Dr Patrick Stapleton told a Limerick coroner’s inquest that the Type B meningococcal infection he found that Aoife had contracted was readily treatable with targeted antibiotics.
He told Coroner John McNamara that Aoife most likely would have survived had she received the medications in time.
“It is highly likely that the outcome would have been different and optimal,” he said.
Once he realised the 15-hour delay involved, he rang the executive-on-call at UHL, Fiona Steed, and raised his concerns and recommended an urgent investigation.
Every two hour delay in administering the medications results in a twofold increase in meningitis and sepsis mortality risk.
Registrar Dr Muneeb Shahid, who was responsible for the emergency department section at UHL where Aoife was on December 17/18, 2022, said he cannot recall a nurse urging him to check on the teenager that night.
He also said he cannot recall a nurse manager urging him to leave the resuscitation unit where fracture patients were being treated to check on more seriously ill patients including Aoife in Zone A of the emergency department.
Dr Shahid said he had gone to a cubicle to check on Aoife after a Senior House Officer raised concerns at 6am on December 18 about her possibly having meningitis and had seen Aoife’s parents, James and Carol.
But Aoife’s parents, who were with her during her time in the emergency department, insisted to the inquest they had never seen Dr Shahid before.
UHL legal counsel, Conor Halpin SC, insisted to the inquest that Aoife was always a Category Two or seriously ill patient at UHL – after Dr Shahid raising the possibility that Aoife had been re-triaged to a less serious Category Three patient despite her having sepsis.
Meanwhile, the executive-in-charge at University Hospital Limerick (UHL) broke down and cried as she told the inquest that she thinks of Aoife every day and every night and will never forget “her beautiful face”.
Fiona Steed, who was executive-in-charge at UHL on December 17/18 2022, said understaffing and overcrowding undermined the ability of the hospital to care for its patients.
Aoife died from meningitis-related sepsis after arriving at UHL after 5pm on December 17 – but was not seen by a doctor until 6am and did not receive antibiotics until after 7am, a delay of 15 hours and 15 minutes.
“I have been moved by Aoife’s death every night and every day since,” she sobbed.
“I look at my daughters and realise how lucky I am to have them. I think of Aoife.
“I will never forget Aoife or her beautiful face. These are not hollow condolences. It has completely altered my approach to life and my approach to my children.”
Members of the Johnston family became visibly upset during Ms Steed’s evidence.
Aoife’s sister, Meagan, left the inquest courtroom in tears as she said: “We go home without Aoife every day.” She was comforted by her parents, James and Carol, and her sister, Kate.
Ms Steed that the words “major emergency” and “warzone” were never used to her on the night of December 17 in terms of the chaotic conditions in the emergency department.
“Those words were not used to me on Saturday. They were used to me on Sunday.”
Ms Steed was asked by counsel for the Johnston family, Damien Tansey SC, what she did when she became aware that two consultants had declined to attend UHL emergency department despite a call from a nurse manager warning about the spiralling pressure on staff.
A paediatric consultant declined to attend but then arrived at UHL within 30 minutes and worked for over two hours to assist patients.
Emergency Consultant Dr James Gray declined to attend.
“I called the (UHL) Clinical Director and said that Dr Gray did not come in. It is not a complaint – I escalated it.”
Ms Steed said she alerted him (Clinical Director) by text but did not receive a reply that night.
“I do not have the power to compel consultants to come in.”
She advised medical staff on duty that night to implement a surge policy, to reopen some units and to transfer patients on trolleys from the emergency department to wards.
However, this ward transfer was not done due to infection and geriatric care concerns.
“When I didn’t hear back…I wrongly and regrettably thought my advice had been followed. The emergency department should not hold all the risk as it did that night – absolutely it was. It should have been spread across the (hospital) group.”
Assistant Director of Nursing Patricia Donovan was the ADON on duty in UHL when Aoife was brought to UHL’s emergency department.
James and Carol Johnston warned they had to watch their daughter dying despite their desperate and repeated pleas for her to be helped.
Despite being the most seriously ill patient in the emergency department, Aoife was not mentioned in the nursing handover report on December 18.
ADON Donovan said UHL that evening faced a shortfall of 21 nursing staff – 17 of which were known about in advance and four were unplanned.
Aoife arrived in UHL as Ireland went from a Status Red to a Status Yellow ice alert and the hospital faced a flood of patients injured in ice-related falls.
Concerns about overcrowding in the emergency department were brought to Ms Donovan’s notice by the Clinical Nurse Manager on duty, Katherine Skelly.
Ms Donovan said that senior managers were alerted and surge measures were organised amid growing concerns over patient treatment waiting times.
“I recommended that she (Katherine) contact the Emergency Consultant Dr Jim Gray and the Paediatric Consultant and advise them of the activity in the departments,” she said.
“In particular I wanted the consultants to be aware of the number of Category Two patients awaiting treatment.”
“The Emergency Consultant would only attend for a major emergency and not for volume,” she explained.
Mr Tansey SC asked what her response was to this refusal?
“(I was) disappointed – not surprised but disappointed,” she said.
Ms Donovan wept as she addressed the Johnston family.
“As Katherine (Skelly) said it has impacted hugely on all of us that worked there and still work in that department. I cannot know your pain. I am very sorry (for your loss),” she said.
The inquest, which is in its third day at hearing, dealt with evidence from a number of medical personnel on duty over that 48 hour period.
It emerged that several nurses and nurse managers had desperately sought clinical support measures given the spiralling pressure on the emergency department over December 17/18 2022.
Mr Tansey said that three separate opportunities to intervene to save Aoife were missed.
The numbers in the emergency department soared from 101 to 191 patients in just over 24 hours.
Category Two patients, which require treatment within 15 minutes, faced lengthy delays in treatment due to the overcrowding.
The longest wait for a Category Two patient that weekend was a shocking 19 hours.
A less ill Category Three Patient faced a wait time of up to 39 hours.
UHLG Clinical Director Damien Ryan, who was not in the role when Aoife died, said the issue of overcrowding and patients spending excessive time on trolleys will be addressed when a new 96 bed unit opens at UHL and further investment in the hospital is completed.
“It is not satisfactory,” he said in terms of the conditions at UHL over December 17/18 2022.
“It (UHL) is the hospital in the region that others feed into. One of the things we have put in place (after Aoife’s death) is an emergency department escalation plan. It has a number of triggers – the number of patients in the department, the number waiting to be seen, the number of Category Two patients.”
“It is fair to say that if the scenario pertained today, the emergency medical consultant on call would attend under the emergency escalation plan.”
The inquest is expected to conclude on Thursday.
Today’s News in 90 Seconds – April 24th
