An inquest has heard claims that medical staff at the one of the country’s largest private hospitals missed several opportunities to diagnose a cancerous tumour when taking MRI scans of a patient who died four months later.
Bridget McKeown (68), a mother of three from Balbriggan, Co Dublin died at a nursing home in Swords on September 30th, 2019 after her family had discharged her from the Beacon Hospital in Sandyford, Dublin on May 14th, 2019.
Ms McKeown’s family had removed her from the Beacon against medical advice but claiming it was for concerns over her safety and the treatment she had received there over 19 days.
The inquest heard that she had a cancerous tumour that had not been captured on a number of MRI scans carried out by Beacon staff on her spine.
At an earlier hearing of the inquest of Ms McKeown’s death last October, her son, Micheal McKeown, gave evidence that she had been brought to the Beacon because her family was concerned about the treatment she had received earlier at Beaumont Hospital in Dublin.
The inquest heard they had moved her to the Beacon because they were worried doctors at Beaumont had missed something as she was still suffering pain after having been treated for gallbladder stones.
Evidence
It also heard evidence that a consultant surgeon, Reza Kalbassi, who examined Ms McKeown on admission at the Beacon, had asked for the patient to be reviewed by the hospital’s consultant neurologist, Jennifer Dineen, as her condition was not improving.
Dr Kalbassi said he expected that Ms McKeown would be seen within 24 hours but it was five days before she was examined by Dr Dineen as no other consultant neurologist was available.
A consultant oncologist at Beaumont Hospital who treated Ms McKeown after she had been discharged by her family at the Beacon, Liam Grogan, said he believed the spinal cord compression she suffered as a result of the cancerous tumour was “a significant factor in her early demise.”
Coroner, Cróna Gallagher subsequently adjourned the inquest to gather further information from staff at the Beacon in relation to its care of the patient.
At a resumed hearing at Dublin District Coroner’s Court on Tuesday, Dr Dineen said she had reviewed an MRI scan of Ms McKeown’s spine on May 14th, 2019 and was satisfied there were “no red flags".
Dr Dineen, who now works at the Consultants Private Clinic at Cork University Hospital, said she had ordered another MRI scan but that Ms McKeown had been discharged by her family before it could take place.
Asked why it had taken five days to see the patient after she had first been contacted by Dr Kalbassi about reviewing Ms McKeown, Dr Dineen said she was the only neurologist attached to the Beacon and the hospital had no provision for an on-call service.
She explained she was on leave for two days, followed by a weekend, while she was attending a clinic all day on the day before she examined the patient.
Dr Dineen stressed that she had not been given any information to suggest there was an urgent need to see Ms McKeown as there was no evidence from scans that she was suffering compression of her spinal cord.
The inquest heard that Ms McKeown was in severe pain and could not move her legs but had no sensory loss when examined by Dr Dineen.
The consultant said she believed the most likely cause of the patient’ condition was a spinal cord compression.
She told the coroner that she decided to order another MRI scan of the patient’s spine as Ms McKeown’s family were unhappy.
In reply to repeated questions from the coroner about whether she was aware that earlier scans had not captured all of Ms McKeown’s spine, Dr Dineen initially said she could not recall.
She subsequently said that a nurse had told her that a scan had covered the first five vertebrae of the middle section of the patient’s spine but that nobody had highlighted that the various scans had not covered all of Ms McKeown’s spine.
Dr Dineen said the important thing was that she had decided that the best thing to do was to order another scan of the full spine.
She added: “I am a careful clinician no matter what anyone else here might think.”
Dr Dineen said she would never have been consulted if full scans of the patient’s spine had been carried out at the outset.
However, she agreed that Ms McKeown’s loss of mobility would have been due to the tumour on her spine.
Cross-examined by Mr McKeown, Dr Dineen acknowledged that the Beacon had no arrangement for providing access to a neurologist when she was unavailable.
Asked if things were very different in terms of support where she was now working, Dr Dineen replied: “Yes.” She added that it was a factor in her decision to move to Cork.
Dr Dineen said only having one neurologist in the Beacon when it had an emergency department was “not ideal.” She also remarked that her meeting with the deceased’s relatives had been “an extremely hostile situation.”
“You were extremely angry with me before I said one word,” she told Mr McKeown.
Coding system for MRI scans
The inquest also heard evidence that a coding system used to order MRI scans created the potential for a mismatch between what type of scan was ordered and carried out.
A consultant radiologist at the Beacon who reviewed the patient’s scans, Mary O’Malley, accepted that five lower vertebrae in the middle part of Ms McKeown’s spine were never the subject of an MRI scan.
However, Dr O’Malley stated: “I was happy I was covering the area I was supposed to be covering.”
She also noted that only the consultant who ordered an MRI scan could vary the area of the spine to be examined.
The inquest heard changes to how scans were ordered and performed had been made at the Beacon as a result of what happened in Ms McKeown’s case.
Dr Gallagher adjourned the hearing until a date to be fixed in the near future.
Mr McKeown expressed concern that the inquest had still not been completed some 45 months after his mother’s death, particularly as a separate but related inquiry by the Irish Medical Council had been put on hold pending the outcome of the inquest.
However, Dr Gallagher said she had no control over the IMC’s procedures.
