Verdict of medical misadventure recorded at inquest into Cork man’s death

John Bray suffered fatal internal bleeding following a liver biopsy, the inquest heard

A verdict of medical misadventure was recorded in the death of John Bray, 52, in St Vincent’s University Hospital in Dublin on March 31, 2023. Picture: RIP.ie

A Cork man suffered fatal internal bleeding from a liver biopsy that was performed to help doctors to diagnose a condition which had baffled them for several months, an inquest has heard.

A verdict of medical misadventure was recorded in the death of John Bray, 52 — a father of three from Coolroe Meadows, Ballincollig, Cork — in St Vincent’s University Hospital in Dublin on March 31, 2023.

Dublin District Coroner’s Court heard that Mr Bray, a software engineer with IBM, died after suffering multi-organ failure.

The inquest heard the exact cause of the illness that had affected Mr Bray for several months was only discovered through the results of an autopsy.

Pathologist Niamh Nolan said the autopsy showed that the deceased had suffered intra-abdominal bleeding which she concluded was linked to a liver biopsy.

Background to illness

She said the background to Mr Bray’s illness was pulmonary hepatic failure (a condition affecting the lungs of people with advanced liver disease) due to histiocytosis (a rare blood disorder).

The pathologist said it was likely that the deceased had developed a rare type of histiocytosis known as Erdheim-Chester disease.

The deceased’s partner, Majella Connolly, told the inquest that he had first become unwell in June 2022 when he suddenly appeared jaundiced.

The inquest heard that Mr Bray had been referred to a consultant hepatologist at the Bon Secours Hospital in Cork, Diarmaid Houlihan, because doctors were concerned that he had some “unusual and challenging” condition as there was no obvious cause for his jaundice.

Prof Houlihan said the patient had appeared generally well apart from feeling itchiness on his skin until February 2023. 

Prof Houlihan said Mr Bray, at that point, became “very sick, very quickly”. He was unwell and feverish, while his jaundice had deepened significantly. He was admitted to hospital in Cork on February 15, 2023, before being transferred five days later to St Vincent’s in Dublin.

In reply to questions from the coroner, he said he could not guess how Mr Bray might have responded to treatment if he had been diagnosed with Erdheim-Chester disease earlier. The inquest heard that although the condition is incurable, treatments are available.

A consultant radiologist at St Vincent’s, Gerard Healy, said Mr Bray was settled following the biopsy and had shown no signs of any bleeding or pain. 

However, the inquest heard, his vital signs deteriorated several hours later and an urgent procedure was performed after it had been identified that Mr Bray was suffering internal bleeding from his liver.

Dr Healy told the coroner that following the patient’s death, a review had found that the management of his care had been appropriate.

At the conclusion of the oral evidence, solicitor for St Vincent’s, Ciara Deasy, called on the coroner to return a narrative verdict to reflect the complexity of the case and how the cause of Mr Bray’s liver failure was not clear until an autopsy had been carried out.

However, Dr Cróna Gallagher said she would record a verdict of medical misadventure as the evidence showed the patient’s death was linked to the liver biopsy.