Paralysed clot victim chose to die, inquest told

A man left paralysed and on a ventilator from a blood clot on his spine opted to die rather than suffer further pain, an inquest heard today.

Dublin City Coroner’s Court heard how Ronald Lindsey had a voice box attached so he could his explain his decision to his family, before asking doctors to switch off his ventilator knowing it would end his life.

The inquest was told the 61-year-old, who waited 96 hours for surgery, suffered from a condition recorded in just 300 patients worldwide which was fatal if not treated in 12 hours.

He had complained of severe abdominal pain for two days prior to arriving at the accident and emergency department of St James Hospital on the evening of March 4, 2005.

But due to delays in diagnosis, as he had been suffering from acute kidney infection on admission, and the severity of his condition he did not undergo surgery for four days.

The inquest was told that Mr Lindsey, with an address at Iveagh Trust Hostel, Bride Street, Dublin 8, was Warfarin dependant, but due to his social arrangements did not control his medication properly and had missed a string of medical appointments.

“The chance of having this clotting is rare,” said Dr Bernard Silke consultant physician at St James’ Hospital. “I have never seen a case like this before. The chances of any physician seeing a case like this is extremely rare. It is possible he was bleeding for two days before he came to hospital.”

After arriving at the hospital, Mr Lindsey was not seen by medics until 5.20am the following morning and was left on a trolley until a bed was found on Sunday afternoon.

By the next day nursing staff reported a deterioration and paralysis in the lower body, not consistent with a kidney infection, but by the time a MRI scan was requested the department concerned was closed for the night.

Dr Silke said a call was made to Beaumont hospital for an emergency MRI, but senior staff, while not refusing a scan, decided it would be of no value given the patient’s poor prognosis.

A MRI scan was performed in St James the next morning, confirming bleeding on the spine, and the spinal unit at the Mater Hospital agreed to perform emergency surgery.

However, in the following days Mr Lindsey suffered respiratory failure and back at St James’ attempts to wean the patient – who had bronchitis – off a ventilator failed.

On April 22, when told the prognosis that he would remain paralysed and on a ventilator, Mr Lindsey chose to have the ventilator turned off. He died later that day.

Dr Silke said end of life issues are extremely distressful for everybody, not alone for the family, adding his patient had been a courageous man.

It was protocol in the hospital for three senior consultants and a patient to agree on ending a life, while Mr Lindsey saw a psychiatrist in the Mater Hospital.

Dr Silke believed the patient was fully aware and competent at the time.

Mr Lindsey was fitted with a voicebox so he could explain his decision to his sisters Winifred Leonard and Olive Cummins.

In a statement, Ms Cummins said her brother was in a lot of pain when doctors gave him the gloomy prognosis that he would be paralysed and have to stay on a ventilator.

“He grabbed my hand so tight it hurt and said he could not take the pain any longer,” she said.

“He was in terrible pain and very agitated.

“I believe my brother was capable of making a decision at that time to come off the ventilator.”

Barrister Thomas Fallon, representing the family, questioned why a patient should be allowed to come to such a decision when in severe pain and asked for the hospital’s code on such a procedure and the records relating Mr Lindsey’s decision be made available to him and the court.

Beaumont Hospital, who had no legal representation at the inquest, will also be contacted regarding claims made at the inquest.

Dublin City Coroner Dr Brian Farrell adjourned the hearing.