Senior nurse manager tells inquest overcrowding situation in A&E that night was “akin to a war zone”Nurse Skelly said she rang two consultants to come in that night, with one “declining” her requestAoife’s parents told how they begged staff to help their daughter
Aoife’s parents fought back tears as they revealed how they repeatedly begged UHL doctors and nurses to help their daughter as her mother Carol warned she watched helplessly as her daughter was dying in front of her eyes.
Even other emergency department patients were pleading with UHL staff to help the teen who was screaming in agony as her condition became critical.
Aoife’s parents used two chairs in the hospital’s emergency department storeroom to create a makeshift bed in a desperate bid to make their seriously ill daughter more comfortable. They submitted this picture to the coroner today.
The Clare teen perched precariously on the makeshift bed as there were no trolleys available, such was the level of overcrowding.
Clinical nurse manager Katherine Skelly described the emergency department as being “akin to a war zone” and worse than if there had been a major accident.
Nurse Skelly said she rang her managers and two consultants to voice her serious concerns over general patient safety that night as over 160 patients flooded into the emergency department.
Her calls pleaded for the escalation plan to be triggered and the pressure on the understaffed emergency department to be urgently eased.
Aoife was ranked as a Category Two patient which meant she should have received medical treatment for her sepsis within 15 minutes.
“I never worked in accident and emergency again after that weekend,” she said.
“It absolutely broke me professionally and personally that that girl (Aoife) died.”
There were 15 nurses on duty in the UHL department that night – five fewer than normal with Ms Skelly warning that 30 staff would have been required to deal with the huge volume of patients.
Aoife – despite having a GP referral letter which advised that she needed urgent treatment for suspected sepsis – was not given the proper treatment until over 12 hours after she was brought to UHL.
Her inquest opened before Limerick Coroner John McNamara with profuse apologies to the Johnston family from both the Health Service Executive and the University of Limerick Hospitals Group for the failings in care provided to Aoife in December 2022.
Both apologies, delivered by HSE counsel Conor Halpin SC, acknowledged the catastrophic outcome of the care failings involved and apologised to the Johnston family for what happened and the loss of Aoife which resulted.
Aoife’s parents, James and Carol, attended the Kilmallock inquest alongside her sisters, Meagan and Kate.
The family requested that framed photographs of Aoife be placed on the table before the coroner to remind everyone of the needless death of the Fifth Year teen.
Aoife’s parents delivered emotional testimony at the opening of the inquest on the horrific circumstances of their daughter’s death at UHL.
“We watched our daughter die,” Carol told the hushed courtroom.
“I would not wish it on anyone. God love her. We told her she was in the best place (UHL) but it turned out she was not.”
Aoife arrived at UHL with a referral letter from ShannonDoc GP Dr Madlala Mdumiseni which alerted UHL that she had suspected sepsis.
The GP warned that the teen’s condition was urgent and that his referral letter should be given to UHL emergency department staff on their arrival.
Despite this, Aoife was not seen for triage assessment for an hour and a half.
Aoife arrived at UHL at 5.40pm and the GP’s letter was handed in to staff.
However, Aoife was not seen for triage until 7.15pm – and was not seen by a doctor until 6am the following morning, when she was immediately put on antibiotics as her condition worsened and she began to lose consciousness.
James said that he repeatedly begged staff on duty to help his daughter as her skin developed a blotchy-type rash and another mark developed near her eye.
She was violently getting sick and her vomit was green in colour.
“I was up and down to the nurses all night pleading with them to help my daughter,” James said.
“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?’
“There was no trolley available so we tried to make a bed for Aoife with two chairs. Aoife’s skin became very blotchy. She also had a mark on her left eye which looked like a birthmark on the corner of her eye.”
“I brought this to the nurse’s attention. Aoife was violently vomiting and it was pure green liquid.”
Counsel for the Johnston family, Damien Tansey SC, said that by the time Aoife received the appropriate treatment it was too late.
Aoife, who was from Shannon in Co Clare, died at UHL on December 19 2022 after contracting bacterial meningitis and then sepsis.
Nurse Skelly said she was shocked by the chaotic scenes in the emergency department on December 17/18 when she came on duty.
“What I observed was akin to a war zone. Every area was overcrowded with patients. Trolleys were placed back to back and lined either side of the corridors,” she said.
“Every available floor space was taken, patients were lying and sitting in every nook and cranny. Trolleys were lined up outside toilets, blocking exit doors and the emergency trolleys.
Nurse Skelly said she personally rang two consultants including Emergency Consultant Dr Jim Gray, who had been in UHL all day and was due back the following morning, telling him the department was in crisis and asking him to come into UHL.
“I escalated what I perceived was a serious and immediate risk. At approximately 10.30pm I phoned both consultants.
“Firstly I spoke to Dr Gray. I escalated to him the risks to patients, the volume and acuity and how unsafe the department was and requested that he come in. He, however, declined my request.”
An unnamed paediatric consultant was also asked to attend UHL that night and, despite initially refusing, attended the hospital within 30 minutes.
The senior nurse on duty in the emergency department, Ciara McCarthy, is now in Australia and her evidence to the inquest was in the form of a deposition.
She said she had contacted three doctors over December 17/19 to voice her concerns about the condition of Aoife Johnston.
One doctor who Ms McCarthy said she spoke to was Registrar Dr Mohammed Hassan who was working in the resuscitation unit.
However, Dr Hassan told the inquest he had no direct or indirect involvement in Aoife’s care – and cannot recall any such conversation with Ms McCarthy.
The triage official on duty, Nurse Ariane de Guzman, said she ranked Aoife as a Category Two patient and felt she should have been assigned to the resuscitation unit.
However, there were only seven bays in the resuscitation unit and it was already dealing with 14 seriously ill patients.
She said she went to a doctor, whose name she cannot remember, and related both her assessment of Aoife as being a Category Two patient and that the GP had thought she displayed signs of sepsis.
That doctor, she said, told her the resuscitation unit was full.
Aoife was instead sent to Zone A – and was initially on a wheelchair in a room her parents described as resembling a storage room.
The inquest, which is expected to conclude on Thursday, resumes tomorrow.