Consultant Apologizes After Woman’s Death Linked to TB Drug

A hospital consultant has publicly apologized to the family of a woman who died following a toxic reaction to a drug prescribed for latent tuberculosis. Dymphna Dykes, aged 68, passed away from multi-organ failure linked to a severe side effect of the antibiotic Isoniazid. The incident has raised serious questions about medical oversight and communication within healthcare systems.

At the Dublin District Coroner’s Court, a verdict of medical misadventure was recorded regarding Dykes’ death, which occurred at St Vincent’s University Hospital on March 26, 2021. A postmortem revealed that Dykes, originally from Carrick-on-Suir in County Tipperary, suffered acute liver failure due to the drug’s toxicity.

The court heard that Dykes had been prescribed Isoniazid for six months, but the necessary monthly liver function tests to monitor its effects were not performed. Testimony revealed that Dykes had completed her course of Isoniazid just two weeks prior to her admission to Tallaght University Hospital (TUH) on February 24, 2021, where she was diagnosed with severe liver malfunction. She was subsequently transferred to St Vincent’s, but her condition had deteriorated to the point where a liver transplant was deemed unsuitable.

Consultant hepatologist Dr. Niall Breslin testified that it was likely the liver damage began within the first few months of treatment. Dr. Seamas Donnelly, a respiratory medicine consultant who treated Dykes at TUH, explained that Isoniazid is the standard first-line treatment for latent TB. After prescribing the medication, he had contacted Dykes’ GP, Dr. Siobhan Kierans, on August 25, 2020, to ensure monthly liver function tests were arranged.

Dr. Donnelly indicated that he had not received a response from Dr. Kierans and assumed the tests were being conducted. He acknowledged that the current health system does not provide a foolproof method to track such essential follow-ups.

During the inquest, it was revealed that Dykes had missed a follow-up appointment and had canceled another due to a family bereavement. Dr. Donnelly noted that no alerts were raised regarding her care during that period. In a moment of reflection, he stated, “Myself, the GP and the system let the family down,” as he addressed Dykes’ husband, Freddie, and their daughters, Kerena and Aiveen.

Dr. Kierans admitted to not fully reading the letter from Dr. Donnelly regarding the liver tests. She expressed regret, stating that the oversight was “a bit stupid.” She also acknowledged her limited knowledge about the necessary monitoring for patients on Isoniazid, agreeing that there was a lack of systematic follow-up in her practice.

Pathologist Niamh Nolan provided evidence that Isoniazid caused significant liver damage, leading to a liver weight of 390 grams compared to the normal weight of approximately 1,500 grams. She noted that such severe side effects are rare, affecting about 1% of patients.

Counsel for Dykes’ family, William Reidy BL, argued for a verdict of medical misadventure. He highlighted the communication failures between the doctors and the absence of a clear protocol for ensuring patient safety regarding the liver tests. He stated that it was “deeply worrying” that the GP had not comprehensively addressed the issue raised in the correspondence.

On the other hand, counsel for Dr. Donnelly called for a narrative verdict, suggesting that a finding of medical misadventure would oversimplify the complexities of the case.

Coroner Cróna Gallagher ultimately returned a verdict of medical misadventure, indicating that the recommended tests for Dykes were not conducted during her treatment. She emphasized that this verdict was neutral, reflecting the unintended consequences of a medical treatment rather than negligence.

Dr. Gallagher noted that while she could not recommend specific actions to prevent similar incidents, the case highlighted the critical need for better communication among healthcare providers. Following the inquest, family solicitor Aidan Flahavan expressed hope that lessons would be learned from this tragedy, despite the absence of formal recommendations.

This case underscores the importance of rigorous monitoring in medical treatments and the critical need for clear communication among healthcare professionals to safeguard patient health.