Inquest Reveals Missed Liver Tests Contributed to Death

An inquest has concluded that a woman who died from organ failure did not receive vital liver function tests that could have monitored the adverse effects of a medication she was prescribed. The case of Dymphna Dykes, who was under treatment for latent tuberculosis, highlights significant lapses in medical oversight that ultimately led to her tragic death.

On February 24, 2021, Ms. Dykes presented at Tallaght University Hospital with acute liver dysfunction after taking Isoniazid for six months. Her condition worsened, and on March 15, she was transferred to St Vincent’s University Hospital to be evaluated for a liver transplant. Unfortunately, she was deemed unsuitable for the procedure. Despite discontinuation of the medication two weeks prior to her admission, Ms. Dykes succumbed to multi-organ failure on March 26, primarily due to acute liver failure attributed to Isoniazid toxicity.

During the inquest, pathologist Dr. Niamh Nolan described the acute liver failure as “very rare,” affecting only one percent of patients. Dr. Nolan conducted the postmortem examination and reported that Ms. Dykes’ liver was “markedly shrunken,” weighing only 390 grams, significantly less than the normal liver weight of approximately 1,500 grams.

The inquest revealed that patients prescribed Isoniazid are required to undergo monthly liver function tests to monitor potential toxic effects. However, these tests were not conducted during Ms. Dykes’ treatment period. Professor Seamas Donnelly, who prescribed the medication, expressed regret to the Dykes family, stating, “Myself, the GP and the system let the family down. As the prescribing physician, the buck stops with me.”

Professor Donnelly had initially informed Ms. Dykes’ general practitioner, Siobhan Kierans, about the need for monthly liver function tests in a letter sent upon prescribing Isoniazid in August 2020. He indicated that he would arrange for these tests at Tallaght University Hospital if they could not be conducted by the GP. Nevertheless, he assumed the tests were being carried out in follow-up consultations, despite receiving no confirmation from Ms. Kierans, which he acknowledged was not unusual.

Ms. Kierans, who is no longer practicing, admitted during the inquest that she did not thoroughly read the correspondence concerning the liver function tests. “It must have gone under the radar,” she said, adding that she had not previously prescribed Isoniazid and had no specific instructions to monitor its effects. She acknowledged a lack of familiarity with the drug and described her oversight as possibly “naive.”

The coroner, Dr. Cróna Gallagher, returned a verdict of medical misadventure, stating it was a neutral conclusion that reflected the unintended consequences of the medical treatment provided. While no specific recommendations were made, Aidan Flahavan, representing the Dykes family, expressed hope that lessons would be learned from this case to prevent similar tragedies in the future.

The inquest underscores the critical importance of adhering to recommended monitoring protocols in medical treatments, particularly those involving potentially harmful medications like Isoniazid.