ED staff were in ‘an impossible situation’, inquest told

A doctor who was working in the emergency department at University Hospital Limerick on the evening Aoife Johnston presented has said staff were in “an impossible situation” as a result of chronic overcrowding at the facility.

Dr Leandri Card was the only senior house officer on duty on the night of 17 December 2022.

She has started giving evidence to the inquest into the death of the 16-year-old, who died after being sent to the emergency department with suspected sepsis on that weekend.

Proceedings resumed at Kilmallock Courthouse a short time ago.

In her deposition to the inquest, Dr Card said the department was extremely busy on the night, with Category 2 patients waiting 19 hours to be seen, while those listed as Category 3 patients faced a 39 hour wait.

She said nursing staff were overwhelmed by the volume of people seeking treatment with almost 200 people waiting in the emergency department.

Dr Card said many of the Category 2 patients were very sick with a cold spell exacerbating the usual pressures.

She detailed how a nurse had asked her to review Aoife Johnston at 6am on 18 December, as she had not been seen by a doctor at that stage, some 13 hours after her arrival at the hospital.

Ms Johnston was conversing with her but seemed anxious when the examination began, Dr Card said.

She had generalised body pain and was flushed in appearance but had no rash. Her white blood cell count was normal at the time.

Dr Card said she suspected the patient may have had a viral illness but explained that conditions like meningitis can be hard to diagnose in an emergency department setting and she requested further tests.

As a precautionary measure, she prescribed antibiotics and carried out a viral swab to augment blood tests.

She considered moving Ms Johnston to the resuscitation area but said this was not an option due to the level of overcrowding there.

Dr Card said that at the time of her examination, the clinical picture was not that of a patient who would deteriorate as rapidly as Ms Johnston did.

Under cross-examination by Counsel for the Johnston family Damien Tansey, Dr Card explained how patients in the emergency department are routinely prescribed medication without being seen by a doctor.

While this is far from ideal, she said it happens on “every shift, every day”.

She agreed with Mr Tansey that this was not best practice and might result in adverse outcomes, as the full clinical picture was not taken into account in such circumstances.

However, she said that “due to the state of the department” being “like a war zone…you do what you have to, to survive”.

Dr Card got upset a number of times while recalling her experiences on the night in question.

She agreed with Mr Tansey that the wait times in the emergency department are intolerable.

She said the Aoife Johnston case had an impact on her and her decision to cease working for the Health Service Executive was directly linked to the events of that weekend.

The inquest is continuing.