Inquest hears bruising on 85-year-old UHL patient’s body could not be explained

Janet, Maire-Claire, Des, and Joe, children of the late Michael Power, hold a picture of their father at Kilmallock Coroner's Court. Photo: Brendan Gleeson.

BRUISES and abrasions found on the body of an elderly patient on an โ€œunderstaffedโ€ ward at University Hospital Limerick (UHL) could not be explained, an inquest heard yesterday (Wednesday November 15) at Limerick Coronerโ€™s Court.

Michael Power (85), of Uregar, Kilmallock, was found unresponsive by a nurse in his single room on ward 8C at around 10.30am on March 13, 2021.

He had not been physically checked by staff for over an hour, despite being admitted to the ward on March 5, seriously ill, with laboured breathing and a history of chronic obstructive pulmonary disease (COPD).

Staff noticed abrasions and bruising to Mr Powerโ€™s head and body when he was found unresponsive in his room, however this was only flagged as concerning by an undertaker who alerted Mr Powerโ€™s family, which in turn delayed his funeral as a post mortem was conducted.

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Mr Powerโ€™s family acquired his medical notes as well as CCTV footage of Ward 8C on the morning of his death.

The CCTV footage revealed the father of four had taken an โ€œassisted fallโ€ near the wardโ€™s nurses station at 6.30am, however the fall was not documented and Mr Powerโ€™s family had not been not informed.

Staff gave evidence that they were โ€œshort of staffโ€ and under pressure trying to monitor and care for 20 patients on the 20-single-room ward, which was designated a Covid-19 ward in what were โ€œdifficultโ€ times.

Not physically checked for over an hour

There was one healthcare assistant (HCA) on the ward, and nurses had requested an extra HCA to give Mr Power one-to-one care but none were available.

Under cross examination by John Monaghan BL, counsel for the Power family, instructed by solicitor Bill Oโ€™Donnell, the HCA who was on duty on the ward that morning replied that she โ€œabsolutelyโ€ could have used additional HCA resources, and she could have spent more time with Mr Power if she had โ€œless patientsโ€ to help look after.

Staff said Mr Powerโ€™s condition had improved throughout the previous few days, but on March 12 he appeared confused and was frequently removing a face mask that was supplying him with a โ€œsignificantโ€ volume of oxygen.

Mr Power was checked by a nurse at 9.15am and was not physically checked again until 10.21am, when he was found to be unresponsive and pronounced dead shortly thereafter.

While it was accepted that Mr Power was not physically checked during this period of time, counsel for the HSE, Denise Mulcahy BL, instructed by Karen Watret of Doyle Solicitors, said staff were able to visually monitor Mr Power and his oxygen levels as they were passing his room by looking at him through a glass window.

The late Michael Power.

A post mortem on March 16 determined that Mr Power, who was pre-deceased by his wife Claire Power, died as a result of sudden cardiorespiratory failure along with severe restrictive pulmonary disease.

A pathologist who gave evidence about the post mortem, but who did not perform the autopsy, confirmed the abrasions on Mr Powerโ€™s body – including a 21x4cm laceration to his lateral chest, a 13x6cm bruise to the right side of his temple, and bruising on his right shoulder, back, and arms – wereย  โ€œnot life threateningโ€ and โ€œcould not be connectedโ€ to his death.

The pathologist told Mr Monaghan that he could not say for sure if Mr Powerโ€™s bruising was due to one or a number of falls but that either scenario was โ€œpossibleโ€.

Ms Mulcahy, acting for the HSE, said photographs of Mr Powerโ€™s injuries, which were shown to the coroner, had been taken two days after his death. She noted that the pathologist witness had stated that bruising in elderly people is often not always immediately visible.

In her submission to the court, Ms Mulcahy said the cause of death was acute cardiorespiratory failure.

Limerick Coroner John McNamara said he accepted there had been โ€œcommunications failings clearlyโ€ in the case and he returned a โ€œnarrative verdictโ€.

โ€œPeople can point to Covid, but the Power family should have been notified and kept in the loop about their fatherโ€™s care – no two ways about it,โ€ Mr McNamara said.

“UHL has failed to adequately account for our father’s death”

John Monaghan said the Power family โ€œremain upset that in their fatherโ€™s final hours he didn’t get one-to-one care, they didn’t get to say goodbye, nor were they forewarned of his condition deterioratingโ€.

He said the familyโ€™s โ€œtremendous shockโ€ at suddenly learning about their fatherโ€™s death was โ€œexacerbated by bruises that were not explained, and they remain upset at the lack of clarity and transparency of their fatherโ€™s careโ€.

Joe Power, a son of the deceased, said: โ€œWe are confident our fatherโ€™s death could have been avoided, and UHL has failed to adequately account for our fatherโ€™s deathโ€.

In his undisputed deposition to the court, Mr Power said it was โ€œmost unsatisfactoryโ€ that none of his family were asked to be involved in a UHL internal investigation into his fatherโ€™s death and that โ€œthe panel of investigation never even looked at the photos of bruising on our fatherโ€™s bodyโ€.

He said UHLโ€™s complaint procedure in relation to their fatherโ€™s case had been โ€œdiscontinued twiceโ€ and the โ€œinquest delayed by the HSEโ€.

โ€œMichael Power was a good father, a good husband, and a good grandfather, and his bruising was only discovered by an undertaker who retuned his body for a post mortem,โ€ Mr Power said.

โ€œMichael Power deserved better than that, we deserve better than that, the people who attend UHL deserve better than that,โ€ he concluded.

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