The inquiry into the unexpected death of a well-known car dealer heard that he may have been misdiagnosed in a private hospital, which could ultimately have reduced his chances of survival.
The late JJ Fleming (60), of Blackrock, Salthill, walked into the Galway Clinic on November 6 2013 complaining of numbness in his legs, but died in Bon Secours Hospital on December 8 – where he had been transferred, at the request of his wife.
“If he’d seen a neurologist straight away, and had the appropriate treatment, we would not need an inquest,” Maria Fleming told the inquiry at Galway Courthouse on Thursday. “Why did it take nine days for them (Galway Clinic) to seek a neurologist’s opinion?”
The father of four had been on holidays in Spain in November 2013 when he began to feel unwell. He went home early to attend an out-patient’s appointment with consultant urologist, Dr David Boucher Hayes, in the Galway Clinic, as he was heading away himself the following day.
His wife said that he had an uncomfortable night at home on November 5, however, and was advised to pack an overnight bag so that he could be admitted to the Clinic for routine tests.
He walked in the following day, and was told that he did not have prostate or urological problems – as he had been told by his GP and hospital staff in Spain – but rather five trapped nerves in his back.
“I arrived back on November 9, and was alarmed to hear that he needed surgery,” Mrs Fleming said.
Urgent decompression was required, she was told, as his condition was deteriorating daily, his legs were weakening, and he now walked with a limp.
She questioned why the surgery was not performed until November 13 – a full week after being admitted. And, she said that his condition actually got worse after the operation.
Her husband complained all day after the surgery of a burning sensation in his legs, but was told that it was normal.
She said that it was not until a year later, when she received a claim form from the VHI, that she found out he had been brought back to the operating theatre the following day as an MRI had confirmed a bleed.
“Nine days after surgery he was essentially paralysed… He questioned his care, and voiced his concern,” she said.
He was seen by Dr Michael Hennessy, a consultant neurologist visiting from the Bon Secours Hospital, and diagnosed with mononeuritis multiplex, which is damage to one or more peripheral nerves – the nerves outside the brain and spinal cord.
On Dr Hennessy’s advice, and on the requests of Mrs Fleming, her husband was transferred to Bons Secours Hospital on November 25, where he was admitted under a new team, put on steroids, and a marked improvement followed.
“There was a total transformation, and his mood improved greatly – they were all so much more positive about his recovery,” she said.
Their daughter had set a date for her wedding in August 2014, and Mr Fleming was determined that he would be able to walk her up the aisle.
“It gave us great hope,” his wife said. “I was advised to make changes to our home, as he would be coming home in a wheelchair.”
However, his condition deteriorated in the early hours of December 5, and he became unresponsive.
“When I arrived, he was motionless in the bed, the neurologist said that he had suffered a major brain haemorrhage… he looked like he was asleep,” Mrs Fleming recalled.
He passed away on December 8 and, when his wife called to the Bons Secours Hospital in March 2014 for the results of the post-mortem examination, she was told by the consultant that her husband may have been initially mis-diagnosed; that the inflammation of his spinal nerve roots could only have been detected by a neurologist.
“He said that he had not required the initial treatments (operations), that it would have been steroids (treatment) – which is what he had in the Bons,” she said.
“I was shocked that he’d had two surgeries in the Clinic that he had not required.”
However, Dr John Burke, an orthopaedic surgeon at the Galway Clinic told the inquiry that Mr Fleming’s symptoms “fitted with Cauda Equina Syndrome (CES)…”
This condition affects the nerve roots in the lower end of the spinal cord, and needs to be dealt with urgently, as it would have worsened with time. He added that compressed nerves were discovered when Mr Fleming went under the knife.
However, he acknowledged that this may not have been a correct diagnosis. “When he began to worsen, I knew it was another factor, and called in Dr Michael Hennessy,” he said.
This initial diagnosis was shared by other consultants, who had assessed Mr Fleming while he was a patient in the Galway Clinic – among them, Dr Ronan Kavanagh, an expert in the area of inflammatory diseases, and Mr Fleming’s rheumatologist since 2010.
Former Consultant Neuropathologist at Beaumont Hospital, Professor Michael Farrell, carried a post-mortem examination on the brain, and submitted a report to the Inquest, which was read into the record.
He concluded that death was due to a stroke, most likely caused by “extreme” arteriolar sclerosis, which is common in diabetics, from which Mr Fleming suffered for 30 years.
His findings in relation to what caused the initial complaints, while on holidays, were at odds with some of the other medical evidence given on the day, and Mrs Fleming’s legal team requested that Prof. Farrell would attend the Inquest at an adjourned date in September.
Galway City Council turns down Mad Yolk Farm site
An application to retain farming-related development on a site in Roscam has been turned down by Galway City Council.
The local authority has refused to grant retention permission to applicant Brian Dilleen for subsurface piping to be used for agricultural irrigation at ‘Mad Yolk Farm’ on Rosshill Road.
It also refused permission for the retention of a bore-hole well, water pump and concrete plinth; and two water holding tanks for 6,500 litres; and other associated site works.
In its written decision, the Planning Department at City Hall said: “The proposed development, would if permitted, facilitate the use of the site for the provision of sixty 15.5m high seed beds, which have been deemed by the planning authority not to be exempted development.
“Therefore a grant of permission for the proposed development would facilitate the unauthorised development and usage on the site, contrary to the proper planning and sustainable development of the area.”
The site has been the subject of enforcement action by the local authority.
A lengthy Appropriate Assessment Screening report, submitted with the planning application, concluded “beyond reasonable scientific doubt, in view of the best scientific knowledge, on the basis of objective information and in light of the conservation objectives of the relevant European sites, that the proposed retention and development, individually or in combination with other plans and projects, has not and will not have a significant effect on any European site”.
A borehole Impact Assessment Report concluded that the proposed retention development “on the hydraulic properties of the aquifer is considered negligible”.
It said that there was “no potential for significant effects on water quality, groundwater dependent habitats or species associated with any European site”.
Six objections were lodged by neighbours, including one from the Roshill/Roscam Residents Association, which argued the Further Information submitted by the applicant did “little to allay our concerns” about the impact of the development on an “extremely sensitive site”.
The applicant has until June 29 to appeal the decision to An Bórd Pleanála.
NUIG student accommodation firm records loss
The property company which operates student accommodation on behalf of NUI Galway recorded a €3.4 million increase in turnover in 2019.
However, Atalia Student Residences DAC (Designated Activity Company), which is owned by the university, recorded a loss for the year of €6,300.
Accounts for the company for the year ended August 31, 2019, show that while there was a loss, retained profits are at more than €1.6 million. The accounts are the most up to date available from the Companies Registration Office.
The previous year, the company made a profit of more than €460,000.
Atalia Student Residences operates the 764-bed Corrib Village apartment complex and the 429-bed Goldcrest Village.
The figures show that the company’s overall turnover jumped by 52% – from €6.4m to €9.8m.
Turnover for accommodation services was up from €5.2m to €8.4m; and from conferences and events was up from €850,000 to €1.1m. Turnover from shops was down from almost €328,000 to €290,000.
Outside of the academic year, both complexes are used as accommodation for conference delegates, while Corrib Village is also used for short-term holiday lets.
The accounts show fixed assets – including fixtures and fittings, plant and machinery and office equipment – valued at €1.5m. Its current assets were valued at more than €7m, including ‘cash at bank and in hand’ of almost €6.9m (up from €5.6m last year).
The company owed creditors €6.9m, including €5.2m in deferred income.
It employed 38 people (which includes its five directors) last year, up from 31 the previous year.
As well as operating the student accommodation complexes, the company also markets conference facilities and services on behalf of the university.
It pays rent to NUIG but the figure is not included in the company accounts. In 2018, the rent figure was just over €2.25m.
In Corrib Village, a single bedroom with a private en suite for the academic year costs €5,950. For Goldcrest Village, the figure is €6,760.
Call for two-way cycling under Galway City outdoor dining plan
Bike users want the local authority to examine the introduction of two-way cycling on one-way city centre streets.
Galway Cycling Campaign has again called for cycling to be allowed both ways. It comes as Galway City Council prepares to cordon-off parts of city centre streets to traffic, and make Dominick Street Lower one-way, to facilitate outdoor dining.
The cycling organisation said that the proposed pedestrianisation plan at the Small Crane, and the one-way system on Dominick Street, will result in lengthy diversions for people on bikes.
It has pointed out that school children and their guardians who cycle along Raleigh Row, and turn right towards Sea Road, will probably continue to do so even when the Small Crane is cordoned off to traffic, because the alternative route – via Henry Street – is too long a detour.
Similarly, it has been suggested that food-delivery services on bikes are unlikely to go the ‘long way round’ via Mill Street and New Road to get from Bridge Mills to restaurants on Dominick Street and would be tempted to cycle the ‘wrong way’ down the proposed one-way street or on the footpath.
Shane Foran, committee member of Galway Cycling Campaign, said now would be an ideal time to introduce two-way cycling on some one-way streets.
“It’s not controversial,” insisted Mr Foran. “It’s a general principle in other countries, if you are putting in new traffic arrangements, you would try and keep access for people on bikes.”
The regulation is contained in the National Cycle Policy Framework 2009; and a specific objective was contained in two of the most recent previous City Development Plans.
He said a former minister and Galway West TD, the late Bobby Molloy, had the vision to change the legislation in the late 1990s – but it hasn’t yet been embraced here.
“Bobby Molloy, who couldn’t be classed as an eco warrior, changed the law in 1998, so that it is available to local authorities to put up a sign granting an exemption from restrictions for people cycling on one-way streets.
“The road stays one-way for cars, and two ways for bicycles. Clearly that’s not going to be a sensible to do everywhere, like Merchants’ Road. In those situations, you might need a cycle track or lane to segregate people from traffic.
“But if it’s a low traffic street, with low speeds or relatively lower volumes of cars, then it should be possible for people on bicycles to cycle in both directions and still have it one-way for cars, without it being a major safety issue. It works in other countries,” said Mr Foran.