Cork mother honoured for her global patient safety crusade 

A mother who became a fearless patient advocate following her son’s needless death more than 20 years ago has been honoured by University College Cork (UCC) for improving patient safety and healthcare systems around the world.
Cork mother honoured for her global patient safety crusade 

Patient advocate Dr Margaret Murphy pictured with her husband Barry after she was awarded an honorary doctorate at University College Cork (UCC). Barry was diagnosed with the same condition that killed their son Kevin three months after his death and successfully underwent treatment. Photo: Daragh Mc Sweeney/Provision

A mother who became a fearless patient advocate following her son’s needless death more than 20 years ago has been honoured by University College Cork (UCC) for improving patient safety and healthcare systems around the world.

Dr Margaret Murphy, whose son, Kevin, died in 1999, aged 21, from a treatable condition following a series of medical oversights and blunders, said while much progress has been made, much more needs to be done. "The pace of change is very disappointing. It is far too slow for people like me," she said.

But I have come across some amazing people in healthcare.

She was speaking as UCC awarded her an honorary doctorate in medicine yesterday. She described it as a bittersweet honour, saying: "I came to all this advocacy work because of the needless death of Kevin.

"What makes today very special is the people here in UCC have shown great vision - to allow people like me to come in and speak to the undergraduate medical students.

"For for us, that is hugely important because it makes you feel that you are part of the formation process of the future healthcare providers. It’s good to have the opportunity to help shape them and of course it’s also honouring Kevin."

"Margaret is a truly extraordinary person." (Left to right) Patient advocate Dr Margaret Murphy, Dr Jean van Sinderen-Law and Professor Helen Whelton after Dr Murphy was awarded an honorary doctorate at University College Cork (UCC). Photo: Daragh Mc Sweeney/Provision
"Margaret is a truly extraordinary person." (Left to right) Patient advocate Dr Margaret Murphy, Dr Jean van Sinderen-Law and Professor Helen Whelton after Dr Murphy was awarded an honorary doctorate at University College Cork (UCC). Photo: Daragh Mc Sweeney/Provision

Kevin had hypercalcemia - too much calcium in the blood - a treatable condition once diagnosed early. But following a litany of professional and system failures, vital test results were missed and standard procedures for treating the condition were never implemented.

He died in 1999, aged just 21. Poignantly, his father, Barry, was diagnosed with the same condition three months after his death and successfully underwent treatment. Since then, Margaret has worked tirelessly with healthcare professionals on disclosure and the creation of a no-blame culture in the medical profession.

She has represented Ireland in the World Health Organisation's Patients for Patients Safety initiative, and has given talks around the world. "I use Kevin’s patient journey to highlight the errors. Kevin is fondly known and spoken of by people in so many countries," she said.

"And my call is for care that is delivered with head, with heart, with hand, and with knowledge, compassion and with skill."

She described Kevin as a "scamp" who bucked authority. "But he found his mum pulling on the reins quite repressive but more than anything else he was my beautiful boy," she said.

"He was handsome, he was strong, he was carefree.

"I remember one of his own friends saying that Kevin was going to be very good at something but we will never know now, and another friend piped up and said 'what’s the matter with you - he was very good at being a friend'.

"Could you say anything better about somebody than they are being very good at being a friend?"

UCC President, Professor John O’Halloran, said Dr Murphy has made an extraordinary contribution to the field of patient safety and healthcare quality improvement, describing her as an "incredibly positive force for change" while being understanding of the real challenges faced by clinicians.

Professor John O’Halloran, President of UCC and patient advocate Dr Margaret Murphy pictured in UCC where she was awarded an honorary doctorate. She is an "incredibly positive force for change". Photo: Daragh Mc Sweeney/Provision
Professor John O’Halloran, President of UCC and patient advocate Dr Margaret Murphy pictured in UCC where she was awarded an honorary doctorate. She is an "incredibly positive force for change". Photo: Daragh Mc Sweeney/Provision

“Her powerful personal testimony as to the series of events that led up to and followed on after Kevin’s tragic death, has had direct personal impact on many healthcare students and professionals worldwide,” he said.

UCC’s head of student health, Dr Michael Byrne, who delivered the encomium for Dr Murphy said she has had an extraordinary impact around the world - making healthcare a safer place for us all. Speaking afterwards, the head of UCC’s College of Medicine and Health, the ceremony Professor Helen Whelton, paid tribute to Ms Murphy.

"To lose a child is any parent’s nightmare. Margaret is a truly extraordinary person in the way she has applied the nightmare of the loss of her lovely son Kevin to transforming the culture in our health care settings,” she said.

“She has tirelessly and effectively promoted open disclosure and learning from our mistakes. I am delighted to see her honoured for her contribution to the quality culture in our health services."

Almost 4,700 students will be conferred at UCC during the month of November.

How what happened to Cork's Kevin Murphy helped improve healthcare globally

Kevin Murphy's patient journey has been used to help train medics and improve healthcare systems across the world over the last two decades.

Kevin, from Montenotte in Cork, was 19 in 1997 when he complained of persistent back pain. He was referred to an orthopaedic consultant and blood tests revealed high levels of calcium.

But the results were underplayed and the consultant's intention to see Kevin again in the New Year was never conveyed to Kevin. Kevin's symptoms persisted and he had repeated consultations with his GP and others over the next year-and-a-half.

After spending the summer of 1999 in the US, he returned to his GP complaining of lethargy, occasional vomiting and continuing bone pain. Blood and urine samples were taken again and the practice nurse wrote the results on a post-it note, drawing attention to the now seriously high calcium levels.

Kevin was admitted to Cork's Mercy Hospital on September 23, 1999, but his GP’s referral letter focused only on test results which supported his own diagnosis of leptospirosis.

"He was handsome, he was strong, he was carefree." The late Kevin Murphy
"He was handsome, he was strong, he was carefree." The late Kevin Murphy

When Kevin’s medical file was being compiled in the hospital, the post-it note with the vital calcium results was attached to the referral letter, but it wasn’t seen until six weeks after Kevin's death. It later emerged that the standard blood test in the hospital at the time did not include testing for calcium levels.

Doctors remained unaware of Kevin's dangerously high calcium levels and he was misdiagnosed with nephritis. His condition deteriorated further and he was transferred to Cork University Hospital on September 25, where he was treated at registrar, not consultant, level.

He died of cardiac arrest there the following day. At the time of death, the level of calcium in his blood was higher than any ever recorded at CUH.

His family subsequently took legal action against two consultants, two GPs and the Mercy hospital arising from the failure to diagnose and treat Kevin’s underlying severe hypercalcaemia. In 2004, they were awarded €76,000[/url and donated the money to two charities.

They said the legal action was never about money but was taken to rectify the "grave injustice" done to Kevin and to prevent such a situation occurring again.

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