It was likely a 44-year-old Meath man who had an ulcer which bled profusely and led to his death had the ulcer for some time, an inquest heard yesterday.
Deputy Dublin City Coroner Maria Colbert said at the end of yesterday's hearing that she was concerned at a number of issues which arose in evidence and was therefore adjourning the inquest to October so she could obtain medical records.
Surgeon Joseph McGrath, who treated Bernard Briody before his death in May last year, told Dublin Coroners Court it was "likely this ulcer was there for some time". He added it was unusual for a 44-year-old man to die from a duodenal ulcer. The court heard Mr Briody, from Moylough, Oldcastle, had presented at Our Lady's Hospital in Navan with abdominal pain a number of times going back to the 1990s.
He also had attended the hospital's A&E unit on January 21st and 25th last year with abdominal pain. He wasn't admitted on either occasion. Gallstones were considered as a possible diagnosis but ruled out when he attended the hospital for an ultrasound on January 28th.
A doctor who saw him on January 25th put him on a six-week course of Nexium, a drug used to treat ulcers, and Mr Briody's GP sent a fax to Mr McGrath on February 2nd in which he queried whether Mr Briody may have a peptic ulcer and requested he be assessed in the outpatient department.
Mr McGrath said he sent the fax to medical records to have an outpatient appointment arranged. One was arranged for September 2004. But Mr Briody, a lorry driver, was back in hospital on May 4th. He was admitted with abdominal pain, had another ultrasound on May 5th and again it was negative for gallstones. He was discharged on May 7th as he was "pain-free and comfortable", Mr McGrath said, and he was to be reviewed in outpatients on May 31st.
But three days after his discharge he was admitted again, as an emergency. He had been losing blood. An endoscopy examination found a large duodenal ulcer, which had been bleeding. The ulcer was injected to prevent further bleeding and the man was stable for a number of hours, Mr McGrath said.
However, the patient had a further bleed early the next morning, May 11th. He had a further endoscopy and it was decided he needed surgery. When he was operated on Mr McGrath said he found the bleeding from the ulcer to be "torrential". It was the worst bleeding he had ever seen and he had difficulty controlling it. Another surgeon assisted him to stop the bleed. Mr Briody had lost "his entire blood volume" and clotting factors in his blood. He was so unstable he was returned to theatre that evening when it was found he was "oozing from all his tissues".
A decision was made, Mr McGrath said, to transfer him to Dublin's St James's Hospital where he would be under a haematology team to deal with his blood-clotting problems but he died shortly after arriving there on May 12th.
Cross examined by Damien Tansey, solicitor for the Briody family, Dr McGrath said: "It's very possible the ulcer was there in January." He said he had not tested the patient for peptic ulcer disease but that was "part of the plan" when he would return to outpatients.
Mr McGrath confirmed to Mr Tansey that he dictated a letter to the medical records department, which was typed on May 28th, saying he was concerned Mr Briody had attended A&E twice in January and while on both occasions it was recommended he attend the surgical outpatient department for follow up, his "casualty cards" were not brought to his attention. The letter, read out by Mr Tansey, ruled inadmissible by deputy coroner Maria Colbert, said that as a result of him not getting these cards the man "remained untreated for a period of time" and had now been admitted as an emergency.
"Clearly our system has fallen down in relation to this gentleman and I am anxious to ensure this experience is not repeated," the letter continued.
The coroner said it seemed like "a crisis situation in May" in relation to the man's condition and it couldn't have developed overnight.