On May 14th, Mary Bartley Meehan was permitted to visit her husband, Ultan Meehan (79), outside Kilbrew Nursing Home in Ashbourne, Co Meath.
The visit was specially arranged during lockdown on seats outside because she had lost her son and Ultan's stepson, Adrian Bartley (52), who also lived at Kilbrew, to coronavirus just six weeks earlier. Adrian had Down's syndrome and dementia.
Mary was “deeply shocked” at the “horrific” condition of her husband, who also suffered from dementia and was terminally ill with cancerous tumours on his face.
“I don’t think I will ever forget it,” she told The Irish Times at her home near Navan.
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Her husband was wearing a jumper belonging to her late son – the two men had shared a room at Kilbrew – and somebody else’s shoes.
The side of his face was black with congealed blood. His nails were long and black from picking at his facial tumours, which had become an open wound and infected.
She would never forget the smell from the wound, she said.
Wearing full protective clothing to guard against Covid-19, she felt compelled to take off her gloves and cut his nails herself; her requests to the home had gone ignored, she said
“I know I shouldn’t have done it but I couldn’t leave him with those long nails scraping the wound that was bleeding,” she said.
Visiting restrictions at nursing homes from early March meant Mary had been unable to bring her son and husband home at weekends since February. Most weekends, she bathed her husband, and cleaned his wound. She knew how to calm him; she gave him a sweet and put on some music.
Doctor assessment
On May 29th, two weeks after Mary visited and following sustained pressure from Mary, her advocate and a HSE social worker to have Ultan seen by a local GP, he was assessed.
A doctor referred him immediately to Connolly Hospital in Blanchardstown, Dublin, the location where Adrian had died two months earlier.
Medical records from May 29th – the day that he was admitted – say the nursing home was “unable to manage” the wound on Ultan’s face and that it had become infested with maggots.
On June 15th, with her husband’s health deteriorating rapidly, Mary was permitted to spend an hour with him. By then, his wound was bandaged and he had been shaved.
“His face was spotless clean,” she said.
He died later that day.
A medical certificate put sepsis as the cause of death but also listed “Covid in April 2020” as one of several underlying health conditions.
On March 27th, the day Adrian was rushed from Kilbrew to hospital with severe breathing difficulties, a doctor at the hospital called the nursing home and directed that Ultan be tested immediately for Covid-19 given that the two men shared a room.
Ultan was a risk to others because, like many with dementia, he liked to wander around. It took 17 days for the result to come back; he was positive but had no symptoms.
Adrian tested positive for Covid-19 in Connolly Hospital. On March 31st, as his condition deteriorated, Mary said her goodbyes to her son on a video call with two nurses.
“I kept saying to him that he was going to see his daddy,” she said, referring to her late first husband.
He died two hours later.
Shock
The story of Mary, her husband and her son has shocked those who tried to help them.
Mary's advocate, Maureen Finlay, who works with Sage Advocacy, a support group for vulnerable adults, said that calls to Kilbrew in May requesting that Ultan be transferred to a hospital or hospice care went ignored; the home said they were taking care of him, she said.
“This is one of the worst and most horrific cases I have ever come across and I have dealt with some very difficult ones. I was shocked. I spent the night crying after seeing the pictures of Ultan,” said Ms Finlay.
From April 1st, the day after Adrian’s death, to June 2nd, shortly after Ultan’s admission to hospital, Sage issued four “notices of concern” to the HSE and the health service regulator, the Health Information and Quality Authority (Hiqa), about Kilbrew Nursing Home.
On June 10th, Sage's executive director, Mervyn Taylor, escalated matters, writing to then minister for health Simon Harris asking him to investigate the Co Meath home.
“At a care level, it is probably as bad as I have seen. The tragedy for Mary is just awful because she has lost a son and a husband in 10 weeks. It is a personal tragedy of terrible dimensions,” Mr Taylor said.
Safeguarding team
The minister’s private secretary, Matthew O’Gorman, responded to Sage by email on June 26th, saying that the Department of Health had brought the group’s concerns about Ultan Meehan to the attention of the HSE, which had referred the case to the local safeguarding team.
Mr O’Gorman said Hiqa “has no legal role in examining individual complaints” but that it does take into account all information it receives including complaints from the public when carrying out inspections and this information informs “a risk-based approach to regulation”.
The HSE said it had “no governance or oversight” over private nursing homes as they were private organisations but that its safeguarding team had “limited authority to provide oversight or to intervene in private nursing homes”. It directed any further queries to Hiqa.
Hiqa told The Irish Times in early June, prior to Ultan’s death, that it was aware of Sage’s concerns and had engaged with Kilbrew and staff in Connolly Hospital in relation to his care.
Fine Gael TD Fergus O'Dowd, who was made aware of details of the case, expressed concern about the lack of care and proper medical overview of Ultan.
"How often did they look at his case? To have maggots in his wound is something you would see in the 18th century, not in Ireland today, not in a nursing home today," Mr O'Dowd said.
Hiqa carried out an inspection of Kilbrew on June 4th and is compiling a report.
Further review
James Keeling, chief executive of Kilbrew Nursing Home, said it had submitted a report to the regulator and “awaited the outcome of a further review by Hiqa”.
Mr Keeling declined to answer questions about Ultan’s medical condition during his wife’s visit on May 14th or why it took two weeks for him to be transferred to hospital.
“It is not appropriate to go into clinical detail relating to any resident or their treatment,” he said.
“At all times, we work to provide the best of care to every resident, who each have a dedicated GP assigned to them.”
Mr Keeling, in his written responses, referred to the toll taken on Kilbrew from coronavirus.
Internal HSE figures in late May indicated there had been 15 confirmed or probable Covid-19 deaths at the home. Kilbrew also lost nursing and care staff to illness and self-isolation. The home had 59 residents in July 2019 and has a capacity for a maximum of 74.
“Kilbrew Nursing Home, like many others, has been under acute pressure in the midst of the pandemic, and its managers and staff have and continue to work extremely hard to deliver best in care for all of its residents,” Mr Keeling said.
Mary said the Covid-19 pandemic could not be used to explain the state she found her husband in when she last visited him at his nursing home.
“That’s no excuse,” she said.
