Doctor who treated Aoife Johnston tells inquest UHL is ‘not a safe environment’ for patients

A doctor who treated 16-year-old Aoife Johnston before her death at University Hospital Limerick (UHL) cried in the witness box at the teenager’s inquest and told Limerick Coroner John McNamara that UHL’s emergency department “didn’t was a safe place.” environment” for patients.

Dr. Leandri Card told how she was trying to treat 191 emergency patients on her own, and how she and the emergency room nurses were ‘overwhelmed’ the night Aoife presented at hospital.

The South African resident, who worked as a Senior House Officer (SHO) in UHL’s Emergency Department, said “every inch of the floor space” was taken up by patients on trolleys when Aoife gave a presentation on December 17, 2022.

“It looked like a war zone. It was an impossible situation,” she said.

Dr. Card told the inquest being held at Limerick Coroner’s Court in Kilmallock that due to overcrowding and pressure on staff, she and other doctors routinely prescribed drugs to ED patients without seeing or examining them first.

“It happens every shift, every day,” she said.

Dr. Card agreed with Damien Tansey, senior counsel and barrister representing the Johnston family, that this was “not best practice”.

Dr. Card said this was the norm and the only way patients would get medication as quickly as possible because doctors were too busy dealing with patients.

“It’s not a safe environment, you do what you have to do, it’s not best practice.”

When asked by Mr. Tansey whether this practice would lead to “adverse outcomes” for patients, Dr. Card: “Absolutely.”

She said that despite prescribing antibiotics to Aoife at 6.40am on December 18, to treat suspected meningitis, Aoife was not given the medicine for an hour and 15 minutes.

Dr. Card said the drug, which was heard may have saved her life, “was not given as immediately as it should have been.”

The witness said she did not have access to where medications were kept. Prescription medications were normally administered by nurses, but Dr. Card indicated she did not blame anyone for the delay: “A lot of times it doesn’t happen as immediately as it should because the nurses are overwhelmed.”

She agreed she was still ‘troubled and disturbed’ by Aoife’s death.

She said doctors routinely “don’t have enough time” to read patients’ medical records before prescribing them drugs. Instead, they have brief conversations with nurses who inform them of the patient’s symptoms.

Dr. Crandall also agreed that she was “alone” as the sole SHO in the emergency department on the night Aoife was brought in by her parents, and was trying to “manage 191 patients”.

She said an episode of severe weather had “exacerbated” emergency room overcrowding and that “category two patients”, including Aoife, who are considered seriously ill patients, were “deteriorating” due to long waiting times to see a doctor to consult.

The inquest found that staff were unaware of plans at UHL to implement measures to restrict patient flow, despite the hospital being notified in advance of the weather alert.

Dr. Card said the recommended time for a CAT 2 patient, including Aoife, to see a doctor is between 10 and 15 minutes.

However, Aoife languished on two chairs for twelve hours before being seen by Dr. Card. There were no carts for her to rest on and her parents said she was “in pain” as they shouted for “help” but they said “there was no help”.

Dr. Card wiped away tears and described the situation in Limerick’s emergency room as “unbearable”.

She said other CAT 2 patients waited longer than Aoife – some waited an average of 19 hours to see a doctor, and Category 3 patients waited 39 hours.

Aoife presented on UHL on December 17, 2022 at 5:40 PM. The hospital’s protocols on sepsis, which require that sepsis-pending patents be seen urgently, were not followed.

Aoife wasn’t tested until 7.15pm that evening and wasn’t given antibiotics until it was too late. She died at UHL on December 19.

Dr. Card said she examined Aoife at 6am on December 18, 12 hours after Aoife received a referral letter from a doctor questioning sepsis, a life-threatening condition that requires treatment with a regent.

Dr. Card cried and took several deep breaths, trying to compose herself as she gave evidence.

She agreed that she had been seriously emotionally affected by Aoife’s death and that the teenager’s death had led to her leaving the HSE.

Dr. Card said the emergency room and the adjacent Resus (resuscitation room) were “full” with carts blocking doorways.

She said: “There was no room, in, our out.”

She agreed that there were not enough staff and too many patents, which had created a perfect storm in the ED.

Dr. Card said Aoife’s death was “instrumental” in her decision to leave the HSE to work in a private clinic, and said she has not worked in an emergency department since.

Dr. Card said she had scanned Aoife’s patient file before seeing her for the first time at 6am on December 17, but she said she had not seen the GP’s referral letter at this stage, in which the GP indicated he suspected Aoife suffered from sepsis.

On Monday, former UHL clinical nurse manager Katherine Skelly said the emergency department was like a “war zone” and “in crisis” like nothing she had ever seen.

Ms Skelly, who was also deeply traumatized by Aoife’s death and retired, said she made several calls to senior staff, including UHL ED consultant Dr. Jim Gray, to come to the Ed to help her, but she said, “he refused,” and told her he had already been in and would come again the next morning.

Dr. Gray is expected to testify before the inquest on Thursday.

Aoife eventually underwent a CT scan of her brain after she became unresponsive and her brain swollen. Doctors put her in a medically induced coma to ease the swelling, but she did not survive.

UHL triage nurse Ariane DeGuzman told the inquest on Monday that after reading the referral letter from Aoife’s GP and her examination when she first arrived at UHL, she went to Resus and asked a registrar to accept Aoife, but he refused.

The resuscitation room was also overcrowded with patients.

The investigation will continue Tuesday afternoon and is expected to last until Thursday.