The sister of a 51-year-old farmer who died at home five days after having a hip replacement in the Bons Secours hospital in Galway said she believed it could have been a preventable death.
Coroner Eamon MacGowan described the death of Declan Keaveney of Carranree, Skreen, Co Sligo on September 7th 2021 as “a troubling case”.
An inquest at Sligo Coroner’s court heard that on the morning he died, the deceased contacted his brothers after falling in his home. His brother TJ Keaveney said he was lying on the floor of the sitting room when he arrived. He was conscious and talking but was weak. Another brother, Kieran, rang the doctor and dialled 999 but Declan stopped breathing. They did CPR and when paramedics arrived they spent an hour trying in vain to resuscitate his brother before saying there was no point.
Marie Vining, the deceased’s sister who is an advanced nurse practitioner said she believed it was a preventable death.
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“I know Declan enjoyed his life despite a lot of pain over the years but I grieve for the life he had to come,” said Ms Vining. She said she hoped protocols are reviewed and lessons learned from her brother’s death.
Mr MacGowan was told Ms Vining spoke to her brother every day when he was in hospital.
She was concerned when he complained of pain and swelling to his knee three days after surgery because of his history of Deep Vein Thrombosis (DVT) which progressed to a Pulmonary Embolism (PE).
Declan told her that staff were aware of his previous PE and she asked if he was having Clexane injections.
He told her he was on anticoagulation tablets. He was discharged on Monday September 6th and he told her that evening he had an ice pack on his knee.
She was surprised to hear he was on aspirin, considering his previous history of PE, as anticoagulation injections are used in the UK where she worked in a clinic that provided DVT diagnostic and treatment services.
Ms Vining said she was on the phone to her brothers while paramedics were trying to resuscitate Declan. When she heard it was going on for an hour “immediately I knew it was PE and resuscitation was futile”. She spoke to the GP who was there and “we agreed it should stop”.
She was concerned that her brother was discharged with a swollen knee and knee pain .
“I believe if his leg had been scanned it would have identified the clot and circumstances may have been different and he would have been treated with Clexane/Rivaroxaban.”
Ms Vining said she believed consideration should be give to scan lower limbs if pain and swelling are present prior to discharge, especially if a patient had a history of DVT and/or PE.
Professor Stephen Kearns told the coroner he had been treating Mr Keaveney for arthritis since 2007. He previously had “resurfacing” hip surgeries to his right and left side in 2007 and 2008 but in 2021 he experienced significant pain in his right hip, thigh and knee and shortening of his right leg. Professor Kearns said before surgery he went through all the risks with Mr Keaveney including the risk of DVT, pulmonary embolus and other potential orthopaedic complications.
Mr Keaveney’s BMI was 32.3 which the inquest heard would be considered obese, he had history of hypertension and type 2 diabetes. He was also a smoker.
The surgery lasted for one hour and 20 minutes .
Professor Kearns said he reviewed the patient the following morning and his pain was well controlled, he had some minimal leg swelling and his leg lengths were equal.
When he contacted the ward at 4pm on Monday, he was told Mr Keaveney had been reviewed by an intern and had gone home. The review documented that the leg was swollen but there was no clinical evidence of a DVT.
Professor Kerns told Roger Murray, solicitor for the Keaveney family, that there was no evidence of DVT.
“You cannot say he did not have a DVT either,” said Mr Murray.
The inquest was told that since January 22nd the hospital does provide information to patients alerting them to signs and symptoms of DVT.
Returning a narrative verdict Mr MacGowan found that Mr Keaveney died from a pulmonary embolus following on from a right hip replacement. He recommended that a risk assessment score in writing to measure the risk of PE in a surgical patient should be attached to a patient’s file. He also recommended that when a member of a medical team does a patient review that it should be communicated to the relevant consultant.
Ms Vining said Declan who had taken over the family farm was a “bit of a joker” and a much loved member of the community for whom nothing was ever too much trouble.
She said pre-Covid he had loved dancing and couldn’t wait to have the hip operation so he could get back dancing.