No information about the family’s right to ask for a post-mortem examination
Explaining Options for a Post-Mortem
Mr Brennan had been ill for some time when his cardiac function deteriorated rapidly and he died suddenly in hospital. Mr Brennan’s wife wanted to find out exactly what the cause of death was, because her husband had died unexpectedly. She was upset that no post-mortem was carried out to establish this.
The hospital explained that the man’s death did not fit the criteria for a Coroners’ post-mortem but apologised to the woman for the fact that the option of a hospital post-mortem had not been discussed with the family at the time. The medical team could have decided to do a post-mortem themselves, even if the Coroner did not require one, but they had not considered this necessary and were not aware that the family would have valued the information it might have given.
As a result of the woman’s complaint, the hospital undertook to review and amend its guidelines following the death of a patient to include discussion with the family about a post-mortem where relevant.
Hospital did not perform post-mortem following patient’s fall
Providing explanations
Mr Devitt was receiving treatment in hospital following a stroke. He had at least one fall while a patient, this being quite a severe one where he broke a tooth and suffered a serious laceration to his head. His family were very shocked by his death a couple of days after this fall. His daughter complained that the hospital had delayed in informing the Coroner of her father’s death and had not carried out a post-mortem. As a result, the family did not know whether their father had died of the admitting cause, a stroke, or as a result of the fall and injury to his head.
Following the Ombudsman’s intervention the hospital apologised unreservedly to the family for the distress caused and undertook a range of initiatives to prevent this happening again.
Failure to arrange post-mortem examination
Timely arrangements
Mrs Fleming was 82 years old and living in a residential care setting for older people. Mrs Fleming suffered from Alzheimer’s disease and had been assessed as being at high risk of falls. She died eighteen months after going to live in the facility.
Mrs Fleming’s family had a number of complaints about their mother’s care and death. One of the complaints concerned the family’s wish to donate their mother’s brain to a neurological research facility at a local hospital, an idea that had been proposed to them by one of the medical staff caring for their mother, and how this wish was frustrated. The family also requested a post-mortem to determine the cause of death as their mother had a number of traumatic falls in the days preceding her death. The family believed the post-mortem had been agreed to by the medical consultant.
The family assumed that their mother’s body would be transferred to the hospital on the day that she died and that the post-mortem and donation of tissue would take place the following day. Instead they discovered that her body had remained in the nursing home mortuary and that no arrangements had been made for the post-mortem. The family was greatly distressed by the situation. Ultimately, after much delay and confusion, they decided to withdraw the request for a post-mortem and the offer to donate their mother’s brain for research.
The Ombudsman investigation found that the absence of appropriate protocols between the facility and the hospital delayed the transfer of the body to the hospital. The investigation found that there had been a complete breakdown in communication between staff in the nursing home, staff in the hospital and the family.
Family could not view loved one in public mortuary
Death in a Public Place
Mr Fitzgerald was hill walking when he became ill suddenly and died. The Ambulance service and the Gardai attended at the scene. Mr Fitzgerald was unresponsive to intervention by the Ambulance crew and the crew decided that there was no point in bringing him to the hospital. It was decided to remove his body to a local undertaker / funeral home. From there his body was removed to a public mortuary at the request of the Gardai, as a post-mortem was required.
When the family arrived at the mortuary some time later, they were told that they could not visit Mr Fitzgerald’s remains. They understood that this was because his death had not yet been formally certified by a doctor, but were very distressed and clearly wanted to spend time with him.
The Coroner later explained to the Ombudsman that the family was unable to view the remains, not because of a problem about the certification, but because the mortuary did not have the facilities or staff to enable this to take place. He said he was sorry for the distress caused to the family and regretted that the situation was not explained to them before they made the journey to the mortuary.
What can we learn?
The Ombudsman has received many complaints over the years relating to post-mortems. Post mortems are rarely something we give much thought to until faced with a traumatic event. Families are often uncertain about the circumstances in which the Coroner may require a post-mortem to be carried out. They may be unaware that a hospital post-mortem can be carried out to determine the cause of death, even if not required by the Coroner, and are often unaware that they may request such a post-mortem. Complaints have also been made about delays in arranging for post-mortems or in having the remains released or available to view.
The death of a loved one, whether anticipated or unexpected, is always traumatic for the relatives. The HSE’s Standards and Recommended Practices for Post-Mortem Examination Services recognises how important the post-mortem examination process is for families in providing information and comfort about the care of the loved one. Confusion around the need for, or right to, a post-mortem, can only compound the problems of the bereaved. Yet again, complaints like this show the need for good communication, clear procedures and adherence to procedures.