could explain to them [Mr Ruane’s family]. I have no definite evidence of how this happened. It is just a mystery,” he said.
When asked if any changes were made in the unit to prevent such an incident occurring again, Mr McCormack replied that if they knew what happened they would have changes made.
“From a risk assessment point of view, if there was a rough edge or an area where he could have slipped we’d deal with it in the evening [but] we are at a loss as to what happened here. There is no question if we had any idea what happened we’d deal with it.”
There is no CCTV system on the premises and Mr McCormack explained that legislation prevented them from recording the patients in their care.
Mr Ruane had been a patient in the Sacred Heart since November 2011 and suffered two falls, one of which was observed and in the other case he was found on the floor by staff.
Dr Elaine Walsh, a Consultant in Old Age Psychiatry, explained that in a dementia population, the falls generally come under two categories, either witnessed or not witnessed. She said she found if Mr Ruane fell while unobserved he would not have the agility to pull himself up.
She said in her opinion the most likely explanation is that he stumbled and caught the left side of his chest, possibly against a solid edge before he steadied himself and did not end up on the ground.
The inquest heard from different doctors who agreed that an older person does not need the same level of force to sustain a serious injury and severe coughing can result in a  fractured rib.

DID NOT LOOK DISTRESSED
Staff nurses who cared for Mr Ruane all explained that he had been pleasant during April 26, 2012 and did not look distressed or in pain. Dr Edyta Truszkowska explained there was no evidence of trauma to him and he was able to breathe without pain.
Nurse Karen Maloney explained she started work at 8pm on April 26 and found Mr Ruane to be pleasant and smiling at staff. At 9.30pm she went to give him his supper and noticed swelling around his neck and the emergency ambulance was contacted.
Mr John O’Dwyer, Coronor for south Mayo said he was satisfied that the injury to Mr Ruane was sustained in the Sacred Heart Hospital between 24 hours and 48 hours before his admittance to Mayo General. He said the family had come to the inquest wanting to get answers but that was not possible.
He said he was satisfied Mr Ruane was cared for by the staff in St Anne’s and recorded an open verdict and expressed his sympathy to Mr Ruane’s family. Mr John O’Donnell, BL for the HSE also expressed their sympathy to the family and explained the staff had done all they could to determine how the injuries were sustained.

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