The intensive care unit of Limerick Regional Hospital is so understaffed at night that porters or security staff have to be called in to watch patients who require individual attention.
This emerged during an inquest into the death of a 20-year-old Limerick man, who fell out of his bed while being cared for in the specialist unit in the hospital in March 1997.
The acting coroner for Cork City, Mr Patrick Dorgan, criticised the Mid-Western Health Board for its failure to co-operate with the inquest initially by advising the nurses on the ward through its legal advisers not to make statements regarding the incident.
Mr Adrian McInerney was admitted to the hospital on March 10th, 1997, after falling down the stairs in his home at O'Callaghan Avenue, Killeely, Limerick. He had earlier had a few drinks with his brother and on returning home decided he would go out again.
His mother, Mrs Olive McInerney, said he stumbled and fell, banging the right side of his head behind his ear against the wall. He was removed to hospital by ambulance and was semi-conscious in the intensive care unit. On March 14th, as she sat by his bedside, he reached out his hand.
The following day he recognised his mother and her sister when they visited.
"For the week while he was in Limerick we were told there was no bleeding or clotting. We were told that after he came home he might have mood swings," Mrs McInerney said. When they left the hospital that night Mr McInerney seemed better.
She rang the hospital later and was told that her son had suffered a setback, as he had fallen out of bed, and the family should come to the ward.
Nurse Mary O'Donnell said when she came on duty Mr McInerney was restless and restful alternately. He appeared to know his family when they visited.
After he was settled for the night, she went to get his drug treatment and heard a noise. She went into the ward and saw Nurses Walsh and Leahy helping him to stand. The sides of his bed were up.
Mr McInerney was helped back into bed. He was sensitive to light and he still had the headache which he complained about from the time he became conscious.
"After about five to 10 minutes he had a general seizure. He had been having epileptic seizures previously. I called the doctor and while he was examining him he had another seizure on the left side," said Nurse O'Donnell.
She called the doctor back an hour later because she was unhappy with the patient's condition and he was taken away for a CT scan. Mrs McInerney rang and she told her what happened and the family were advised to come back to the hospital.
After Mr McInerney returned from the scan he was transferred to Cork Regional Hospital, where he died on St Patrick's Day.
Questioned by a solicitor representing the family, Nurse O'Donnell said it seemed Mr McInerney got out of bed and fell. He had a slight bruise on his cheek. She said the bed rails on the side were up and it was possible he climbed over them or got out at the end.
She said he had been restless and agitated for most of the week. When patients were that ill and getting out of control, during the day there would usually be a nurse available to watch the person on an individual basis.
However, at night because of staffing levels, they would have to ask a porter or a security person to sit with the patient.
"On the first night Adrian was admitted, he was very restless. We bleeped the porter and security a few times before we got an answer. In the meantime three of us managed to keep him on the bed."
The porters and security men will not stay with patients all the time because they say it is not their job, Nurse O'Donnell added.
She agreed they were understaffed at night and that the scan taken after Mr McInerney fell out of the bed showed he was bleeding.
Nurse Vera Leahy said she did not see him fall out of the bed but she heard a thudding noise. She went into the ward and saw him lying face down on the floor beside his bed.
Mr Dorgan apologised to the family of Mr McInerney for the delay involved in having the inquest heard. Insp John O'Brien and the family solicitor said they had extreme difficulty in getting a response or any type of co-operation from the Mid-Western Health Board. The nurses were advised by the board's legal advisers not to make statements concerning the incident.
The coroner said an inquest was not a trial and nothing could contribute more to suspicion and worry than instances where the facts are not provided quickly for the next of kin.
"The nurses had nothing to hide. A lot of upset and trauma caused to the family could have been avoided if this case had been dealt with in a different manner by the health board," said Mr Dorgan.
He held that Mr McInerney's death was due to head injuries, including a fracture of the skull.