Medical misadventure cause of young mum's tragic death

The West Galway Coroner has issued a finding of medical misadventure in relation to the death of a patient who did not receive antiobiotics for 36 hours after developing an infection following a routine cyst removal operation at the Galway Clinic. An inquest was held yesterday into the death of Saundra O’Connor (42), of Gardenhan, Claregalway, who fell into a coma and was left in a semi-vegetative state after suffering severe multiple organ failure following a laparoscopy at the Galway Clinic in Doughiska on January 25, 2005.The mother-of-two, who ran a beauticians salon in Claregalway, died on February 19, 2008 at University Hospital Galway, where she was cared for round-the-clock since the operation at the clinic.The cause of death was recorded as bronchial pneumonia due to post operative Streptococcal A infection, which caused sceptic shock and in turn led to cardiac arrest, multiple organ failure and brain injury.Coroner Dr Ciarán MacLoughlin declared Mrs O’Connor’s death a case of medical misadventure.Her husband, Martin O’Connor, reached a €580,000 settlement in the High Court with the Galway Clinic and consultant gynaecologist Dr Andrea Hermann last year when he sued for wrongful death. The parties had denied medical negligence.However at the inquest in Galway, Dr Hermann said she “fully accepted” that Mrs O’Connor should have received antibiotic treatment sooner than she did.“Earlier implementation of antibiotics would have been better and would have led to a better outcome . . . if I would have any opportunity to turn this clock back, by God I would,” she said under cross examination by the barrister for the family, Maura McNally.The inquest was told Mrs O’Connor attended her GP, complaining of a dragging sensation on her left side and suffering from day flushes and night sweats. Dr Joan Davern referred her to Dr Hermann, who diagnosed polycystic ovarian syndrome and scheduled the keyhole investigative procedure called laparoscopy for January 25, 2005. She performed a diathermy, which involves lasering a cyst. After the day procedure, Mrs O’Connor complained of nausea and had a high temperature so she was detained overnight.The nursing notes stated that Mrs O’Connor suffered from abdominal pain, was not responding to pain killers, had bouts of vomiting and recorded a temperature of 39 (102) degrees. Dr Hermann told the inquest she believed her patient was suffering from the flu and did not recommend antibiotics. Dr Hermann did not consider the possibility of an infection as the patient had a bowel movement. After failing to answer her phone for 45 minutes, the consultant returned to the hospital at 4am on January 28 when the patient’s condition had further deteriorated and she decided to perform a second laparoscopy. When two litres of brown fluid was discovered inside the peritoneum cavity, Dr Hermann called consultant general surgeon Dr William Joyce to assist. He believed there may have been a perforation or tear of the bowel wall so he performed a laparotomy, but found no evidence of tears.Culture tests taken from the tissue found the presence of the bacteria Streptococcal A. Doctors then treated her with extremely strong antibiotics but the infection produced toxins that caused her organs to fail, including the heart, kidneys, lungs and finally the brain. She had a heart attack and was transferred to the intensive care unit of the Galway Clinic. Medics used the defibrillator 18 times over 45 minutes. When she was stabilised, she was transferred to the University Hospital Galway where tests revealed she had sustained a devastating neurological injury. While in a “near persistent vegetative state” and with the help of a ventilator, she was cared for at the hospital for three years until she passed away.Dr Hermann said she had three other patients who suffered from nausea and a high temperature that day after similar procedures so was not overly concerned at Mrs O’Connor’s condition.When it was put to her that there was no indication on the nurses notes that there had been a bowel movement, Dr Hermann said it was likely she got this information from the patient.She told the inquest that Streptococcal A septicaemia was “exceptionally rare”.“Most probably anyone who is coming in contact with a patient with this particular disease is finding it difficult to figure it out,” the German native said.However, Dr Joyce in his evidence said he saw this infection “all too infrequently”. “It’s not rare. Certainly over the last 20-30 years it has become more common, probably because of the overuse of antibiotics,” he stated.When asked what his assessment would be if a patient had undergone an abdominal procedure and developed a temperature of 102, Dr Joyce replied: “Obviously sepsis would be the initial thought process”. To confirm this diagnosis tests such as a white cell count could be conducted, which would take just 40 minutes to get results.When Dr Hermann expressed her condolences to the family of Mrs O’Connor, three of her sisters shook their heads.Outside the inquest, solicitor for the family Roger Murray said they were very pleased with the verdict of medical misadventure and would be happy to cooperate with the Medical Council should they wish to initiate an investigation. A solicitor for the CEO of the Medical Council attended the proceedings and maintained a watching brief.Dr Hermann was suspended late last year by the Galway Clinic over concerns about patient outcomes in a number of cases. Dr Hermann sought an interlocutory injunction in the High Court last November against the hospital to stop it withdrawing her rights to practice at the clinic.The mother of two girls, Sarah (17) and Lauren (13), Mrs O’Connor was well known from her time working behind the Clarins cosmetic counter in Brown Thomas, before she set up her own salon in Claregalway.