A “gargantuanly overcrowded” emergency department at University Hospital Limerick (UHL) was “like a death trap” on the weekend that Aoife Johnston (16) presented suffering from suspected septic shock, an emergency medicine consultant has said.
“Aoife Johnston had no chance,” Dr James Gray, who was on-call on the weekend in question, told Limerick Coroner’s Court on Thursday morning.
Dr Gray, who agreed that he was the most senior clinician working in the hospital’s emergency department while “on-site”, said he would have attended the emergency department on the evening that Aoife presented at the hospital, December 17th, 2022, had he known about her case.
He likened UHL’s emergency department to an aeroplane with passengers in every seat and blocking up the aisles. “The department could not function,” he said.
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“It was grossly overcrowded,” he said, “and dangerous”.
Dr Gray was the emergency medicine consultant on-call from 8am on December 17th to 8am to December 19th, and attended the emergency department “during the day” on both Saturday and Sunday.
He said he did not accede to a request from clinical nurse manager Katherine Skelly to attend the department on Saturday evening because he had to attend the hospital again on Sunday morning. He also noted that it was impossible to attend the hospital due to capacity difficulties at the emergency department, “because it was always overcrowded”.
“I was physically unable to come in,” he said. “I’m not Superman.”
He added: “The department was habitually overcrowded ... and still is.”
He said, while he was on-call, he was available to give advice to medical staff at the hospital over the phone, and attend on a “case by case basis”.
He said he was not made aware of Aoife’s case. “I was not aware of any individual case that warranted my attention,” he said.
He agreed with Damien Tansey SC, for the bereaved family, that it was entirely unacceptable that scores of Category 2 patients were waiting hours to be seen by doctors on the night in question.
He said “the only thing that would have worked” in tackling the crisis unfolding at the hospital was enacting the hospital’s “major emergency” plan. This, Dr Gray said, was the decision of the executive on call – Fiona Steed, general nursing manager, in this instance – along with the hospital’s executive team.
Activating the hospital’s major emergency plan would have triggered a “cascade” effect, with consultants on call required to attend the hospital.
Ciara Daly, counsel for Ms Steed, put it to Dr Gray that it was only the executive team that could “activate” the plan.
Dr Gray replied it was “his understanding” that the executive on call made the decision along with the hospital’s executive team.
The consultant said it was “entirely unacceptable” that Aoife waited 15 hours to receive medication for suspected sepsis. He said when she did eventually receive antibiotics, “her prognosis was very poor”.
Had she been seen within 10 minutes – “which she should have been ... as per the [hospital’s sepsis] protocol”, Dr Gray said – Aoife would have had a much better chance of survival, the inquest heard.
He noted that when she did receive care from Dr Leandri Card, the senior house officer on duty over the weekend, “she got good care, but it was far too late”.
Dr Gray agreed that the pathogen in Aoife’s body, meningococcus, was amenable to antibiotics. “That’s the tragedy of this situation,” he said.
He described the teenager’s experience in the emergency department – left without a bed, she lay across two chairs while suffering from septic shock – as “an abuse of human right”. “No dignity, no privacy ... very poor,” he said.
Limerick Coroner’s Court heard on Wednesday that it was “highly likely” that Aoife would have survived had she been treated with antibiotics in a timely and appropriate manner.
However, the teenager – who presented at UHL on the evening of December 17th with suspected sepsis – waited over 15 hours to be given vital antibiotics. This was despite her being triaged as a Category 2 patient, which meant she should have been seen by a doctor within 10 to 15 minutes.
Dr Patrick Stapleton, a consultant microbiologist at UHL, told the court on Wednesday that the pathogen present in Aoife’s body, meningococcus, was amenable to antibiotics, and could have been treated with a range of antibiotics.
A pathologist, Dr Terezia Lazlo, confirmed that the cause of death in Aoife’s case was purulent meningitis. Dr Lazlo gave evidence on behalf of Dr Gabor Laskai, who carried out the postmortem.
The inquest, sitting before Mr John McNamara, continues.
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