University Hospital Limerick ED ‘akin to a war zone’ on weekend Aoife Johnston died, nurse says

Nurse manager says there were so many individual cases that night it was equivalent to major incident like bus crash

The Emergency Department at University Hospital Limerick was “akin to a war zone” on the weekend that 16-year-old sepsis patient Aoife Johnston died there , a senior nurse has said.

Clinical Nurse Manager 2, Katherine Skelly, was on duty on the night that Aoife attended and she said that weekend proved the busiest on record until then with 160 patients in the Emergency Department.

“What I observed was akin to a war zone – every area was overcrowded with patients. Trolleys were placed back-to-back and lined either side of the corridors. Every available floor space was taken, patients were lying and sitting in every nook and cranny,” she said.

Ms Skelly said that there were 15 nurses on duty that night but the correct allocation was 20 and given the volume of patients presenting at the ED due to falls and accidents on icy roads and footpaths, she estimated that they would have needed 30 nurses.

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She said that such was the volume of patients that 67 Category 2 Patients – seriously ill patients who should be seen by a doctor within ten to fifteen minutes – were waiting for ten hours which was posing a serious safety risk to patients.

She said while they were not dealing with any single major incident like a bus crash, there were so many individual incidents that she believed it was the equivalent of a major incident which prompted her to ring the ED Consultant Dr Jim Gray.

“I escalated to him the risks to patients, the volume and acuity and how unsafe the department was and requested that he come in. He declined – the conversation was brief – he said he had been in already that day and would be in again in the morning. I was disappointed.”

Ms Skelly was giving evidence at the inquest into the death of Aoife Johnston from Shannon who died from sepsis at UHL on December 19th, 2022 almost 48 hours after she was presented at the hospital’s emergency department where she was left waiting for 12 hours before she saw a doctor.

Ms Skelly said that she had since left University Hospital Limerick and was now working elsewhere but she had never worked in an Emergency Department because of Aoife’s death.

“Absolutely it broke me personally and professionally that that poor girl died,” she said.

Nurse Ciara McCarthy, who cared for Aoife in Zone A where Category 2 patients were being treated, is currently in Australia so she did not attend the inquest but her deposition in which she outlined what steps she took to treat Aoife was read into evidence.

Ms McCarthy said that it was a particularly busy night in the Emergency Department with approximately 70 patients where there are three nurses allocated to look after them and she checked regularly on Aoife including at 11.50pm on December 17th.

Aoife stated that she was nauseated and vomiting so she Ms McCarthy spoke to a doctor, Dr Babal Rag, advising him that Aoife had not yet been seen by a doctor and she needed some medications, so he wrote a prescription for her which she (Ms McCarthy) administered, she said

At 1.40am Aoife’s vital signs had not improved so she contacted another ED Registrar, Dr Muneeb Shahid, and brought Aoife’s medical notes to him in the Resuscitation Room and he prescribed further medications for Aoife.

Ms McCarthy said she checked Aoife again at 4am where her vital signs were again a concern, so she spoke to another ED Registrar, Dr Mohamed Hassan, whom she asked to come and see Aoife, but he refused and said it sounded viral and to continue treating her with paracetamol every four hours.

Dr Hassan said that he had no recollection of ever having that conversation with Nurse McCarthy and thought it highly unlikely it ever happened as it wasn’t the appropriate channel of communication for a nurse in Zone A to contact him directly in the Resus Room which was very busy on the night.

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