Doctor who fought to save Aoife Johnston’s life tells inquest ‘impossible overcrowding’ at UHL later led her to quit HSE

A doctor who fought to save the life of teenager Aoife Johnston has said medical staff faced “an impossible situation” in University Hospital Limerick’s emergency department because of chronic overcrowding in December 2022.

The 16-year-old Clare native died from sepsis after waiting over 12 hours for treatment – despite having arrived at UHL with a letter from a ShannonDoc GP stressing that she required urgent care because of suspected sepsis.

A Limerick Coroner’s Court inquest under Coroner John McNamara was told today by Senior House Officer Dr Leandri Card that doctors and nurses faced “an impossible situation” on December 17 and 18, 2022.

“Nursing staff were overwhelmed due to the large number of patients,” she said. “It was an impossible situation.”

Dr Card – who fought back tears as she offered testimony – revealed that there were 191 patients in the emergency department on December 17/18.

The inquest has already heard that there were just 15 nurses on duty along with three doctors – Dr Card and two registrars.

The emergency department was struggling to cope with a surge of patients due to a cold snap which had resulted in a large number of patients suffering falls and fractures.

Category Two patients, which require treatment within 15 minutes, faced lengthy delays in treatment due to the overcrowding.

Dr Card said the longest wait for a Category Two patient that weekend was 19 hours.

A less-ill Category Three Patient faced a wait time of up to 39 hours.

Aoife was a Category Two patient.

One nurse had pleaded with managers to trigger the UHL emergency response plan to ease pressure on the critically overcrowded emergency department.

Dr Card, who is from South Africa, wiped away tears as she told the inquest she no longer works for the HSE and is now employed in a private urgent care centre.

Dr Card agreed with counsel for the Johnston family that the situation in UHL ED that night was instrumental in her leaving the HSE – the second medical official to leave because of the intolerable situation in UHL with overcrowding.

The inquest previously heard from a senior nurse manager that the overcrowding situation in the emergency department that night was “akin to a war zone” and worse than if there had been a major accident.

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 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.

Clinical nurse manager Katherine Skelly rang her managers and two consultants to voice her serious concerns over general patient safety that night as more than 160 patients flooded into the emergency department.

She warned that the crisis facing the UHL emergency department that weekend was worse than if there had been a major accident such as a bus crash.

“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.

“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.

“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.

“The waiting areas were overflowing with sick patients, some sitting on the floor. The paediatric area was full – all cubicles were occupied. Patients were sitting inside the paediatric zone on chairs and with sick children in their arms.”

Aoife’s inquest opened yesterday 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.

Aoife’s parents, James and Carol, attended the Kimallock inquest alongside her sisters, Meagan and Kate.

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

“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.

She was then placed in a wheelchair in what her parents described as a store room.

James and Carol had to try to create what they described as a make-shift bed from two chairs pushed together in a bid to allow their desperately ill daughter find some comfort before she received a trolley.

No trolleys were available for Aoife on December 17.

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 when she was immediately put on antibiotics as her condition worsened and she began to lose consciousness.

“I was up and down to the nurses all night pleading with them to help my daughter,” James Johnston 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.”

Carol said that at one point, after begging for hours for help for Aoife, they were told she would be treated as if she had meningitis.

But her parents were then asked to help medical staff by holding her down for an intravenous treatment as Aoife’s limbs were by now involuntarily jerking.

“At 6am my daughter was finally reviewed by a doctor. She was in agony with pain in her head, her right leg, she was vomiting and she had blotchiness on her skin,” Carol said.

“The doctor told us that she would treat Aoife as if she had meningitis. After the doctor left, Aoife started to deteriorate even more. James went to the nurses station for help.

“Aoife was taken to resuscitation. By this point, Aoife’s limbs were moving involuntarily. I was asked to hold down my daughter’s arms so they could administer treatment.

“We were subsequently advised that Aoife would be put into an induced coma as there was a swelling on her brain and that the coma would allow her body to relax.

“Aoife was moved to ICU. Following a number of scans we were advised that there was nothing that could be done to save Aoife.”

Counsel for the Johnston family, Damien Tansey SC, said that by the time Aoife received the appropriate treatment it was too late.

“At that point everything possible was done to save Aoife but it was too late,” he said.

Aoife, who was from Shannon in Co Clare, died at UHL on December 19, 2022, after contracting bacterial meningitis and then sepsis – but had been waiting for over 12 hours for treatment.

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