Medical Misadventure Verdict in Death Linked to Drug Tests

An inquest into the death of Dymphna Dykes has concluded with a verdict of medical misadventure, after it was revealed that crucial liver function tests were not performed during her treatment. Ms Dykes died on March 26, 2021, from multi-organ failure attributed to acute liver failure, a condition linked to her use of the medication Isoniazid for latent tuberculosis.

Ms Dykes first presented to Tallaght University Hospital on February 24, 2021, with acute liver dysfunction after taking Isoniazid for a six-month period. Her health declined rapidly, leading to her transfer to St Vincent’s University Hospital on March 15, 2021, where she was evaluated for a liver transplant but was declared unsuitable. Despite discontinuing the medication two weeks prior to her admission, she succumbed to her condition shortly thereafter.

During the inquest, pathologist Dr Niamh Nolan noted that the acute liver failure was a result of Isoniazid toxicity, a rare occurrence affecting approximately one percent of patients. She described Ms Dykes’ liver as “markedly shrunken,” weighing only 390 grams compared to the normal weight of around 1,500 grams.

The inquiry highlighted that patients prescribed Isoniazid are typically required to undergo monthly liver function tests to monitor potential adverse effects. However, these tests were not conducted throughout 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.”

In his practice, Professor Donnelly had instructed Ms Dykes’ GP, Siobhan Kierans, to perform the necessary tests and indicated he would coordinate them at Tallaght University Hospital if the GP could not. During follow-up consultations, he assumed the tests were being conducted, as he did not receive any communication to the contrary. He later acknowledged that Ms Dykes may have been referring to routine blood tests rather than the critical liver function tests.

Ms Kierans, who is no longer in practice, admitted during the inquest that while she read the correspondence regarding the tests, she did not recall its specifics or Ms Dykes mentioning the need for liver function monitoring. She attributed the oversight to the volume of letters her practice received daily, stating, “This one wasn’t highlighted enough and brought to my attention.”

The coroner, Dr Cróna Gallagher, concluded that the absence of the recommended tests led to unintended consequences, ultimately resulting in Ms Dykes’ death. She returned a verdict of medical misadventure, characterizing it as a neutral verdict that reflects the complexities surrounding the treatment and subsequent events.

Legal representative for the family, Aidan Flahavan, remarked that although the coroner made no formal recommendations, they hope that lessons will be learned from this tragic case. The events surrounding Ms Dykes’ treatment highlight the critical importance of adhering to medical guidelines and the need for effective communication among healthcare providers to ensure patient safety.