By Irishexaminer.com,Seán McCárthaigh

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She said she was not shy about expressing her displeasure at what she described as “a very small report after a long investigation”.

“I’m dissatisfied with the way the HSA has not sent information in a timely fashion. That is not appropriate,” said Dr Nolan.

Mr Byrne, 79, a widower and father of five from Ard Brid, Suncroft, died when an ambulance burst into flames shortly after it arrived outside the emergency department at Naas General Hospital on September 22, 2016.

Two paramedics who tried to assist the patient were also injured.

It is understood the fire arose after an oxygen cylinder in the vehicle ignited.

The inquest was originally opened and adjourned in March 2017 to allow for a file on the case to be forwarded to the DPP.

Dr Nolan recalled her predecessor as coroner, Denis Cusack, had raised concerns at the time about the time waiting to receive reports on the case, particularly from the HSA.

She also noted the case had been outside her hands for a seven-year period as the DPP had only directed last February that no prosecution should arise from the circumstances of Mr Byrne’s death.

She revealed she had only been furnished with the HSA’s summary report in June 2025 and she was not satisfied its content was sufficient.

Dr Nolan said she had to use her statutory powers to direct the HSA to produce additional documents and exhibits, which she only received last week.

She observed she should not have to resort to such a course of action to obtain relevant paperwork.

Counsel for the deceased’s family, John Kennedy SC, said it was “wholly unsatisfactory” that there had not been meaningful engagement by the HSA. He expressed concern he would not be in a position to ask questions of an expert witness due to give evidence at the hearing based on the HSA’s summary report.

Counsel for BOC Gases, which supplied an oxygen cylinder used in the ambulance, Ronan Kennedy SC, also said he was extremely concerned to discover at the hearing that other parties might have material which had not been available to his client.

Mr Kennedy claimed he was entitled to be provided with a list of witnesses and copies of their draft depositions, as well as any other relevant material in advance of the inquest proceeding.

Counsel for the HSE and the National Ambulance Service, Damian Sheridan BL, said he also had identified three additional witnesses on top of 12 proposed witnesses due to be called by the coroner.

Dr Nolan adjourned the hearing to a date to be determined after hearing submissions from various legal teams that a fresh jury should be empanelled to hear the case, and to allow for all relevant documents to be circulated to the parties.