FULL REPORT: Medical misadventure verdict in tragic death of young Leitrim farmer

An inquest in Sligo last Monday returned a verdict of medical misadventure in the case of a 31-year-old Leitrim farmer who was gored by a bull on the family farm on February 2, 2019 and died 12 days later in Sligo University Hospital.

Anthony Cull, Castlefore, Keshcarrigan, Co Leitrim suffered a shoulder dislocation and muscle injuries after he was attacked and struck with force by the animal while cleaning a pen on February 2 at the farm in Keshcarrigan.

He attended Sligo University Hospital and was treated for his injuries.

He was discharged on February 7 but collapsed at home two days later and returned to the hospital on February 9.

On this second occasion, he was not given a CT pulmonary angiogram which would have shown up the presence of blood clots in his lungs and would have “in all likelihood averted the tragedy of his death.”
He was discharged home after two hours.

After again becoming unwell at home, Mr Cull returned to the hospital for a third time.

On attending the emergency department on February 14, he was seen by a consultant in emergency medicine and it was arranged for him to have an urgent CT scan which confirmed he had a pulmonary embolism. It was a very large saddle embolism which has a very high mortality rate.

He was administered a “clot buster” drug. Despite treatment he became more unstable and had a cardiac arrest. He did not respond to resuscitation and he was declared dead at 4.08pm.

An autopsy report found that Mr Cull had died from bilateral pulmonary emboli and congestion in both lungs following on from an injury received from a bull while working on a farm.

Anthony's parents Gerard and Dympna, sister Nicola, and best friend Kevin Scollan were present at the hearing.

Speaking after the inquest, Gabriel Toolan, solicitor acting for the Cull family, said it was “just unthinkable that something of this magnitude could have happened.”

Mr Toolan said lessons seem to have been recognised and protocols implemented which is a source of some solace to the family, “but obviously nothing can replace or substitute the intense loss and grief the family have experienced over the past four years.”

He described Anthony as “an extraordinary young man” who had developed his own electrician's business, and was very successful and very popular.

“He helped his father throughout his life on the family farm and they were in the process of transferring the farm and Gerard was looking forward to retirement.

“Whilst there was the initial trauma of course of having suffered quite a serious injury on the farm, all the expectations were that he was going to recover and he was expected to recover.”

EVIDENCE

Gerard Cull told the inquest that on February 2, 2019, he and his son Anthony had been cleaning a shed which contained two bulls.

He heard one of the bulls “squeal like a pig” and it turned on Anthony. He shouted for Anthony to get out of the pen. Anthony started to run for the barrier but the bull hit him before he got there.

Mr Cull ran over and picked up a grape and started to hit the bull who was trying to knee Anthony and was hitting him with its head with serious force. He jumped the barrier to keep the bull away and opened the gate to let it out.

He called the ambulance and an air ambulance took Anthony to hospital in Sligo. Anthony was released on February 7 and on February 9 he was again taken by ambulance to Sligo hospital after collapsing in the bathroom and complaining of a pain in his chest.

He was released from hospital on February 9 but was very weak and had to be brought to the car in a wheelchair.

Mr Cull was told Anthony had low blood pressure and to raise his legs up higher than his head if he felt unwell.

He said over the next few days Anthony fainted a good few times and spent most of the time in bed which was unlike him.

On February 14 he fainted again and they called an ambulance and he was taken to hospital again where he died that day.

Karen Baxter from the Health and Safety Authority said the HSA was not informed of the incident until it was brought to its attention by the Gardai in April 2021. No prosecution was taken in relation to health and safety legislation breaches.

Paramedic Pat Moran of the air ambulance said the patient was lying on the floor of the shed in extreme pain and distress. He was removed to SUH.

"I only came to know Mr Cull for a few days and he left a definite impression on me".

Mr Zia Janjua, Consultant General Surgeon SUH, said Mr Cull suffered multiple blunt injuries and was particularly sore in the chest, right shoulder and left leg / thigh.

He was in charge of Mr Cull from February 2 until his discharge on February 7.

Blood samples were taken and x-rays and a CT scan took place. A diagnosis was made that he had blunt thoracic abdominal and musculoskeletal trauma and would require observation for any deterioration and would need pain relief.

Over the next few days he was reviewed regularly and his observations remained normal. Pain was the main issue and he was again seen by the pain team and was given a sling by the orthopaedic team for his right shoulder.

On February 7 he did not show any signs of deterioration and he was clinically improving. Discharge was discussed with him and he was happy with it.

He said he only came to know Mr Cull for a few days and he left a definite impression on him. He was a healthy young man with a great sense of humour. He was shocked to learn of his death which he said was very difficult to accept.

Symptoms pointed to simple fainting episodes triggered by pain said registrar

Dr Edward Herridge, Registrar in Emergency Medicine, treated Mr Cull on February 9. He attended at 7.43am and Dr Herridge saw him at 8am.

Mr Cull told him he had been pain overnight and been nauseous. He collapsed with loss of consciousness in the bathroom. He then had a second collapse and an ambulance was called.

Dr Herridge examined him and did not find any heart or respiratory failure. His lungs sounded clear. He was awake, alert and fully conversant.

He prescribed him IV fluids and medicine for sickness and a set of blood tests and an ECG were taken.

Dr Herridge formed the opinion his symptoms pointed towards vasovagal syncope (simple fainting episodes) triggered by pain.

He managed to walk around the department twice although he was in discomfort from his injuries.

His blood results were within expected limits and the ECG showed no signs of a lack of blood supply to the heart or blood clots on his lungs.

Dr Herridge explained the benign nature of vasovagal syncope and gave him an information leaflet about first aid to someone who suffered a simple faint.

He was discharged from the department at 9.47am.

"Not sure any action on February 14 would have changed the outcome on that day" - Consultant

Dr Karen Harris, Consultant in Emergency Medicine at SUH, was the consultant on call on February 14 when Mr Cull presented to the Emergency Department.

One of the Senior House Officers told her the patient warranted a CT pulmonary angiogram as she was concerned he might have a pulmonary embolism.

Dr Harris noted in her statement that Mr Cull had presented on February 9 after collapsing at home and was treated with IV fluids and antiemetic and discharged home.

Dr Harris said when Mr Cull was brought back by ambulance on February 14 his respiration rate was fast. He was pale with normal blood pressure but a fast heart rate and low oxygen saturations.

He was given two litres of oxygen. He had bloods done and an ECG which was abnormal and showed evidence of heart strain and fast heart rate.

Dr Harris assessed him and was immediately worried about him as he likely had a pulmonary embolism. A CT scan confirmed he had a large pulmonary embolism.

She told his parents how sick he was and gave him a “clot buster” drug. The Culls were very upset and had lots of questions why he wasn't on blood thinners from his previous admission.

She said Mr Cull deteriorated and went into cardiac arrest very quickly. After an hour of resuscitation he remained in cardiac arrest and they stopped resuscitation at 4.08pm.

Dr Harris said she was not sure any action on February 14 would have changed the outcome on that day.

She wasn't involved on February 9 but said it was likely his symptoms on that day were related to blood clots and Mr Cull should have been readmitted to hospital.

She said unfortunately they did not have a formal protocol in place at that time for such situations and he was not admitted.

Mr Toolan told the inquest the Cull family did not accept the findings of Dr Herridge and are of the firm belief that Anthony should have undergone a detailed investigation on February 9, including a CT sub pulmonary angiogram which would have revealed a pulmonary embolism and would have averted the tragedy of his death.
He said a verdict of medical misadventure should be delivered.

Declan Hegarty, solicitor for the HSE, said the question of the verdict was a matter for the jury and should they determine it to be medical misadventure, the HSE had no problem with that.

The jury delivered a verdict of medical misadventure. Coroner, Eamonn MacGowan, Sgt Derek Butler on behalf of An Garda Siochana, Mr Hegarty on behalf of the HSE, and the jury all offered their sympathies to the Cull family.

Mr Toolan said the HSE has formally apologised to the family and confirmed that legal proceedings are now in train.

Mr Toolan said the family only learned at the inquest that protocols are now in place in the hospital to avert tragedies like this in the future.