“Man was in agony after waiting nine hours to see a doctor at hospital as artery ruptured, inquest heard

Pat Murphy (34) had to take a taxi from his home in Glanmire, Co Cork, to CUH because no ambulance was available, an inquest heard.

A CT scan was only done after a seizure, because one of the hospital’s scanners was broken.

His widow, Keerti Murphy, said she was “traumatized and scarred” by the knowledge that, in the hours before his death, her husband had not been seen by a doctor, despite his agony.

She said he was in so much pain that he had to lie on the floor rather than sit in a chair in the emergency room.

Dr John O’Mahony SC, on behalf of the Murphy family, said the deceased had suffered “a crushing delay – a huge delay where vital time was lost”.

The Murphy family said they were further traumatized by the fact that sections of Mr Murphy’s observation care notes at CUH were missing from his file and could not be located.

He died at CUH on September 3, 2021, two days after his admission.

It was confirmed that the matter had been referred to the National Incident Management System (NIMS).

Dr O’Mahony noted that the NIMS report, dated March 22 last year, concluded that the type of injury involved was “a misdiagnosis – an incorrect diagnosis”.

Ms Murphy said her husband was in perfect health, ran road races and had never complained of medical problems.

Mr Murphy, a chemical engineer, had complained of excruciating chest pain but was initially assessed as suffering from possible renal colic or a kidney stone.

Her damaged artery was only diagnosed following an urgent CT scan after a seizure.

CUH has officially apologized to the family for the failings in their care. The Murphy family insisted the delays were key to the tragic outcome.

Mr Murphy, who has a PhD in chemical engineering and works at Pfizer, went to CUH after complaining of chest pain on the evening of September 1, 2021. The pain was traveling up from his chest to his neck and up to his back.

He was assessed and classified as a category three patient. This meant he should have been seen within two hours.

The hearing was told he first fell ill at 9pm on September 1 while watching a World Cup qualifying match between Ireland and Portugal on television.

“I remember him coming alive in our living room. Cristiano Ronaldo was going to score a goal and Pat was scolding him,” his widow said.

Suddenly, she said, he clutched his chest. Ms Murphy said her husband was in perfect health, ran road races and never complained of medical problems.

Clutching his chest, he told his wife to call SouthDoc, a GP service.

“I remember very clearly being scared,” she said. “Pat hadn’t had anything like this before. Pat was suffering.

At one point he said, “I can’t take the pain anymore.”

After telephone consultations with a nurse and then a doctor, Ms Murphy called an ambulance. Her husband was in so much pain he could barely speak.

There was no sign of an ambulance after 45 minutes, so they went to CUH by taxi.

He arrived at 12:55 a.m. on September 2, was triaged four minutes later and was expected to see a doctor within two hours.

However, the investigation revealed that he was not seen by a doctor until 9.30am.

At one point he said, “I can’t stand the pain anymore. »

He was found to have an aortic dissection aneurysm, a condition in which blood leaks into the artery wall.

This requires early diagnosis and urgent treatment. Mr Murphy underwent emergency surgery but died at 1.23pm on September 3.

Ms Murphy said she hoped he would recover.

“He was hooked up to monitors, a tube in his mouth,” she said. “His body seemed swollen and an aluminum foil blanket with layers of blankets barely kept him warm.

A nurse slipped her hand into mine, suggesting I call a priest. The last ounce of my hope has been destroyed

“I was taken to speak to a surgeon who told me it was critical. I knew the chances were slim, but I was still hopeful.

“When I returned to his room, a nurse slipped her hand into mine, suggesting that I call a priest. The last ounce of my hope was destroyed.

“The presence of the priest sank our hearts to the depths. The priest asked me to kiss Pat’s forehead and whisper to him that I love him and that (our son) Rohan loves him too.

“Then I heard the monitors shut off for the last time. I felt the pain and anguish tear through my body. I could barely keep my balance.

Ms Murphy, a science graduate, said she and her husband’s family were then taken to two meetings at CUH in 2022, when the sequence of events was explained.

“What we heard was much more haunting and scarring,” she said. “We were told of nine-hour waits, not having timely access to working scanners that could have redirected the diagnostic error, and missing observation pages. »

Caoimhe Daly SC read a formal letter of apology to the Murphy family on behalf of CUH.

“We unreservedly and sincerely apologize for the failures of care during Patrick’s admission to CUH and for the failure to diagnose an aortic dissection,” the statement said.

“A review of Patrick’s care highlighted that a number of items were not delivered as quickly as they should have been.

“We can assure you that lessons have been identified and shared within CUH to ensure our clinical training processes are strengthened to avoid such a tragic outcome for others in the future. »

The inquest before Cork Coroner Philip Comyn is expected to conclude today.