A High Court judge yesterday found that an inquest into the death of a pregnant woman in Co Sligo was "defective" and "less than sensitive". Mr Justice Sheridan ordered a new inquest into the death of Mrs Caroline Leyden (29) at Sligo General Hospital on January 30th, 1996, and quashed the finding of an inquest last year by the Sligo County Coroner, Dr Desmond Moran, into the death.
Mrs Leyden, who was nine months pregnant, was pronounced dead after collapsing at the Tractec factory in Sligo where she worked as a quality controller. At an inquest presided over by Dr Moran on February 19th last year, the jury returned a verdict of death caused by a massive haemorrhage.
Mr Leo Leyden (38) a farmer, of Ballinfull, Co Sligo, last week applied to the High Court, by way of judicial review, for orders quashing the inquest's decision because of a dispute at the hearing between the coroner and his solicitor, Mr Damien Tansey.
Mr Adrian Hardiman SC, for Mr Leyden, said Dr Moran had roared and shouted at the solicitor and gave an extraordinarily belligerent performance.
Yesterday the judge expressed his deep condolences to Mr Leyden over the tragic loss of his wife in tragic circumstances. He agreed that the manner in which the inquest was conducted had been less than sensitive. It was clear that Dr Moran and Mr Tansey did not get on, he said.
The judge said he had to ask if there was an alternative question on the cause of death which was proper to put to the jury. The question the coroner put, which the jury went along with, was that Mrs Leyden had died of a massive haemorrhage.
Mr Justice Sheridan said Dr Moran had indicated he was satisfied as to the cause of Mrs Leyden's death before the pathologist, Dr Nessa O'Donnell, had concluded her evidence. He said Dr Moran had said: "There, you have it" to Mr Tansey before that evidence was finished. That should have been left unsaid.
The coroner had refused to allow Mr Tansey cross-examine the pathologist, telling him he could raise the matter later during other medical evidence, Mr Justice Sheridan said. But when Mr Tansey had attempted to cross-examine two other medical doctors, he was stopped and the coroner had threatened to have him expelled from the hearing.
The manner in which the inquest had been conducted was both insensitive and unsatisfactory, the judge said. While he was not apportioning blame, he was mindful of Mr Leyden's situation, having to listen to all of this. Every person was entitled to expect the rules of natural justice be observed.
Inquisitorial or not, he could find no case that could be more serious than an inquest into the cause of the death of a person.
Mr Leyden was entitled to expect that fair procedures be applied in such circumstances. "I am not satisfied that he got them, " the judge said.
Quashing Dr Moran's inquest, he ordered a fresh inquest by another coroner as soon as possible and awarded costs against Dr Moran.
Earlier in court, Mr Hardiman, for Mr Leyden, said the coroner seemed determined to return a verdict in accordance with a pathologist's evidence. No evidence which could challenge that interpretation of what happened to Mrs Leyden was permitted by the coroner, he said.
Mr Joseph Finnegan SC, for Dr Moran, said that while a solicitor was entitled to test evidence at an inquest he must do so within the limits imposed by legislation governing the holding of inquests.
It was not wrong for an investigating authority to reach a certain view at an early stage in the proceedings as long as it remained open to other possibilities during the course of the subsequent evidence, counsel said.