Lack of scan delayed surgery, inquest hears

DOCTORS could not operate on a man requiring urgent surgery as there was no out-of-hours scan facility at the hospital, an inquest has heard.

Gerard Hayes, aged 38, of Rusheen, Holycross, Bruff, Co Limerick, was admitted to Mallow General Hospital’s Emergency Department with abdominal pain at 4.10am on October 8, 2009.

He had been discharged home from Limerick Regional Hospital the previous day.

Dublin County Coroner’s Court heard that upon examination his abdomen was rigid all over.

Surgeon Mr Fuad Aftab was contacted by phone and they planned to operate at 8am.

A CT scan was necessary prior to surgery, which could not be carried out until 9am as there is no personnel at the hospital to operate the scanner during the night even in emergency situations.

The scan was then sent to the Mercy University Hospital in Cork to be read by a radiologist, a situation which has since changed as there is now a radiologist with expertise in reading CT scans.

The scan showed severe inflammation and a hole in his bowel and Mr Hayes underwent surgery around 2.30pm that day.

During surgery, Mr Aftab found 1.5-2 litres of pus all around Mr Hayes’s abdomen with severe inflammation of the colon.

Asked by counsel for the Hayes family, Paul McMorrow BL whether the amount of pus “concerned him”, Mr Aftab said it did.

“It put something in my mind the process was going on for some time,” he said, in his opinion for about 24 hours.

A colostomy was carried out.

Asked by the coroner Dr Kieran Geraghty if Mr Hayes went on to develop generalised sepsis (infection) and renal failure because he was “too far gone when he operated on him”, Mr Aftab said that was the most likely explanation.

The inquest heard Mr Hayes, who was morbidly obese with a body mass index of 40, was discharged home from Limerick Regional Hospital the previous day with a diagnosis of diverticulitis; a condition where pouches form in the wall of the colon and then get inflamed or infected, after spending a night on a trolley on a corridor.

He was prescribed antibiotics to treat the condition.

Dr Syed Altaf Naqvi, who discharged Mr Hayes, said the 38-year-old’s abdomen was soft and not tender and that he was mobile and denied pain.

He said if there was rigidity and rebound tenderness he would have kept him in.

He advised Mr Hayes to return to the hospital if there was any problem.

Mr Hayes died on October 11. A postmortem found Mr Hayes, who was also a heavy smoker, died due to damage to his lungs, as a consequence of massive infection due to abscesses in his abdomen.

This followed surgery for perforated diverticulitis. Obesity was a contributory cause.

Coroner Dr Kieran Geraghty recorded a verdict of death due to natural causes.