An inquest into the death of mother-of-three Karen McCabe who died nine days after she underwent a procedure to have varicose veins removed has been adjourned until May.
Ms McCabe, 46, was a private patient of Professor Austin Leahy, a Consultant Vascular Surgeon in the Bon Secours Hospital in Dublin from April 2014, the inquest at Dublin Coroner's Court heard.
On 6 August, she underwent a radio frequency ablation procedure, carried out by Mr Leahy to have varicose veins removed.
She attended Beaumont Hospital on 14 August complaining of a pain in her leg and was pronounced dead at 10.45am on 15 August 2014.
Pathologist Dr Jane Thorpe, who carried out the post-mortem examination on Ms McCabe, told the inquest that the cause of death was a pulmonary embolism that occurred nine days after a varicose vein procedure.
She said the likely source of which was deep vein thrombosis which occurred in the lower limbs; that is a blood clot which travelled from the leg to the lung.
Dr Thorpe told the inquest that the lower limbs had not been examined as part of the autopsy as that would not be routine once the cause of death, the pulmonary embolism, was established.
Questioned by David Nolan SC, who is representing Ms McCabe's family, Dr Thorpe said that it was possible to say that the likely source of the clot was the lower leg, as in 99% of cases the source was the pelvic or abdominal areas or the lower limbs and the pelvic and abdominal areas had been examined and no evidence of a clot found.
First consultation in 2014
Prof Leahy told the inquest that Ms McCabe had her first consultation with him on 17 April 2014.
He said that she had varicose veins which he described "very extensive" on her left leg, she had restless leg syndrome and Raynaud's disease which was affecting her hands.
A decision was made to proceed with surgery on the varicose veins on her leg by means of radio frequency ablation and avulsion procedures under local anaesthetic.
Prof Leahy said Ms McCabe was advised of the risk of deep vein thrombosis and pulmonary embolism.
In the case of this particular procedure he told the inquest that the risk was one in 1,000 and that fatal pulmonary embolisms were much rarer again.
When asked by the coroner he said Ms McCabe had been quite disabled by the pain of varicose veins and the restless leg syndrome.
He said that she was overweight and that was a risk factor in relation to deep vein thrombosis or pulmonary embolism but said she had lost two stone.
Prof Leahy carried out the procedure on the morning of 6 August 2014, and he told the inquest that it was difficult but it went well.
He said that Ms McCabe was advised to keep mobile and move about wearing elastic socks.
He went on holiday to Ballydavid in Co Kerry on 8 August.
On Wednesday 13 August Prof Leahy said he had missed a call from the Bons Secours hospital, however he told the inquest that he could not return the call as it came from a general hospital number.
He said that on his recorded phone message he said that people who wanted to contact him should send a text and he did not receive one.
Questioned by barrister for the McCabe family, David Holland SC, Prof Leahy said that a document, which included emergency contact information to contact him or his team at Beaumont Hospital, was given to Ms McCabe during their first consultation in April.
Woman complained of leg pain in phone call
Staff nurse at the Bons Secours Hospital in Dublin told the inquest she took a call from Ms McCabe on 12 August 2014.
Ms Thompson told the inquest that Ms McCabe complained of a pain in her leg that felt like a pulled a muscle in her knee.
Ms Thompson said she asked Ms McCabe if she had experienced symptoms such as pain in the lower leg, swelling, discolouration or warmth, in order to assess if there was a risk of deep vein thrombosis.
She said Ms McCabe told her that she did not have these symptoms.
Ms Thompson said that Ms McCabe told her that she thought she should be “taking it easy” after the surgery, and she advised her that she should mobilise.
Ms Thompson said that Ms McCabe that she would inform Professor Leahy about the matter, but she said that Ms McCabe informed her that he was on holidays and did not want him to be contacted.
Ms Thompson said on advice from a doctor she consulted at the hospital she advised Ms McCabe to come to the Bons Secours, however she said Ms McCabe said she was not confident to drive and did not have a lift.
Ms Thompson said that she also advised Ms McCabe to attend the emergency department at Beaumont Hospital or her GP, however again she said Ms McCabe said she could not go.
Ms Thompson said Ms McCabe said she would go for a walk and Ms Thompson believed she would attend a GP.
David Holland SC queried why details given by Ms Thompson including that Ms McCabe sought a repeat prescription; that Ms Thompson had checked for symptoms of deep vein thrombosis, that she had not contacted Prof Leahy because Mrs McCabe instructed her not to; that she had advised Mrs McCabe to go to the Beaumont Emergency Room or to her GP were not recorded in the telephone advice form prepared soon after the call was made.
He put it to Ms Thompson that her statement of fact may be a "recollection of what you might have done, should have done, would usually do."
Ms Thompson responded that it was her recollection of what was said.
Clinical Nurse Manager at the Bons Secours Hospital, Ingrid Mangan, told the inquest that Ms McCabe had called the hospital again and was advised to come in.
Ms Mangan said that she was in some distress when she came in complaining of severe knee pain.
Ms Mangan said that Dr Kingsley Opputeh, a senior house officer reviewed Ms McCabe and wanted to carry out some tests - an ultrasound and X-ray.
Ms Mangan said in the absence of the consultant, Dr pputeh did not have the authority to order those tests.
The inquest heard that the hospital's policy on bookings and admissions stipulated that where a patient arrives at the hospital and no prior booking has been made, and a consultant or a consultants secretary cannot be contacted, no procedures or tests can be carried out.
Ms Mangan said that she tried to call Prof Leahy but could not get through.
She said that according to Prof Leahy's voice message she should not leave a voice message, but she did not recall any instruction to send a text message instead.
Ms Mangan said it was not policy for nurses to use their personal mobile phones to send text messages and that a computerised system to facilitate contacting doctors by text was not introduced at the hospital until 2015.
Ms Mangan said she did not contact Prof Leahy's secretary.
She said Ms McCabe was then referred to Beaumont Hospital emergency department with a letter.
The inquest has been adjourned until 9 May.
