A 71 years old man died after suffering a fatal reaction to the generic form of an antibiotic, which had been prescribed following the extraction of teeth in UHG last summer, an Inquest into his death heard.
Coroner for West Galway, Dr Ciaran MacLoughlin, explained to the man’s family that owing to his previous history of taking a similar drug, it could not have been predicted that death would result – none of the medical witnesses had ever experienced such an outcome when treating anaphylactic shock.
Patrick Naughton of 155 Corrib Park, Newcastle, walked to nearby University Hospital Galway on the morning of his death, May 23 last. He had an appointment for extractions at 8am, and was picked up by his daughter, Louise King, at 1.05pm.
She said he was in perfect health, and had no complaints apart from a tingling sensation in his tongue, as the local anaesthetic wore off.
They went shopping and picked up his prescription for an antibiotic, ‘Co-amoxiclav’ – a penicillin-based drug, which is better known by its trademark/proprietary name, ‘Augmentin’.
Being on a medical card, Mr Naughton was sold a generic form of Augmentin – of which there are many, the Inquest heard.
After his dinner, he took the antibiotic, lay down for a short time, and then came downstairs clutching his chest.
“His speech was impaired, and his tongue was severely swelled,” Mrs King recalled.
He was driven to A&E immediately, but died later that night.
Oral surgeon, Patrick McCann, told the inquiry that Mr Naughton’s existing medications – which had previously included Augmentin – were noted on his chart before the procedure, so it was well-documented that he had had no known allergy to penicillin.
“The allergic reaction was not predicted,” he said.
He added that the anaphylactic shock that ultimately caused the death was not a delayed reaction to the local anaesthetic and sedative given to Mr Naughton prior to the dental procedure.
The Inquest heard that when Mr Naughton presented to A&E his GCS – which measures brain function – was 15 out of a possible 15. He was given the standard treatment for anaphylactic shock, which included oxygen, antihistamines, steroids and adrenaline, but his condition deteriorated.
Despite his swollen tongue, Mr Naughton initially had 95% oxygen saturation, but this gradually decreased, and the last resort was to perform a tracheotomy – a difficult, but necessary, procedure to install a definitive airway.
However, the consultant anaesthetist on call, Dr Leo Kevin, said that owing to Mr Naughton’s already large – and now swollen – neck, it was impossible for emergency medical staff to identify the usual ‘landmarks’ such as the Adam’s Apple, so they could not perform the procedure there and then.
“The only safe way to do a tracheotomy in this situation is a slow dissection by an ENT surgeon in the operating room,” he explained.
However, within seconds of arriving, Mr Naughton had no pulse, and chest compressions were commenced. After one hour of CPR, resuscitation ceased, and he was pronounced dead at 10.30pm.
He said that Mr Naughton’s pre-existing medical problems had shortened the odds of survival.
“A young person with anaphylactic shock is more likely to be retrievable,” he said.
Mr Kevin told the Inquest that he suspected Mr Naughton had suffered a cardiac arrest on the operating table. He agreed with the Coroner, that the stress of the allergic reaction had likely caused him to go into heart failure.
However, consultant pathologist, Dr Michael Tan, said that he could find no convincing evidence, when examining the heart muscle under the microscope, to say that a heart attack was the cause of death.
He concluded that the anaphylactic shock was “most consistent” with a severe reaction to an antibiotic.
Dr MacLoughlin returned a verdict in accordance with the medical evidence, that death was caused by asphyxia, due to anaphylactic shock, due to a severe allergic reaction to Co-omoxyclav.
“You hear occasionally of people dying from a severe reaction to peanuts or wasp stings, this was the same kind of thing – normally, it is quite successfully treated,” the Coroner said.
“Because of his previous history of being given this chemical, doctors felt he had no known allergy, and couldn’t have expected this to happen.”
He offered his sincere sympathies to Mr Naughton’s children, in-laws, and other family members who attended the Inquest, on the tragic and unexpected circumstances of his death.
Cyclists and disability groups don’t feel the love for ‘kissing gate’ barriers
From the Galway City Tribune – Cyclists and disability groups long campaigning for the removal of ‘kissing gates’ on popular routes were overjoyed to see the one at ‘the Swamp’ in the Claddagh removed last week.
But their joy quickly turned to anger when it was returned a few days later. They learned that it had only been taken out to facilitate a private company. Grant Thornton had organised a 5K run along the Salthill Promenade for corporate staff and sports teams.
Gráinne Faller, who organises the Sundays4Safety awareness campaigns in Salthill, said she could not believe how quickly the Council could act to remove, then replace the barrier when bike groups have been calling for their removal for years, only to be met with inaction.
“These gates lock so many people out of our parks and playgrounds. How can we justify blocking access to public spaces? They are ableist, ageist and they block people with buggies and bikes. They really discriminate against parents. And then we learn that the Council is claiming that this isn’t a problem? We wait. And wait. It is not okay. It’s Council-sanctioned discrimination.”
Chairperson of the campaign group Cyclist.ie, Neasa Bheilbigh, said the gates excluded families and people with mobility impairments from using safe active travel routes to school and public amenities.
“To suggest quiet routes through housing estates and parks are not active travel routes, shows a lack of understanding about how people move in our city,” she insisted.
She highlighted the fact that the National Transport Authority (NTA) has committed to providing funding to remove barriers to promote universal access.
“I always feel safer cycling than walking at night, but having to dismount leaves me feeling vulnerable. The Council don’t seem to grasp the needs of people who use non-standard bikes as mobility aids and who cannot dismount or have the strength to navigate through these barriers.”
Liam Ferrie from Menlo said he was long past retirement age but he found his e-bike was a great way of getting around Galway.
“Last Sunday I cycled a total of 28km without any difficulty – apart from a very close pass by a motorist. However, if I had come to a kissing gate I’d have had to turn back as there is no way I could lift the bike through it.”
Emergency Medical Technician (EMT) for the National Ambulance Service, Reg Turner, said his family cycles along the Terryland Forest park en route to school and they have to manoeuvre a large cargo bike carrying his baby son through a kissing gate.
“My seven-year-old calls them jail gates. She says she is sick of lifting her bike and asks when are they coming to remove the gates. The crazy thing is the forest can be accessed from various other exits and entrances which don’t have these gates.”
At a Galway City Council meeting last July, City Council Director of Services for Transport, Patrick Greene, told councillors the NTA had written to Councils acknowledging that kissing gates were problematic for some users.
He said the NTA was working to come up with a new design for gates that are more accessible for users such as people on cargo bikes, pram users and people in wheelchairs, and the Council would act on any recommendations from the NTA once an alternative was sourced.
He said the City Council was planning to do an audit of all kissing gates across Galway.
Cllr Noel Larkin stated that without kissing gates, housing estates and public parks would be more accessible to vehicles and could result in antisocial behaviour.
Cllr Donal Lyons said motorbikes and other vehicles could access public parks and amenity areas if they were removed and not replaced.
(Photo: A cargo bike stuck at a kissing gates. The City Council removed one in Claddagh recently for a road race but then reinstated it).
This article first appeared in the print edition of the Galway City Tribune, September 23. You can support our journalism by subscribing to the Galway City Tribune HERE. The print edition is in shops every Friday.
Council needs extra loans for home-buying scheme
From the Galway City Tribune – Galway City Council has had to draw down further loans to keep up with demand for the Local Authority Home Loan Scheme.
At a meeting of the City Council, Director of Services for Housing, Brian Barrett, said they had initially sought approval from councillors for a loan of €4.1 million but such was the demand that they required a further €1.4 million.
A renewed Local Authority Home Loan was announced in December last year and provides for Government-backed mortgages for first-time buyers and ‘fresh-start’ applicants – those who are divorced or separated, or who have undergone personal insolvency or bankruptcy.
The scheme was introduced to provide lower interest rate mortgages to those who are creditworthy but would otherwise find it difficult to access sufficient finance.
Mortgages up to 90% of the value of the property are available, with a limit of €320,000 applicable to Galway. An income ceiling of €65,000 applies to single applicants, or €75,000 in the case of a joint application.
Mr Barrett said since the original scheme was launched in February 2018, 277 applications had been received by Galway City Council and 120 had been approved.
Twenty-three of those loans applied to the Tenant Purchase Scheme for local authority tenants buying-out their homes.
“In February, councillors approved a loan of €4.1 million and we need another €1.4 million . . . we require €5.5 million,” said Mr Barrett, who explained this applied to 2022 applications only.
The funding would be borrowed by the Council from the Department of Housing, Local Government and Heritage.
Cllr Declan McDonnell (Ind) raised the issue of joint applications in the case of parents and an adult child who wished to buy out a local authority house under the Tenant Purchase Scheme.
“There is a situation arising where a parent with a son or a daughter in the house and the parent is in their 60s. After getting approved, they go to the Housing Finance Agency and they’re told they can only get a four-year mortgage – they waste five months getting approved to be told that,” he said, explaining that money would not be loaned for a period beyond when the parent turns 70.
“That information was not relayed to the Council,” added Cllr McDonnell.
Dermot Mahon of the Council’s Housing Department said he was aware of this issue, but it was part of the scheme.
“The loan scheme specifies that the maximum age of the eldest borrower is 70,” said Mr Mahon.
Councillors agreed to increase the loan, bringing it to €5.5 million.
City councillors pack their bags for Dutch transport junket
From the Galway City Tribune – A group of city councillors will be packing their bags for Holland in the coming weeks as part of an initiative to introduce them to revolutionary transport solutions.
A meeting of the Council heard that the National Transport Authority (NTA) was willing to fund a trip for councillors to an area similar to Galway – in order to highlight the possibilities in relation to sustainable travel.
Council Chief Executive Brendan McGrath confirmed that the NTA “feel it would be beneficial for councillors to see some of the solutions implemented in other areas”.
“It would be to a town in Holland, similar in size to Galway, to see their active travel solutions,” said Mr McGrath.
There would be no cost to the City Council, he added.
The meeting heard the trip would last three days and would be open to nine councillors – half of the full Council – while two City Hall officials would accompany them.