A 79-year-old man with dementia who was transferred to University Hospital Limerick (UHL) for treatment got food lodged in his larynx and choked to death, an inquest has heard.
A sitting of the Coroner’s Court in Kilmallock, Co Limerick, heard that Liam Geehan died of asphyxiation, secondary to choking, with a background of comorbidities.
It had been determined at a postmortem in UHL that his larynx had become obstructed by food. However, consultant pathologist Dr Teresa Laszlo found there was minimal fluid and no solid food in the stomach of the deceased.
The pensioner was a fondly remembered long-time patient of Killeline Nursing Home in Newcastle West. His brother John said that Liam had left his home after experiencing “several robberies”.
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Mr Geehan was without teeth, with his transfer notes from the nursing home detailing that he liked to have his food cut up.
He was taken by ambulance to UHL on May 24th, 2023 after his condition deteriorated at the nursing home.
Paramedic Ashley O’Brien said he had signs of infection, “possibly sepsis”, and was “agitated and confused” on the journey to hospital. He arrived at the hospital at 4.16pm.
Mr Geehan was triaged and later seen by various medics and his condition appeared to stabilise. Medical staff were of the opinion that he could be transferred to a step-down facility for further treatment.
He remained on a trolley and at around 12.30pm the following day a member of the nursing team, Shirine Vargassey, found him “unresponsive”.
The pensioner, who also had, among other conditions, Parkinson’s disease, heart disease and type 2 diabetes, was on a trolley in the emergency department.
Ms Vargassey said that Mr Geehan had “suddenly collapsed”. Damien Tansey, SC for Mr Geehan’s family, put it to her that the choking incident occurred around lunchtime. However, Ms Vargassey said she didn’t recall seeing any food in the area around the patient.
She also stated that she didn’t put Mr Geehan up in the sitting position for lunch and nor did she see him eat.
Ms Vargassey said that oxygen was administered and the patient was handed over to the resuscitation staff. Despite the best efforts of the medical team, he was pronounced dead at 12.46pm on May 25th, 2023.
Consultant geriatrician, Dr Catherine Peters, who had seen Mr Geehan earlier that morning, said his sudden death was a source of surprise to her.
Mr Geehan had been sitting on a chair beside a trolley when she engaged with him. He was showing signs of considerable improvement and had been deemed suitable for transfer to a step-down facility.
Dr Peters was informed of the death at 1.30pm and returned to the emergency department, where she was told that Mr Geehan had become “unresponsive while eating”.
Dr Peters said that as “Mr Geehan became unresponsive around the time of eating” she “wasn’t happy to sign off on a cause of death”. Dr Peters contacted the coroner about the sudden death of the pensioner.
In his closing speech Mr Tansey said that John Geehan, a brother of the deceased, had become “greatly troubled” when he learned that Liam had choked in hospital, having initially been told that he had died of a heart attack.
He expressed concern that an investigation wasn’t launched in the aftermath of the choking incident. Mr Tansey said it gave the impression that “old people are expendable”.
Mr Tansey also said he found it extraordinary that the airways of Mr Geehan were not checked when he became unresponsive.
“In the abstract could there be a better place [to experience a choking incident] than in a casualty department in a centre of excellence?” he asked.
He called on the coroner to return a verdict of misadventure.
Meanwhile, Luan Ó Braonáin, SC for UHL, said it was “very wrong” of Mr Tansey to suggest that the hospital took a different approach to the death of an elderly person as opposed to that of a younger patient.
He insisted the matter was treated very seriously.
He said it was unfair to in any way criticise hospital staff who didn’t personally recall their interactions with Mr Geehan.
He said that emergency department staff are professionals doing their very best for patients in a “high-volume department.”
He added that it was an “unusual case” as while there was no doubt there was food in the larynx it was “not clear from whence it came”.
Mr Ó Braonáin offered his heartfelt condolences to the family of the deceased.
Limerick coroner John McNamara recorded a narrative verdict in the case.
He said it was a “difficult day” for all parties involved and offered his sincere condolences to the family of a “very liked and respected gentleman”.
Mr Geehan was late of Castletown Conner’s, Ballyagran, Limerick.
