Retired teacher who died in hospital not reviewed for five days ‘due to Christmas holidays’

The family of Declan Sweeney, a former vice-principal of Synge Street CBS in Dublin, have criticised the care provided to the patient and the response of medical staff at the hospital to concerns they had raised about his deteriorating health in the days before his death.

Mr Sweeney (78), a father of five of Langton Park, Newbridge, Co Kildare, died in Tallaght Hospital on December 27, 2018 – a day before his 50th wedding anniversary and a week after he had been admitted over concerns about a shortness of breath.

On the second day of an inquest at Dublin District Coroner’s Court on Tuesday, counsel for Mr Sweeney’s family, Roger Murray SC, said the net effect of the patient being discharged from the high dependency unit on Friday, December 21, 2018 was that his condition was not reviewed by a hospital consultant “of any description” for five days.

He observed there were no medical notes of Mr Sweeney having been examined on Christmas Day.

Mr Murray also pointed out that the patient was only seen by a medical intern on the following day as a registrar had only reviewed his medical records but conducted no physical examination.

The inquest heard evidence on Monday from Mr Sweeney’s daughter, Michelle Easterly, that they had repeatedly asked hospital staff for their father to be seen by a senior doctor and to be transferred to an intensive care unit as he was regularly confused, sweating profusely and shaking.

Mr Murray told the coroner, Cróna Gallagher, that the situation was complicated by the issue of how consultants were covered over a holiday period for which there was a need for greater governance and oversight rather than being just left to arrangements between consultants.

He claimed there were also concerns around “pinch points” of holidays like Christmas which coincided with a weekend and two bank holidays in Mr Sweeney’s case.

The barrister said Mr Sweeney’s family took some solace from the fact that changes had been introduced in both Tallaght Hospital and at a national level and were “heartened” they had been implemented as a result of the circumstances of his death.

However, he added: “They feel more could have been done and more could still be done.”

He said there was still a need for the concerns of families to be put “front and centre” of improved communications by hospital staff with such concerns to be formally recorded in medical notes.

Calling for a narrative verdict, Mr Murray said it would be the most appropriate verdict in order to reflect the complexity of the case as well as gaps in the treatment of Mr Sweeney.

Mr Murray said a senior doctor at Tallaght Hospital had accepted inappropriate communications by staff on December 21, 2018, had resulted in a missed opportunity to provide proper planning for Mr Sweeney’s care.

He claimed the patient’s family had been “left in the dark” about their father’s condition and were “physically looking in corridors” for answers.

The barrister noted that doctors still expected the patient to live – even in the hours before his death.

Mr Murray said Mr Sweeney’s family remained haunted by the fact that they were not by his bedside when he died.

He highlighted how they could see their father deteriorate before their eyes on Christmas Day and St Stephen’s Day, while it was clear that “no family could have done more.”

Counsel for Tallaght Hospital, Caoimhe Daly BL, also stated a narrative verdict would be appropriate but claimed recommendations were “not necessary” due to the changes that had already been made in relation to additional cover and reviews of rosters over holiday periods.

“It is quite evident that much has been done,” said Ms Daly.

Returning a narrative verdict, the coroner noted that Mr Sweeney had suffered from a number of medical complications including Parkinson’s disease, diabetes and chronic obstructive pulmonary disease.

Dr Gallagher also recorded that the patient’s family were extremely concerned about his care throughout his stay in Tallaght Hospital and that he had not been seen by his primary care team until the day of his death.

The coroner had remarked earlier that it had been difficult to establish who was responsible for Mr Sweeney’s care over the holiday period.

She also noted that a post-mortem had revealed that he had died as a result of acute cardiac arrhythmia (irregular heartbeat) while chronic lymphocytic leukaemia from which he suffered for a number of years was a significant contributory factor.

While welcoming the changes that had already been made at Tallaght Hospital, Dr Gallagher said she did not believe they fully addressed the cross-cover of consultants over holiday periods.

The coroner said a consultant providing cover for a colleague could not be expected to provide the same level of care if their workload was doubled.

Dr Gallagher issued a recommendation that the hospital should arrange locum cover for consultants over holiday periods, particularly Christmas, “to ensure patients are seen by consultants routinely and not just in emergencies.”

The coroner also called for families to be given “explicit information” on the lead consultant responsible for delivering care to a patient at all times as well as being informed of any changes to the “name over the bed.”

She stressed that she was not making any claims that such changes would have affected the outcome in Mr Sweeney’s case.

Welcoming the verdict and recommendations, Mr Sweeney’s son, Ronan – a former intercounty footballer for Kildare – said his family were delighted with the outcome of the inquest.

“Our dad was in the public service for 40 years as a teacher helping people all that time. We just felt that he was left down in his hour of need by the system, not necessarily by anyone individually,” said Mr Sweeney.

He added: “The whole purpose of this was to ensure that this doesn’t happen to another family and we’ve gone a long way to doing that.”