A VERDICT of death by misadventure was returned by the Dublin Coroner's Court yesterday at an inquest on a woman who died in St Vincent's Hospital last year.
Her death followed five weeks of coma, which originated in a cardiac arrest she suffered while undergoing tests at the hospital. Dr Susan Kennedy, a pathologist at St Vincent's, who attended at Ms Eileen Farrell's autopsy, said "a false negative biopsy" performed on the patient prior to the cardiac arrest contained "sizeable" fragments from a large elastic (blood) vessel consistent with an aorta wall". The patterns in the fragments indicated "full thickness" fragments, she said.
The inquest established the immediate cause of her death five weeks later as "catastrophic" bleeding in the lungs caused by the tumour, or "pulmonary haemorrhage caused by erosion of the tracheo bronchial tree by non Hodgkins lymphoma".
Ms Farrell (29), originally from Toronto but with an address at Clarinda Park North, Dun Laoghaire, had been "urgently" referred to the hospital on January 19th, 1995. Preliminary diagnosis and X rays by a consultant respiratory physician, Dr Timothy McDonnell, indicated a large tumour in her chest, which was compressing veins and airways. She was immediately admitted to hospital, and prescribed steroids to reduce neck swellings, pending further tests.
On Monday, January 23rd, it was decided "collectively" to undertake "tru-put" needle biopsy tests on Ms Farrell, to establish the proper treatment for her condition. This involved inserting needles into the tumour and extracting tissue samples for analysis, while the patient was sedated/anaesthetised. It was felt to be the "least invasive" test.
This task was undertaken in the radiological room at the hospital by Dr Peter O'Donovan, a locum consultant radiologist working in St Vincent's at the time. Following an angle assessed from a CT scan of the tumour, a needle was inserted into Ms Farrell's chest to a depth of 4 centimetres. When withdrawn it was found to contain mostly "fat".
A second incision was made along the same line, and to the same depth. This time the biopsy had a "gritty" feel to it, which was thought to be cartilage. Ms Farrell complained about right shoulder pain, which Dr O'Donovan thought related to her posture. Her colour was good and her breathing was normal. Dr O'Donovan proceeded with a third biopsy along the same line as the previous two, to a depth of 5 centimetres this time, and aimed at the tumour.
On insertion of this needle, Ms Farrell opened her eyes with a look of apprehension. Dr O'Donovan immediately removed the needle without any tissue, but Ms Farrell had become unconscious. He administered a drug intravenously and she revived. The cardiac arrest team was summoned and before they arrived Ms Farrell had relapsed into unconsciousness again. Resuscitation took place. CT and ultra sound scans were undertaken. Mr Vincent Lynch, consultant and thoracic surgeon at the hospital, was summoned urgently. He opened Ms Farrell's chest to find "a massive tumour" and that the pericardial sac around her heart was full of blood, restricting its movement. He cut the sac, releasing the blood and manually massaged Ms Farrell's heart until it was beating regularly.
Dr Susan Kennedy, consultant histopathologist at St Vincent's, told the court that the autopsy on Ms Farrell revealed that "a very extensive . . . high grade malign lymphoma which had invaded Ms Farrell's lungs, was the cause of the bleeding and her death. Such tumours were not unusual in young adults and the prognosis of victims was "very poor". "A very high mortality rate is associated with it," she said.
