Verdict returned in relation to death of Limerick man following treatment at University Hospital Limerick

A "TIMELY" surgical procedure would have "avoided the death" of a Limerick man 13 years ago, an inquest heard this Thursday afternoon.

A verdict of medical misadventure has been recorded at the second inquest held for the same person – thought to be the first time in the history of the State. 

Michael Daly Snr, aged 65, of Garryowen, Limerick died on April 7, 2010. He had been treated for rectal pain and bleeding for over two and half years and he had a number of surgical procedures carried out in the Regional Hospital (now University Hospital Limerick).

A 2012 inquest found that Mr Daly Snr had died of cardiac failure due to natural causes.

The second inquest into his death commenced on Monday in Kilmallock Court with the deceased's family hoping the "truth will finally emerge and healing can begin".

Among those to give evidence was the former state pathologist Professor Marie Cassidy who took the stand this Thursday. 

After the four days of evidence had finished, Limerick coroner John McNamara said, this Thursday, it was "a very complex inquest surrounding the circumstance of the death of the late Michael Daly Snr". 

In summarising the evidence, the coroner said Mr Daly Snr unfortunately developed rectal cancer and on August 22, 2007 had cancer surgery. He subsequently developed a "leak" which is a risk associated with this type of procedure.

The surgery was successful and despite an 80% chance of reoccurence the cancer never came back.

"However, following a stoma removal reversal, Mr Daly Snr became unfortunately progressively unwell. It is clear from the evidence and records he had multiple attendances and discharges from University Hospital Limerick through 2008, 2009, 2010.

"Throughout this time his C-reactive protein (CRP) had increased and albumin had decreased which we heard was consistent with chronic inflammation, low blood haemoglobin and an episode of delirium in 2009.

"It is fair to say he underwent a lot of tests and investigations at the hospital. It appears that the cause of his ongoing illness was never established," said Mr McNamara.

The coroner said there were two CT scans taken of Mr Daly's (pictured below in 2008) abdomen and pelvis in 2008 and 2009.

"These are of significance. My independent expert witness gave evidence that the first scan gave rise to significant unexpected findings. In his practice he would have brought this to the attention of  the clinician and the case would have been reviewed.

"The radiologist who carried out the CT scans, in his direct evidence said the information he received before carrying out the scans was patchy. He was unaware Mr Daly Snr had been sick a long while. He recommended a multidisciplinary meeting in his report," said Mr McNamara, who added that in the radiologist's direct evidence he "accepted he misinterpreted or misread the scan" having read and heard the evidence of the independent witness.

The coroner said Mr Daly's consultant said if he had this information he would have carried out a defunctioning colostomy immediately.

Family of Limerick man hope 'truth finally emerges' as second inquest opens

The independent evidence of an intensivist said it was his opinion that "unresolved infection led to sepsis".

"A colorectal surgeon acting on my instruction gave an opinion that on the balance of probabilities a timely defunctioning colostomy would have avoided death.

"A cardiologist accepted the proposition that sepsis would have been a major contributory factor to death because of the excessive demands placed on Mr Daly Snr's heart.

"Professor Marie Cassidy (former state pathologist) gave evidence this morning that it was a combination of factors at play that led to Mr Daly's death," said Mr McNamara.

The coroner said that on the balance of probabilities "I am satisfied that the appropriate verdict to record is medical misadventure".

Mr McNamara amended Mr Daly's cause of death from cardiac failure due to natural causes to cardiac failure and cardiac disease on a background of recent bowel cancer, surgeries, infection, sepsis and peritonitis.

Mr McNamara thanked the legal representatives, medical and independent witnesses, and gardai.

Doireann O'Mahony BL, on behalf of the Daly family, who had sought a verdict of medical misadventure, thanked Mr McNamara.

"The coroner service is a vital public service and the Daly's family faith in the service has been restored," said Ms O'Mahony.

Mr McNamara made it "abundantly clear" that medical misadventure doesn't carry any connotations of blame of liability.

"I would like to express my condolences to the Daly family. Obviously that is the reason we are here," said Mr McNamara.

Earlier, Conor Halpin SC, for University Hospital Limerick, on behalf of the legal team expressed "our sincerest condolences to Michael Daly Jnr and the family and the extended family on the loss of their father".

More to follow online and in print on the reaction of the Daly family to the verdict