The problems at University Hospital Limerick (UHL) have been well documented in recent years, with its emergency department (ED) almost always overflowing with patients.
Consistently found to have the highest daily number of patients on trolleys by the Irish Nurses and Midwives’ Organisation’s trolley watch, last year UHL was found to be the most overcrowded hospital in Ireland.
In 2022, the Health Information and Quality Authority (Hiqa) found that chronic overcrowding as well as significant nurse and bed shortages left the hospital’s ED trying to treat twice as many patients as it was designed to cope with. A year later, a January 2023 report found significant risks to patient safety remained.
These conditions led to the death in December 2022 of 16-year-old Aoife Johnston, in shockingly overcrowded circumstances outlined at the local coroner’s court this week.
Aoife presented to the hospital at 5.40pm on December 17th, 2022. She was not triaged until 7.15pm that night, and she waited over 15 hours to be given antibiotics to treat suspected sepsis.
She was triaged as a Category 2 patient, and should have been seen by a doctor within 10 to 15 minutes, her inquest heard. By the time she was administered antibiotics, it was too late.
But the actions that led to Aoife Johnston’s delayed treatment, and ultimately her death, all come down to the issues highlighted again and again: overcrowding and understaffing.
Dr Leandri Card, a senior house officer (SHO) who was treating Johnston before her death, said she was trying to manage 191 ED patients on her own, and said “every inch of the floor space” was taken up by patients on trolleys, describing it as “a war zone. It was an impossible situation”.
On Wednesday, Dr Patrick Stapleton, a consultant microbiologist at UHL, told Limerick Coroner’s Court it was “highly likely” the outcome in Johnston’s case “would have been different and optimal” had antibiotics been administered in an appropriate and timely manner.
Dr James Gray, an emergency consultant who was on-call the weekend Johnston died, said she “had no chance,” and the department was “like a death trap”.
The evidence presented to the coroner throughout the inquest was an indictment of the health service. This is not how the system should operate.
Aoife Johnston’s death was one of a number at the hospital which have caused concern in recent years. In 2019, 21-year-old Eve Cleary died from a lung clot shortly after spending 17 hours on a trolley in the hospital. In January of this year, a second 16-year-old girl died in UHL, while in February an inquiry was launched following the sudden death of a 33-year-old pregnant woman.
Former chief justice Frank Clarke is compiling a report, due to be completed by the end of May, on the circumstances surrounding Johnston’s death. It will address the contributory factors within UHL that led to the tragedy. But her inquest, which returned a verdict of medical misadventure, also sheds valuable insight into the reality for patients and staff at UHL.
Campaigners have repeatedly said the issues in UHL stem from the closure of the St John’s in Limerick City, Nenagh and Ennis EDs, without ramping up capacity in UHL first.
But according to the Government, steps have been taken to improve the provision of care in the hospital. This week, Taoiseach Simon Harris told the Dáil there had been a 42 per cent increase in staffing levels – or 1,100 additional staff appointed – since 2019. There had also been a 44 per cent increase in the hospital’s budget, he said.
Despite these efforts, issues undeniably remain. Johnston’s parents told her she was in the “best place” at the time of her illness. Unfortunately, this proved to be untrue. In order to ensure optimal care is delivered to all patients, capacity, consultant cover and overall staff levels remain issues that must be addressed.
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