An inquest into the death of a man who told medical staff at St James's Hospital in Dublin that he did not wish to be kept alive by artificial ventilation has been adjourned so that the "end of life issue" can be fully explored at the resumed hearing.
A consultant physician at the hospital told Dublin City Coroner's Court yesterday that three senior medical practitioners involved in the man's care discussed and followed his wishes.
Ronald Lindsey (61), Iveagh Trust, Dublin 8, a hostel for people who were previously homeless, died on April 22nd, 2005, at St James's. Mr Lindsey was on anti-coagulation warfarin therapy for previous deep vein thrombosis and developed a rare complication that left him paralysed despite an emergency operation, the court heard.
Mr Lindsey presented at the hospital's A&E department on March 4th and was seen by a doctor 10 hours later. A severe kidney infection was diagnosed. Mr Lindsey then remained on a trolley until a bed became available a day-and-a-half later.
The following day, a CT scan was carried out which suggested internal bleeding into the spine, Dr Bernard Silk, a consultant physician at St James's, told the inquest.
An MRI scan to confirm this could not be carried out because it was after 5pm and St James's does not have 24-hour access to this service. Dublin's Beaumont Hospital has full-time access to the scanner but when contacted about Mr Lindsey, it said moving him was not advisable and he was not a suitable candidate for surgery, Dr Silk continued.
The following morning an MRI scan confirmed bleeding into the spinal area. There are just 300 documented cases of this occurring worldwide, Dr Silk said, and 40 per cent of those concerned patients on anti-coagulation therapy.
Dr Silk said diagnosis of this was needed within 12 hours to avoid paralysis. He added that it was "completely inappropriate" that MRI services were not always available at St James's.
"We would love to have it 24 hours . . . We have been the strongest advocates for more resources." Paralysis of Mr Lindsey's legs had begun and he was transferred to the spinal unit at Dublin's Mater hospital for emergency surgery.
Consultant orthopaedic surgeon Damien McCormack found "formed blood clots throughout the spine" and "clots extending up towards the neck". Without surgery, Mr Lindsey would not have survived but his prognosis for future mobility was poor, Mr McCormack said.
The Mater also does not have 24-hour access to MRI services. The hospital can contact radiographers in an emergency but has no guarantee that someone will be available.
Mr Lindsey became depressed a few days after his surgery and saw a psychiatrist at the Mater before being transferred back to St James's.
Dr Silk said there was "no prospect of weaning him off ventilation" and Mr Lindsey requested that the artificial ventilation be withdrawn.
A written protocol at St James's states that three senior clinicians involved in a patient's treatment must agree to discontinue artificial ventilation at a patient's request.
A meeting was held and they unanimously decided to follow Mr Lindsey's wishes. The ventilation was switched off and he died the same day.
Thomas Fallon, barrister for Mr Lindsey's sisters, Olive Cummins and Winifred Leonard, said his family were "removed from this decision. They have their own view on this".
Extracts from a statement by Ms Leonard read in court described how her brother communicated to his family with the help of a voice box. "He said he could not take the pain any longer. I believe my brother was capable of making the decision to come off the ventilator."
Mr Fallon said there needed to be "clarity on the end of life issue" and requested a copy of St James's written protocol concerning artificial ventilation.
The inquest heard that due to his living situation, Mr Lindsey's warfarin medication was stolen in the past and he missed many of his hospital appointments to monitor his warfarin therapy.
The inquest was adjourned until March 2nd. Spokesmen for St James's and the Mater said they could not comment until the inquest had concluded.