Inquest told how patient refused to eat

A MAN who refused all forms of feeding during a lengthy stay in hospital died in part from malnutrition, an inquest heard yesterday.

James Cullen, 53, with an address at St Vincent’s Hostel on Anglesea Street, Cork, was fully aware of the consequences of his decision not to eat, Cork Coroner’s Court was told.

Mr Cullen was admitted to the Mercy University Hospital on July 5, 2007 complaining of anorexia, weight loss and dizziness. He died peacefully on August 20, weighing just 32kg.

The inquest heard that Mr Cullen had a range of health problems, including hernia, inflammation of the oesophagus, and a lung infection which all combined to make him feel miserable, and unwilling to eat.

A medical expert was assigned to encourage him to eat and several psychiatric consultations were arranged to ensure there was no underlying mental problem causing his physical illness.

Consultant psychiatrist Dr Jim Cooney, the clinical director of St Michael’s psychiatric unit attached to the hospital, assessed him on three occasions and ruled out any underlying mental condition.

“There was no element of confusion or dementia. He had the capacity to make decisions about his own health care,” said Dr Cooney.

Consultant gastroenterologist Dr Martin Buckley said Mr Cullen was at times begged by hospital staff to eat and that from time to time, he would eat tiny morsels of his hospital meals. But he said his patient pulled out several nasal and gastro feeding tubes and eventually refused to allow doctors to intervene in his feeding regime.

“He was extremely pleasant to deal with,” said Dr Buckley. “But we would put a tube down and he just pulled it out. He did not like the sound of the other treatments.

“He was aware of the implications of not eating, and he understood he really should eat. But he had a simplistic view. He just did not want to eat.”

Dr Buckley ruled out deliberate self-neglect. “He just felt miserable and did not want to eat,” he said.

But he said he would have expected Mr Cullen to survive if he had had adequate nutrition. A postmortem revealed death was due to bronchial pneumonia on a background of malnutrition, with significant lung disease.

Coroner Dr Myra Cullinane recorded a verdict of death due to natural causes.

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