Obstetrician caring for Marie Downey regrets oversight in not discussing epilepsy, inquest hears

Professor Keelin O’Donoghue told the inquest that she made an assumption that Marie's neurologist, Dr Peter Kinirons, knew his patient was pregnant.
Obstetrician caring for Marie Downey regrets oversight in not discussing epilepsy, inquest hears

Marie Downey and her baby son Darragh

The obstetrician who was caring for Marie Downey, and who found her dead in her hospital room with her newborn trapped beneath her, said she regrets not writing to her patient’s treating neurologist to discuss her epilepsy during her pregnancy.

Professor Keelin O’Donoghue, a consultant obstetrician at Cork University Maternity Hospital (CUMH), described it as an oversight on her part that she now sincerely regrets.

She made her comments during several hours of questioning today by the Downey family’s legal representative, Doireann O’Mahony, junior counsel, on the second day of the joint inquest into the deaths of Ms Downey, 36, from Knockanevin near Kildorrery in North Cork, on March 25, 2019, and her newborn baby, Darragh, the following day, both at CUMH.

Ms Downey’s husband, Kieran, previously told the inquest that he believes his wife and son would still be alive if guidelines on the care of pregnant women with epilepsy were followed, and if there was better communication between her treating doctors, and other medical staff.

Kieran Downey, husband of the late Marie Downey pictured at Cork city Coroners Court. Picture: Cork Courts Limited
Kieran Downey, husband of the late Marie Downey pictured at Cork city Coroners Court. Picture: Cork Courts Limited

Prof O’Donoghue told Cork City Coroner Philip Comyn that she had cared for Ms Downey as a private patient during her two previous pregnancies in 2014 and 2016.

She said she was aware of Ms Downey’s history of epilepsy, and was aware at her booking appointment early in her third pregnancy, with Darragh, in mid-2018, that she had an appointment to see her neurologist, Dr Peter Kinirons, at the Bon Secours Hospital the following January — an appointment Ms Downey subsequently postponed for six months because of a close relative's serious illness.

But she told the inquest that she made an assumption that Dr Kinirons knew his patient was pregnant, and she did not write to him to inform him that she was caring for his patient through the third pregnancy.

“It was an oversight on my part not writing to Mr Kinirons", said Prof O’Donoghue.

I regret that I didn’t write to him at that time. It is an oversight I regret.

“I made assumptions that she was continuing with the same pathway of care. I made assumptions that would all continue, and I should have written to him.” 

She said she was shocked later to discover that Dr Kinirons had not been aware of Ms Downey’s pregnancy.

Prof O’Donoghue also said how, during Ms Downey’s first pregnancy, she consulted with Cork University Hospital’s (CUH) in-house neurology experts after Ms Downey suffered a seizure at 30 weeks — when she was not taking her anticonvulsant medication, Lamictal, at the time.

CUH’s neurology team referred Ms Downey back to her own neurologist, following which she resumed taking her medication, and remained on it during her next two pregnancies.

Earlier, the inquest heard distressing evidence about how Darragh suffered a massive and irreversible brain injury after his mother suffered an epileptic seizure, possibly while breastfeeding, and was found partially out of her bed with her baby trapped on the floor underneath her.

The inquest was told that Darragh was delivered at CUMH at 4.18pm on Friday, March 22, 2019, following an uncomplicated pregnancy, and was a healthy baby boy.

Cork University Maternity Hospital. Picture: Denis Minihane.
Cork University Maternity Hospital. Picture: Denis Minihane.

While Ms Downey suffered a significant postpartum haemorrhage, she recovered and spent the weekend in a private single-bed room in CUMH’s postnatal ward.

The alarm was raised around 8am on Monday, March 25, 2019, when Ms Downey was found partially out of her bed, in a contorted position with her lower legs still on the bed, with Darragh trapped under her torso.

The inquest was told that Ms Downey’s right breast was exposed and doctors believed that she may have been breastfeeding when she suffered a sudden onset seizure.

In her statement, Prof O’Donoghue said she found Ms Downey half out of the bed, with her legs still on the bed and her upper body on the floor.

“She was in an unnatural position, with her neck twisted up and to the left, facing the door, up against the corner of the bathroom door and wall,” she said.

“Her face was very suffused and purple in colour, her neck and body were pale, and her legs were pale and white.

I quickly moved over to Ms Downey and felt her neck for a pulse. Her face was suffused and cold. Her eyes were staring, and there was blood around her mouth.”

She said she raised the alarm and several doctors and midwives rushed to the room.

They rechecked for a pulse and confirmed there was none, and they agreed that all emergency medical response should now focus on Darragh, who was recovered “cold and unresponsive” from under his mother’s body.

In her statement, which was read into the record, Dr Hannah Glynn, a junior obstetrics registrar, said as she rushed towards Ms Downey’s room, she passed midwives running towards the neonatal nursery resuscitation room, carrying baby Darragh, and heard one of them say: "I think this baby is gone, and the mother is too".

Prof O’Donoghue pronounced Ms Downey dead at 8.20am.

Consultant neonatologist, Dr Brian Murphy, told the inquest how neonatal doctors began intensive resuscitation efforts on Darragh, including breathing supports, intubation, administration of adrenaline and fluids, and cardiac compressions.

He said a heartbeat was first detected 20 minutes into the resuscitation, but it was just 60 beats per minute — a very low rate — followed by the detection of a weak pulse.

He said Darragh’s heart rate increased to about 136 beats per minute a few minutes later, and he was transferred to the neonatal intensive care unit.

But he said Darragh did not respond to stimuli, there was no spontaneous movement, there was minimal electrical activity in the brain, and at no stage did medical staff see any sustained respiratory effort.

He said Darragh had “an occasional gasp on the ventilator”, but there were no signs of life.

Dr Murphy said by the Tuesday morning, March 26, it was clear that Darragh had been starved of oxygen while trapped under his mother’s body, and had suffered a severe and irreversible brain injury.

He said ongoing intensive care support was futile, and not in Darragh’s best interests and, following consultation with medical colleagues and the Downey family that morning, a decision was taken to withdraw intensive care supports.

“From the moment I met him that morning, I knew the prognosis was bleak,” said Dr Murphy.

I felt it was unlikely he would survive, but I wanted to be absolutely certain for myself, and more importantly for Darragh and his family, that we gave him every chance of recovery.” 

Darragh was brought in a cot to a family room to be with his father and brothers before intensive care support was withdrawn at 4.27pm. Dr Murphy pronounced death at 5pm.

An independent review into the deaths has already found that the care delivered to Ms Downey during her pregnancy and in the postpartum period was not in line with HSE guidelines on the ‘management of women with epilepsy'.

All but its 11 recommendations have been ruled inadmissible by the coroner.

CUMH has previously apologised to the Downey family for the deaths of Ms Downey and Darragh while in its care.

The inquest, which has run late into the evening over the last two days, is set to continue before a jury of four men and three women again tomorrow.

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