A 27-year-old woman from Dublin, known as Katie Doyle, passed away due to a severe pulmonary embolism – a condition where blood clots form in the lungs. This unfortunate event happened shortly after she was released from Beaumont Hospital with an anxiety diagnosis, as was revealed in the Dublin District Coroner’s Court.
This tragic incident occurred on the 4th of January, 2021, a day after Katie suffered a collapse at her Kelly Park home due to the blood clots in her lungs. Contrary to hospital policy, Katie was reportedly not given a D-Dimer test, a crucial procedure used to assess the risk of a pulmonary embolism, when she first came to Beaumont Hospital on New Year’s Eve experiencing difficulty in breathing and palpitations.
Katie’s mother, Susan Doyle, while giving her statement in court, described her daughter as a compassionate and dependable individual who had always been healthy. As her only child, Susan was under the impression that her daughter’s doctors were taking appropriate actions following her discharge on New Year’s Eve with panic attacks.
According to Ms Doyle’s account, Katie expressed fear and anxiety during her final moments on the morning of January 3rd. She had previously confided in her mother about not feeling well on New Year’s Eve, expressing symptoms like shortness of breath and unusually strong heartbeats. Subsequently, Katie was referred to Beaumont Hospital by her GP, Dr Fergus Murray, who highlighted that her heart was beating at 120 beats per minute and that she had been experiencing tachycardia for the previous 24 hours. Katie was seen by Dr Jonathan Oettlé, a senior house officer in Beaumont Hospital’s acute Covid-19 unit, following an initial assessment in the emergency department.
In the courtroom, Dr Oettlé testified that Miss Doyle didn’t have any significant medical or surgical history. Upon first examination, he observed that she was relaxed with a pulse rate of 110. He had computed her Wells’ score, a measure used to assess the likelihood of a pulmonary embolism, as 1.5 due to her rapid pulse, categorising her as a lower risk for pulmonary embolism.
Dr Oettlé also expressed to the court that he saw no evidence of a clotting incident, thus refrained from ordering a D-dimer test. He conceded that the decision involved some element of professional discretion.
Emergency medicine specialist at Beaumont Hospital, Dr. Peadar Gilligan, clarified to the court that a D-dimer test would typically be requested in cases with a low Wells’ score if there were grave health concerns for the patient.
It was clear to Dr Gilligan that Dr Oettlé did not perceive a serious clinical threat.
Dr Oettlé had, in fact, diagnosed Doyle with anxiety. On being queried by Mr Bell if the symptoms aligned with a panic attack considering her continuous 24-hour elevated heart rate, Dr Oettlé replied in the negative.
Nevertheless, the doctor stated that other factors could have caused her increased heart rate, such as the stressful environment of a bustling hospital, causing a “white coat” reaction.
Dr Oettlé also added that a 24-hour span of rapid heartbeat wouldn’t typically suggest a panic attack. He assumed this was the reason why Dr Murray had referred her.
Post an approximately 20-minute consultation, he observed her heart rate reducing to 101. He then provided verbal guidance about managing panic attacks and discussed warning signs, recommending that she should seek assistance if her condition worsened. Subsequently, he discharged her tentatively diagnosing her condition as panic attacks.
Dr Oettlé accepted Mr Bell’s assertion that Miss Doyle was still exhibiting an elevated heart rate upon discharge.
Miss Doyle’s mother testified that her daughter still seemed short of breath when she phoned her after her discharge from Beaumont.
In court, it was revealed that Ms Doyle missed her family’s routine festivities on New Year’s Eve as she felt unwell. On the morning of 3rd January, she collapsed in her house. Hearing a thud from upstairs, her mother ran to see what happened.
“She took a fall and hit the wall,” shared Ms Doyle in court, who explained that her daughter had trouble breathing and appeared as though she was going to have a seizure. The court was informed that post collapse, Doyle had clasped her mum’s hand and her pet’s paw.
Upon Doyle’s instruction, an ambulance was called. On the arrival of the emergency medical team from Dublin Fire Brigade, she was found unbreathing.
Dr Gilligan informed the court that Doyle suffered a cardiac arrest. Once admitted to Beaumont Hospital from her Lusk residence, the attending doctors concluded that she likely had a severe pulmonary embolism. Her treatment included advanced cardiac life support and movement to intensive care; she passed away at about 9 pm the next day.
Pathologist Dr Brendan Doyle stated that Doyle’s death resulted from bilateral pulmonary thromboembolism.
Mr Bell accused the hospital of lacking sufficient investigation into Doyle’s case, asserting that her death was due to medical misadventure because a readily available “simple” D-Dimer test, was not performed on her. He expressed that this had left Ms Doyle profoundly grieving her daughter’s loss.
In contrast, Jane O’Neill from Beaumont Hospital pushed for a natural cause verdict.
Dr Keane concluded with a verdict of medical misadventure, stating there was a high probability that if the D-Dimer test had been conducted, it would have returned positive, triggering a series of further examinations including a CT pulmonary angiogram.
After the inquiry, Ms Doyle implored hospital representatives in court to conduct a blood test in future instances, regardless of their assumptions.
Later, Ms Doyle, through her legal advisor, Dermot McNamara, called on all hospitals and doctors to strictly adhere to existing protocols, ensuring blood tests on patients suspected of blood clots. McNamara stated their consideration of launching a High Court case against the hospital.