A YOUNG DUBLIN woman died from a blood clot shortly after she had spent almost 44 hours sitting in an overcrowded emergency department, an inquest has heard.

Erin Dennis (26), a betting shop worker of Cushlawn, Tallaght, Dublin died on 2 March, 2022 after collapsing at home shortly after she had left the emergency department at Tallaght University Hospital (TUH).

A sitting of Dublin District Coroner’s Court today heard TUH has apologised for any failings that had been identified in a clinical review of the circumstances of Ms Dennis’ death.

However, a barrister representing her family, Nichola Delaney BL, said they had heard many apologies from hospitals about failings in care and wondered how many times it would be “before an apology is sincere.”

The inquest heard Ms Dennis had spent a total of 43 hours and 38 minutes in TUH’s emergency department where kidney stones were diagnosed as the cause of her abdominal pain.

Evidence was also given that an ECG scan was not carried out on Ms Dennis prior to her discharge from TUH as required by the hospital’s policy after she was found with a fast heart rate.

A staff nurse, Junnel Aganon, said the patient’s condition meant her vital signs should also have been checked every 4-6 hours but it was not possible due to overcrowding.

The coroner, Clare Keane, recorded a narrative verdict based on “very complex” evidence relating to several issues regarding the deceased’s health in various periods before her death.

Dr Keane confirmed that the cause of death was a pulmonary embolism due to deep vein thrombosis of an artery in the deceased’s left leg.

The coroner said it came against a background of Ms Dennis having a raised body mass index (BMI), undergoing surgery in Turkey for a gastric sleeve – an operation to remove a large part of the stomach – as well as suffering a fracture to her left ankle while in hospital.

A consultant in emergency medicine, Michael Bennett, acknowledged that Ms Dennis had a protracted stay in a “severely overcrowded and understaffed” emergency department prior to her death.

“With this level of overcrowding, we are unable to see patients in a timely and safe manner due to the lack of clinical space,” said Dr Bennett.

The inquest heard that patients should be triaged within 15 minutes, but it was four hours and 29 minutes before Ms Dennis was seen when she arrived in the hospital on 28 February, 2022.

Once triaged, Ms Dennis’ condition meant she should have been examined by a doctor within one hour.

However, Dr Bennett accepted that it was almost 11 hours before the patient was seen by a doctor, while it took a further six and a half hours before the results of a CT scan became available.

Ms Dennis chose to have the kidney stones diagnosed by the scan managed conservatively and left TUH shortly after 3.30pm on 2 March, 2022.

However, she collapsed outside her home around 5pm and was in cardiac arrest as she arrived back at the hospital at 5.48pm.

Efforts to resuscitate her were unsuccessful and she was pronounced dead at 7.03pm.

Ms Dennis’s mother, Theresa Dixon, broke down in tears as she recounted how her daughter had complained about dizziness, blurred vision and her left eye “turning in” which first led to her being admitted to TUH on 23 January, 2022.

“She was my breath. My only child that came from my body. I have failed her because it was my job to protect her,” Ms Dixon sobbed.

While in hospital Ms Dennis required surgery after suffering a fracture to her left ankle after she fell while going to the toilet on 24 January, 2022.

She was discharged on 17 February, 2022 but needed to return to the hospital on 28 February, 2022 with back pain.

The inquest heard Ms Dennis, who was overweight, had decided to travel to Turkey in November 2021 for gastric sleeve surgery after researching the topic for a few years and was taking multivitamins after the operation.

A consultant neurologist at TUH, Allan McCarthy, said medical records showed that Ms Dennis had been vomiting five or six times a day for an eight-week period when she was admitted to the hospital in January 2022.

Dr McCarthy said the patient had been diagnosed with Wernicke encephalopathy – a brain disorder caused by the lack of vitamin B1.

He noted that the multivitamins that Ms Dennis had been using did not contain vitamin B1.

Dr McCarthy said doctors had believed the vomiting was due to the effect of the gastric sleeve surgery as there was “no other obvious cause.”

The consultant admitted that he was worried about the degree and duration of vomiting as it would lead to a deficiency of vitamin B1 in a patient after 3-6 weeks.

The inquest heard that the fracture to the deceased’s left ankle was linked to a problem with her gait which may have been due to her lack of vitamin B1.

Dr McCarthy also noted there was no record of Ms Dennis taking any anti-blood clotting medication after the surgery in Turkey.

The consultant confirmed that dosage of anticoagulants prescribed to the patient after the surgery on her ankle was doubled during her stay in hospital due to her weight.

Evidence was heard that doctors at TUH did not consider Ms Dennis at risk of blood clots when she attended an outpatient clinic to review her ankle on 1 March, 2022 as she was six weeks after surgery at that stage and her leg appeared normal.

Medical records showed the deceased had never complained at any stage of pains in her leg.

The inquest heard that Ms Dennis had some mobility after she had been discharged home on 17 February, 2022 but also used a wheelchair.

Offering her sympathy to Ms Dennis’ family, Dr Keane said Erin had great hope that the surgery she had undergone in Turkey would be “life-changing.”

“The tragic outcome could not be foreseen,” the coroner added.

She noted risk factors associated with blood clots were a raised BMI index and birth control implants containing etonogestrel (which Ms Dennis had been using).

The coroner said Ms Dennis had also experienced periods of immobility for different reasons ,including the surgery and travel to Turkey and a number of hospital stays, which may have contributed to what happened, although it had not been possible to establish conclusively when the fatal blood clot had developed.

Dr Keane said she endorsed recommendations made following a review of the patient’s death which included the need to adequately resource the treatment of patients with a high BMI and increased staffing levels for the treatment of deep vein thrombosis at TUH.

They also included raising awareness of the risk of travelling to non-EU countries for bariatric surgery.  

Ms Delaney said Ms Dennis’ family would also like to see all patients being assessed for the risk of blood clots within 24 hours of being admitted to hospital.