An inquest into the death of a woman at a Kilkenny hospital 13 years ago has heard that the doctor who allegedly “inadvertently punctured” an artery in her neck is no longer within the jurisdiction and cannot give evidence for the case.
It is alleged that Dr Norbert Lederer, who was a locum consultant anaesthetist at St Luke’s Hospital in Kilkenny at the time, punctured the artery while performing a procedure on June 17th, 2009, to create a new opening for a venous catheter tube to assist Olive McGuire, who had been admitted to the hospital four days earlier suffering from abdominal pain, vomiting and constipation.
The court head from a separate consultant anaesthetist who later looked after Ms McGuire, a 32-year-old mother of two, who claimed he found it “obvious” that the puncture “wasn’t recognised”, so the procedure continued and potentially made the tear “larger”.
In evidence, Dr Niall Kavanagh suggested that an artery puncture is an “acknowledged complication” of the procedure and is one of the “most feared” results of the insertion.
Ms McGuire died on June 24th, 2009, in St Luke’s, 11 days after she was admitted. Two postmortems were carried out in the following days. The court heard the second arose after a conversation took place between consultants and the pathologist to discuss Ms McGuire’s death. Her body had to be retrieved from her family for the second study, before being returned again.
Dr Lederer’s sworn deposition was read into the court record by coroner Tim Kiely, who said Dr Lederer was “unfortunately no longer within the jurisdiction”.
After discussion on whether to allow Dr Lederer’s statement on the case to be read, Mr Kiely said he wanted to allow the jury to hear it. In it, Dr Lederer said the insertion was a “difficult placement” that took “two or three attempts”.
Ahead of performing the procedure, Dr Lederer said he noted that Ms McGuire had undergone a gynaecological procedure for cysts on her ovary, and was a non-smoker who was not on the contraceptive pill. He said he was unable to secure any other peripheral access and, after ensuring Ms McGuire was stable, applied gentle pressure to her for three to five minutes. There was a “small haematoma”, or bruising, “but no active bleeding from the site”, he said.
Ms McGuire was moved to intensive care for further management by doctors, and her blood levels and temperature were stable, Dr Lederer reported. Ms McGuire was on a ventilator having suffered a blood clot and stroke at the hospital.
In his statement Dr Lederer said that based on clinical procedure he informed Ms McGuire’s husband about the possibility of septic shock. Laboratory and chest and head X-rays were ordered, with one brain scan four days later showing a cerebral issue for Ms McGuire, leading to the neurosurgery department in Beaumont Hospital in Dublin being contacted.
“Unfortunately she failed to wake up,” Dr Lederer’s statement read.
Earlier the court had heard from Dr Kavanagh, also a consultant anaesthetist at St Luke’s at the time. Ms McGuire came into his care on June 23rd, 2009, a day before her death. “If you’ve punctured the artery but haven’t advanced further, it’s usually inconsequential ... The puncture will heal itself,” he said.
“Here, unfortunately, it obviously wasn’t recognised and the entire procedure was continued so that the tear would have been larger.”
Raymond Bradley, senior counsel on behalf of Ms McGuire’s family, noted that Dr Kavanagh was not present on June 17th for the procedure. Coroner Tim Kiely said it was an “accepted fact” that Ms McGuire suffered a puncture to her right carotid artery during the procedure.
The court had heard on Wednesday of delays to the brain scan for Ms McGuire, as the CT machine at St Luke’s was temporarily out of service. Medical professionals who gave evidence stressed they had cared for Ms McGuire and sought to ensure she remained stable throughout her admission before her decline and death.
Mr Kiely told the court that the inquest was confined to looking at the circumstances of Ms McGuire’s death and must “not stray into adequacies of diagnosis”. The inquest is expected to conclude on Friday before its jury of three women and three men.