A VERDICT of medical misadventure was returned by a Galway coroner yesterday at an inquest into the death of a Sligo woman whose lung was punctured during a biopsy procedure at a Galway hospital last year.
Ms Marie Kelly (35), a factory worker, from Garravogue Villas, Sligo, was admitted to Merlin Park Hospital, Galway, on November 11th last year with pneumonia.
She had been admitted to Sligo General Hospital with a temperature of 103 degrees three weeks before that, but conventional antibiotics had failed to relieve congestion in her left lung.
She was seen on a routine ward round by a Merlin Park consultant physician, Dr J.J. Gilmartin, and his medical team on the morning of November 12th.
Following X-ray and ultrasound tests to locate the pathology, or infection, in the left lung, Dr Gilmartin delegated responsibility to one of his house doctors, Dr Marie Twomey, to aspirate some fluid from the infected lung to determine what type of bacteria was causing the protracted infection. Dr Twomey, the inquest heard, had performed up to 20 such procedures before.
However, the inquest learned that another, more junior house doctor, Dr Sinead O'Connor, who had never performed this particular procedure before, was the first to attempt aspiration of the fluid, using a needle, and that when this attempt failed Dr Twomey attempted the procedure a second time.
In all, four different attempts were made at four different points to aspirate fluid.
Mr Damien Tansey, solicitor for the Kelly family, said this suggested there had been confusion between the two junior doctors about the location of the infection, as four attempts had to be made to aspirate fluid.
Hospital charts, he added, clearly showed the presence of an empyema, or collection of pus, which was lodged in the lung for some time. He said the junior doctors had set out to remove the empyema and not to take a sample as Dr Gilmartin had suggested. It was agreed that pus would not come through the needle and was likely to block it.
The inquest heard that 15ml of blood-stained fluid and air were aspirated through the needle and shortly after this Ms Kelly coughed up 100ml of blood. She then suffered a cardiac arrest and all attempts to resuscitate her failed and she lost consciousness. She was admitted to the hospital's intensive care unit on a ventilator and remained in a coma for some weeks, suffering renal and finally, liver failure. She was pronounced dead on December 3rd.
The coroner, Dr Ciaran O'Loughlin, put it to Dr Gilmartin that it appeared Ms Kelly had bled into one of the main bronchi following the procedure and he asked how this could happen during a needle biopsy.
"That can only happen if the lung tissue is pierced in some way," Dr Gilmartin replied. The coroner then said it was probable that the needle went through from the area of infection into lung tissue underneath. "That is a reasonable explanation," Dr Gilmartin said. Mr Tansey asked the coroner to insert the term "iatrogenic" which he said meant "physician-induced injury" into his verdict, but Dr McLoughlin refused, stating that this word was commonly used in pharmacological terms with reference to adverse drug effects and not with reference to medical procedures.
Mr Tansey said that everyone now accepted that the perforation of the lung happened during the procedure and it had been an accident.
Before giving his verdict, Dr McLoughlin said Ms Kelly had contracted acute leukaemia when she was 20 from which she had made a complete recovery following a bone marrow transplant. She then contracted hepatitis C in 1994 and in mid-October 1998 she developed pneumonia. He stressed that the leukaemia had not contributed in any way to Ms Kelly's death but it was unclear if the hepatitis had been a minor contributing factor.
The coroner stated that Ms Kelly died as a result of medical misadventure, due to cerebral functional failure, cardiac arrest, haemoptysis (or coughing up blood), pulmonary haemorrhage and needle aspiration for the investigation of pneumonia.
Ms Kelly's sister and three brothers issued a brief statement following the verdict in which they expressed their satisfaction that they had at last been afforded an opportunity to hear at first hand how their sister had died.
Mr Tansey added that the family will now be taking a civil action in the High Court against the parties involved.