Catherine Mary McNamara · Prevention of Future Deaths report

On 13th May 2019 I commenced an investigation into the death of Catherine Mary McNamara. The investigation concluded on the 11th December 2019 and the conclusion was one of Narrative: Died from natural causes contributed to by toxicity of prescribed medication. The medical cause of death was 1a) Acute left ventricular failure; 1b) Coronary atherosclerosis and left ventricular hypertrophy with superimposed opiate toxicity

Catherine Mary McNamara was prescribed significant quantities of pain medication including opiates. On 11th May 2019 she was found in bed at her home address, ████████ Post Mortem examination including toxicology found that she had a level of prescribed opiates in her system which in combination with over the counter medications had contributed to her death from acute left ventricular failure. The evidence indicated that she had not taken any medication after 8th May 2019 and was not seen or heard from after that date and that on the balance of probabilities she died in the early hours of 9th May 2019.

The inquest heard that over a number of years the amount of prescribed opiates had increased to a level where they led her to fall asleep and fall over. After concerns were raised by her family, the General Practitioner and the pain clinic began to work with her to decrease the amount of prescribed opiates she received. This was challenging due to the high dose she had been on. At the time of her death she was on a high level (although it had decreased from the previous higher level). The coroner was advised how she had reached such high levels initially and the understanding of the impact this had on her.