Aoife Johnston’s family to take civil action as they vow to ‘vindicate her life’ after she ‘suffered all night’ in overcrowded UHL

It has emerged Aoife had not been eligible for the highly effective meningitis vaccine because she fell just outside the age-qualifying range when the jab for children was rolled out.

The preventable death of the Co Clare teenager in December 2022 has shocked the public and the healthcare sector, and is the focus of three separate investigations – one of which, under retired chief justice Frank Clarke, remains ongoing.

Such was the “gargantuan overcrowding” at University Hospital Limerick (UHL) – consistently the most overcrowded emergency department the country – consultant James Gray described it as “a death trap”.

Dr Gray told the inquest into Aoife’s death the emergency department would remain dangerous until extra bed capacity was delivered, and stressed that UHL needed 300 beds to eliminate overcrowding.

Clinical nurse manager Katherine Skelly said that what she saw during December 17 and 18, 2022, in the emergency department had been “akin to a war zone”.

The Limerick inquest opened on Monday with profuse apologies to the Johnston family from both UHL and the HSE.

Damien Tansey SC, solicitor for the Johnston family, confirmed the civil action as he said Aoife’s parents, James and Carol, and her sisters, Meagan and Kate, wanted the circumstances of her death fully outlined before Limerick Coroner’s Court so that measures would be taken to ensure no other family suffered their nightmare because of hospital overcrowding.

Officials of both the HSE and State Claims Agency attended the four-day inquest before Coroner John McNamara in Kilmallock.

“There are civil actions in place,” Mr Tansey said. “But this is the forum to vindicate Aoife’s life and the impact [of her loss] on her heartbroken family.”

Aoife’s mother Carol pleaded for changes to emergency department resources in the mid-west and she said no other family should endure their nightmare.

“This should not happen to another child,” Ms Johnston said. “Aoife is gone now so all the apologies and everything that they put in place is… the rest of our lives, it is not going to change that.

“It breaks our hearts – it was a horrible death. She suffered the whole night.”

Aoife died at UHL’s emergency department on December 19, 2022, after waiting 15 hours and 15 minutes for the antibiotics that would have saved her life.

The Leaving Cert student had contracted meningitis and attended UHL at 5.40pm on December 17, but she was not seen by a doctor for more than 12 hours.

This was despite the fact she had attended a ShannonDoc GP at 4pm and Dr Madlala Mdumiseni diagnosed suspected sepsis. He gave the Johnston family a letter alerting the UHL emergency department to this fact and that Aoife needed urgent medical attention.

Due to the overcrowding in the emergency department, Aoife did not even get a trolley – and was placed in what her parents described as a storeroom off an emergency room corridor.

Mr and Mrs Johnston had to push two chairs together to provide their critically ill daughter with a make-shift bed.

Aoife was screaming in pain and even other patients on trolleys pleaded with medical personnel to help her.

Despite the couple begging for their daughter to receive medical attention, she was not seen by a doctor for over 12 hours.

UHL’s emergency department was almost overwhelmed that weekend by a flood of patients, many of whom had suffered falls and fractures as the result of icy weather.

Patient numbers soared to 191, with just one senior house officer dealing with almost 170 patients as two registrars remained in a resuscitation room with 14 patients, despite pleas from nursing staff for one to return to Zone A of the emergency department where patients were on trolleys in front of toilet doors.

UHL was down 21 staff due to illness and weather conditions.

Aoife was not seen by a doctor until 6am and even when that doctor diagnosed the critically ill teenager with meningitis, she was not given antibiotics for a further hour-and-a-quarter.

Just four hours later, Aoife was lapsing into a coma and she died at 3.31pm on December 19.

Consultant microbiologist Patrick Stapleton said Aoife had contracted a Type B meningococcal infection, which is fully treatable with targeted antibiotics once they are given in time.

Dr Stapleton said it was “highly likely the outcome would have been different and optimal” had Aoife received the medications in time.

Aoife’s father James said he repeatedly begged staff on duty on December 17/18 to help his daughter.

“I was up and down to the nurses all night pleading with them to help my daughter,” he 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?’

“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.”

“I continually begged for help. The response was a brown cup for Aoife to vomit into and on one occasion a rebuke: ‘I am well aware she is sick – but I have 70 other patients to look after’.”

HSE chief executive Bernard Gloster issued “an unequivocal apology” to the Johnston family over Aoife’s death.

“I am conscious that no words of mine will take away their pain,” he said.

Both UHL and the HSE had signalled they would not oppose the Johnston’s family request for Mr McNamara to return a verdict of death by medical misadventure.

“I have noted the verdict and thank the coroner for his careful attention to this tragic case. Over the last four days, we have heard great detail on the events surrounding this unnecessary death,” the Mr Gloster said.

“I will now take the outcome of the inquest, study the details of the transcripts and, together with the systems analysis report I received in December, add this to the information available when I receive the outcome of the independent review being conducted by retired chief justice Frank Clarke I will consider next steps.

“I know we have considerable work to do to ensure that the people of the mid-west, and the staff of UHL, have a service they can feel confident in and proud of, and we are working to that end. The details of this inquest will be very much in our minds as we do so.”

However, the inquest was told that such was the profound impact of the circumstances of Aoife’s death and the horrific overcrowding in UHL that a number of staff had left the hospital or transferred out of emergency medicine.

Clinical nurse Ms Skelly warned that the overcrowding situation in the emergency department was unsafe for both staff and patients.

“I never worked in accident and emergency again after that weekend. It absolutely broke me professionally and personally that that girl (Aoife) died,” she said.

Mid-west Hospital Campaign (Clare) co-ordinator Noeleen Moran warned that people across the region feared having to attend UHL given recent revelations about overcrowding, understaffing and lack of bed capacity.

Mr McNamara said the revelations about the circumstances of Aoife’s death were very concerning.

“There were systemic failures, there were missed opportunities and there were communication breakdowns throughout. She should have been treated in a timely manner.”