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Medical misadventure verdict at inquest of nursing home resident

Medical misadventure verdict at inquest of nursing home resident

Bernadette Mee and Sr Gabriel Margaret Mee, sisters of John Mee, alongside Martin Kerrigan from Berwick Solicitors and Doireann O’Mahony BL, captured at Kilmallock Courthouse. Photo credit: Brendan Gleeson.

News story reported in The Irish Times, Irish Examiner, Irish Mirror and Limerick Post


At Kilmallock Courthouse, a detailed inquiry unfolded regarding the circumstances leading to the unfortunate demise of Mr. John Mee, a 71-year-old resident of Cahercalla Nursing Home in Ennis, Co Clare. The formal inquest, adjudicated by Limerick Coroner John McNamara, delivered a verdict of medical misadventure, highlighting a critical medication error as a significant contributing factor to Mr. Mee’s death on June 30th, 2021.

Representatives Martin Kerrigan from Berwick Solicitors and Doireann O’Mahony BL attended the proceedings alongside Mr. Mee’s sisters, Bernadette Mee and Sr Gabriel Margaret Mee.

The inquest meticulously examined the operational pressures on healthcare personnel at the nursing home. Testimonies revealed that the facility was unusually busy, with a staffing ratio of two personnel responsible for the care of 23 residents on the night in question. This detail provided context to the medication error made by staff nurse, who inadvertently administered another resident’s medication, including a high dose of an antipsychotic drug, to Mr. Mee.

Coroner McNamara, in his verdict, emphasised the accidental nature of the overdose yet recognised its role as a material contributory factor to the subsequent fatality.

The inquest’s outcomes underscored the paramount importance of adherence to best practices in the administration of medications within healthcare facilities. It brought to light the challenges faced by nursing home staff and the imperative for systemic improvements to ensure patient safety.

Furthermore, the case acts as a critical reminder of the complexities inherent in healthcare delivery, especially in high-pressure environments like nursing homes. It illustrates the thin margin for error in medication administration and the profound implications such errors can have on patient health and safety.

In sum, the inquest into John Mee’s death has brought important issues to the forefront, catalysing discussions on patient safety, healthcare staffing, and procedural rigor in medication administration.