Belfast Telegraph

Doctors missed chances to detect dying inmate's cancer, inquest is told

By Claire O'Boyle

Prison doctors missed repeated chances to detect and treat an inmate's deadly cancer, an inquest has heard.

Samuel Alexander Smyth, known as Alec, died just four weeks after his cancer was finally spotted in November 2013. By then, it had spread to his brain, glands and probably his bones, the inquest was told.

Along with a large tumour in his right lung and a smaller one in his brain, Mr Smyth was found to have been suffering from pneumonia. His weight fell from 16 stone in April 2013 to 12st 3lbs by the time he died.

Mr Smyth (56), who spent his last months isolated in a filthy cell he shared with his pet budgies, had first presented with a long list of symptoms to a prison GP seven months earlier.

The doctor noted a sore throat, hoarse voice and an upper respiratory tract infection, adding that the prisoner, who was jailed for life in the 1970s, was a smoker. Detecting swollen lymph nodes in his neck and clavicle, Dr Ryan prescribed antibiotics.

The prisoner saw a different GP, Dr Palmer, two weeks later, who again noted Mr Smyth's hoarseness.

He did not check the prisoner's medical history, but noticed a cough and laboured breathing and referred him for a chest X-ray and blood tests.

But Mr Smyth, who was described at the inquest as a stubborn, difficult individual with a history of not engaging with prison authorities, failed to turn up for his X-ray on May 8, 2013.

No medical staff followed up on his decision, the inquest heard. Dr Palmer added: "We did not have a procedure for following up if someone didn't attend."

Results of blood tests ordered by Dr Palmer on April 30, 2013 appear not to have been examined or acted on by any medical staff at the prison.

These results were later found to reveal abnormalities that would have prompted further examination.

Dr Palmer explained that once he ordered the blood tests, the results should have come back to the prison's general medical team rather than directly to him.

He said they were either filed before a GP had a chance to examine them or were checked by a doctor who did not act on the abnormal results. He agreed this was "very concerning". Mr Smyth, who was convicted of murder in 1978 and lived in the separate loyalist wing of Maghaberry, was later seen by a third GP, Dr Takkolu, in an emergency appointment on June 20, 2013.

Again, Dr Takkolu did not examine medical records, but referred him as a 'red flag' suspected cancer case to specialists in Ear, Nose and Throat after hearing about his long-term hoarseness and difficulty swallowing.

Again, Mr Smyth failed to attend the appointment, the inquest at Laganside Court heard.

The prisoner was not seen again by a GP until November 1, 2013.

Again, medical records were not reviewed at this appointment, so his failure to attend his chest X-ray and 'red flag' appointment was not picked up.

Government guidelines suggest patients with 'red flag' referrals are seen within two weeks.

During this appointment, Dr Palmer diagnosed a chest infection and gave the prisoner - who served a total of 34 years in prison - antibiotics.

Two weeks later, Mr Smyth was back in front of Dr Takkolu who inquired about his earlier 'red flag' referral. Mr Smyth revealed he had not attended.

He finally received a CT scan later that month after another visit to Dr Palmer and cancer was diagnosed on November 22, 2013.

Doctors noted then his illness was terminal, although a care plan was not immediately put in place and he was not seen by another doctor until December 3. He died in Belfast City Hospital on December 18, 2013.

The inquest continues.

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