The administration of antibiotics in a timely and appropriate manner would likely have prevented the death of 16-year-old Aoife Johnston, an inquest has heard.
The 16-year-old, who presented at University Hospital Limerick (UHL) on the evening of December 17th, 2022, waited over 15 hours to be given antibiotics to treat suspected sepsis. Ms Johnston was triaged as a Category 2 patient, and should have been seen by a doctor within 10 to 15 minutes, the inquest heard.
Ms Johnston, late of Shannon, Co Clare, eventually died on December 19th, from sepsis related to meningitis.
Dr Patrick Stapleton, a consultant microbiologist at UHL, told Limerick Coroner’s Court on Wednesday that the pathogen present in Ms Johnston’s body, meningococcus, was amenable to antibiotics, and could have been treated with a range of antibiotics.
Dr Stapleton said it was “highly likely” that the outcome in Ms Johnston’s case “would have been different and optimal” had antibiotics been administered in an appropriate and timely manner.
He agreed that delays in treating sepsis significantly increase mortality rates.
Evidence heard at the inquest on Wednesday, sitting at Kilmallock Courthouse in Co Limerick before coroner John McNamara, was often fraught with emotion, with one general nursing manager breaking down in tears in the witness box.
“I have been moved by Aoife’s death, every night and every day,” Fiona Steed said. “I will never forget Aoife, and her beautiful face.”
The inquest heard that on the night of December 17th, nursing staff – amid a “chaotic” and war zone-like environment in the emergency department – contacted two consultants to inform them of significant overcrowding. An emergency consultant refused to attend the hospital following a request from the staff, the inquest heard.
This, it appears, left staff at the hospital “utterly leaderless”, said Damien Tansey SC, for the bereaved family, who were present in court.
Patricia Donovan, assistant director of nursing at the hospital, who told clinical nurse manager Katherine Skelly to contact on-call consultants with concerns about overcrowding, said she was “not surprised, but disappointed” that the emergency consultant did not attend when requested.
She initially told Ms Skelly to contact the consultants as she wanted them to be aware of the significant number of Category 2 patients presenting at the department. She explained that an emergency consultant would only attend the hospital in a major emergency situation, as opposed to a volume issue.
Ms Donovan agreed with Mr Tansey that there was an overconcentration of medical expertise dealing with fractures and broken bones within the emergency department on the night of December 17th, into the next morning. The inquest heard that at one point, two doctors were working in the resuscitation room of the emergency department, while about 160 patients – including scores of Category 2 patients – waited for treatment.
Responding to questioning from Mr Tansey, Dr Muneeb Shahid, a registrar working in the emergency department on the night in question, said he did not recall nursing staff – on three occasions – urging doctors in the resuscitation room to engage with patients elsewhere in the department.
Ms Donovan, who attended the emergency department five or six times during her shift of the night of December 17th, told the inquest that she was not told about Ms Johnston or her condition, despite her being the sickest patient in the department.
Fiona Steed, who was general nursing manager and the “executive on call” on the weekend in question, told the inquest that in a telephone conversation around 10.30pm on December 17th, she advised Ms Donovan on a number of measures to relieve capacity issues at the emergency department. This advice – which would have moved 30 to 40 patients out of the emergency department, Ms Steed said – was not followed, the inquest heard.
“I wrongly, and regrettably, presumed that my advice had been followed,” she said. “Nobody came back to me to say that this hadn’t happened.”
Ms Steed did not attend the hospital on the evening in question, stating that it was not normal practice for her to do so.
When it was put to her by Mr Tansey that it was not beyond her remit to attend at the hospital, Ms Steed said the true extent of the dire situation at the emergency department was not portrayed to her by Ms Donovan. While she accepted that the hospital was severely overcrowded, this was not the criteria for a “major emergency”, she said.
She accepted that nothing she did improved the situation at the emergency department – rather, overcrowding worsened from Saturday night, into Sunday morning.
Ms Steed told the coroner that she had been informed of the emergency consultant’s refusal to attend the hospital on the evening of December 17th, and that she “escalated” this by telling the clinical director of medicine, Declan McNamara, via text message.
Asked by Damien Tansey, for the bereaved family, if she was moved by Ms Johnston’s death, Ms Steed broke down in tears.
“I have been moved by Aoife’s death every night and every day,” she said. “I look at my daughters and realise how lucky I am to have them. I will never forget Aoife, and her beautiful face”
Meagan Johnston, sister of the bereaved, left the courtroom as Ms Steed spoke. As she walked from the room, she said, tearfully: “We go home without Aoife everyday.” This prompted a short adjournment of the hearing.
Ms Steed again offered condolences to the bereaved family before leaving the stand. “She was beautiful, and I will never forget [her] ... I know that is no comfort to you, but it has completely altered my approach to life and my own children,” she said.
The inquest continues on Thursday.
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