‘I look at my daughters and realize how lucky I am to have them’ – UHL executive in tears over death of Aoife Johnston (16)

‘I look at my daughters and realize how lucky I am to have them’ – UHL executive in tears over death of Aoife Johnston (16)
‘I look at my daughters and realize how lucky I am to have them’ – UHL executive in tears over death of Aoife Johnston (16)

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 with suspected sepsis. She was not seen by a doctor for over 12 hours and did not receive the antibiotics that might have saved her life for 15 hours and 15 minutes.

Ms Steed, a former UHL general manager, who is now with the Department of Health, was asked if the circumstances of Aoife’s death had moved her.

“I have been moved by Aoife’s death every night and every day since,” she said.

“I look at my daughters and realize 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.”

The Johnston family say they are determined no other family should endure the tragedy of their loss as they are “haunted” by the fact that Aoife could, and should, have been saved from her infection with prompt antibiotic treatment.

The inquest, before Limerick coroner John McNamara, was told by 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,” she said.

She said she did everything she could to offer support and advice to UHL staff that weekend.

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 spiraling pressure on staff.

A pediatric 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,” said Ms Steed.

She added that she alerted him (clinical director) by text but did not receive a reply that night, saying: “I do not have the power to compel consultants to come in.”

Ms Steed said 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 the 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,” she said.

Ms Steed said she had a fundamental difference with consultants as “I felt that there should be an emergency consultant on site all the time”.

“The emergency department should not hold all the risk as it did that night. “It should have been spread across the (hospital) group.”

A senior nurse said she was “disappointed but not surprised” that two consultants had refused to attend UHL emergency department on December 17/18 2022 amid an unprecedented surge in patient numbers.

One consultant declined but then changed his mind and attended UHL within 30 minutes.

A second consultant said he would only attend UHL emergency department in case of a major emergency and not patient volume issues.

Assistant director of nursing (ADON) Patricia Donovan gave evidence on the third day of the inquest.

Ms Donovan was the ADON on duty in UHL on the evening of December 17, 2022 when Aoife was brought to UHL’s emergency department by her parents.

Aoife had attended a SouthDoc GP who feared that she had sepsis.

Despite a letter from the GP warning that Aoife may have sepsis, she was not triaged for over an hour and was not seen by a doctor for 12 hours.

She died on December 19 from sepsis linked to meningitis as her parents, James and Carol, said they had to watch their daughter dying despite their 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.

Because there were no trolleys available, Aoife had to rest on two chairs pushed together by her parents.

She was placed in what her parents described as a storeroom off an emergency department corridor.

Ms Donovan said she had no involvement in Aoife’s clinical care and her case was not mentioned to her that evening.

She told UHL that evening faced a shortfall of 21 nursing staff – 17 of which were known about in advance with four 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 (CNM) on duty, Katherine Skelly.

Ms Donovan said senior managers were alerted and surge measures were organized amid growing concerns over patient treatment waiting times.

“I recommended that she (Katherine) contacted the emergency consultant Dr Jim Gray and the pediatric consultant and advised 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.”

Ms Donovan said both consultants declined to attend UHL.

However, the pediatric consultant then attended the hospital within 30 minutes and stayed for over two hours helping with patients.

“The emergency consultant would only attend for a major emergency and not for volume,” said Ms Donovan.

Mr Tansey SC asked what his response was to this refusal?

“(I was) disappointed – not surprised but disappointed,” she said.

Mr Tansey asked whether the consultant’s refusal to attend UHL had resulted in the matter being raised with UHL’s clinical director.

“I cannot confirm but I believe that it was,” said Ms Donovan.

Mr Tansey argued that UHL’s emergency department that night was facing “an emergency on steroids”.

She said it was not the norm for nurse managers or senior nurses to call consultants in such circumstances.

Ms Donovan agreed with Mr Tansey that the overcrowding, the understaffing and the large number of seriously ill patients resulted in an enormous risk.

She said that when she arrived at UHL on December 17 there were 153 patients in the emergency department.

However, there was an influx of category two patients over December 17/18, mostly due to falls and fractures.

During Ms Donovan’s shift the number of patients in the emergency department rose to 164. By December 18 it had soared to 191.

Ms Donovan wept as she addressed the Johnston family.

“As Katherine (Skelly) said, it has impacted hugely on all of us who worked there and still work in that department. I cannot know your pain. I am very sorry,” she said.

Ms Skelly had serious concerns that night over the numbers in the emergency department and the large number of patients waiting for treatment.

“I advised Katherine (Skelly) that I would escalate this to the executive-on-call,” Ms Donovan said.

Mr Tansey said the circumstances of Aoife’s death and the fact that she could and should have been saved by the prompt treatment of antibiotics was “haunting” her family.

“This is an open wound for this family,” he said and added that the Johnston family wanted the inquest process to conclude without delay.

Consultant anaesthetist Dr Fasih Khan saw Aoife on December 18 but her condition had deteriorated too far for her to be saved.

Aoife died after critical pressure on her brain stem due to her infection.

“She deteriorated very rapidly,” said Dr Khan.

A junior doctor who fought to save Aoife’s life said medical staff faced “an impossible situation” in the UHL emergency department because of chronic overcrowding in December 2022.

Aoife arrived at UHL at 5.40pm on December 17, but did not receive the critical antibiotics until around 7am on December 18, a delay with tragic consequences. She was not seen by a doctor until after 6am despite pleas from her family.

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.

Mr Tansey said that three separate opportunities to intervene to save Aoife were missed.

“She slipped through all the cracks. She was missed all the way along – from handover, registering meetings and the various reports done.”

The numbers in the emergency department soared from 101 to 191 patients in just over 24 hours.

Two doctors confirmed that such was the scale of overcrowding within the emergency department that doctors would sign prescriptions for medicines to deal with symptomatic issues such as nausea and diarrhea on the recommendation of a triage nurse and without actually having seen the patient.

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 and 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.”

Aoife was ranked as a category two patient which meant she should have received medical treatment for her sepsis within 15 minutes.

The inquest into her death opened on Monday with apologies to the Johnston family from both the HSE and the University of Limerick Hospitals Group for the failures in care provided to Aoife in December 2022.

Aoife’s parents attended the Kilmallock inquest alongside her sisters, Meagan and Kate.

Framed photographs of Aoife were placed on the table before the coroner.

“We watched our daughter die,” Ms Johnston told the courtroom.

“I wouldn’t wish it on anyone. God love her. “We told her she was in the best place (UHL) but it turned out she was not.”

Mr Johnston said: “I went up and down to the nurses all night pleading with them to help my daughter.

“Aoife was screaming in agony with pain to her right leg and head. I heard people outside on the trolleys asking the nurses and doctors to help Aoife. At one point a man said: ‘Is someone not going to go into that girl’?”

The inquest is expected to conclude tomorrow.

Today’s News in 90 Seconds – April 24th

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