The inquest into the death of Aoife Johnston has opened at Kilmallock Courthouse in Co Limerick.
The 16-year-old died at University Hospital Limerick in December 2022.
The teenager, who was from Shannon, Co Clare, experienced a 12-hour wait at the hospital’s emergency department, following her arrival there on 17 December 2022.
She died on the afternoon of 19 December 2022.
Ms Johnston was diagnosed with suspected bacterial meningitis and developed sepsis.
The inquest, before Limerick Coroner John McNamara, is scheduled to run for four days.
As proceedings got underway this morning, two portraits of Ms Johnston were brought into the Courthouse by her family. They are being displayed on a desk, at the top of the court room.
Legal representatives for the Johnston family have expressed concerns that an independent report into the death had not been presented to the family.
Damien Tansey SC said the family were requesting that the coroner direct that this interim report be made available to them.
Conor Halpin SC, for UHL, said the report in question was not a matter of evidence for the purposes of the inquest.
He said UHL had no difficulties with the report being used as an aide memoire, but that it was not appropriate for the Coroner to make a ruling in relation to it.
Mr Tansey has also raised concerns about the availability of some witnesses over the course of this week.
He said the nurse who had sole responsibility at nursing level, in relation to the care of Aoife Johnston, would not be available to attend. The inquest heard she is abroad at present.
Mr Tansey said arrangements should have been made for her to give evidence remotely.
Mr Tansey described the nurse as being of fundamental importance to the proceedings and said it was most unsatisfactory that she could not be cross examined.
He said the family felt this was “strategically convenient” and contended that it was inconceivable that the nurse in question was not available to give evidence.
Mr Halpin said the issue had been addressed in pre-inquest hearings. He said the hospital had made all reasonable efforts to deal with this but had no powers to compel witnesses.
The coroner acknowledged the nurse was an important witness but he said she had made a detailed deposition which would be put on the record. He said he could make no order for her to attend or give evidence.
The coroner said if issues remained at the end of the proceedings, he was willing to revisit the situation.
Some 25 witnesses are scheduled to give evidence to the inquest over the coming days.
It will examine the care provided to Aoife Johnston, at UHL, on the 17 and 18 of December 2022.
Mr Tansey said the situation in the emergency department was “chaotic” by any measure.
He said Ms Johnston had an “utter and profound need of healthcare”.
Formal apology on behalf of HSE
Before her parents gave their depositions, Mr Halpin read a letter to Carol and James Johnston, from the HSE Chief Executive Bernard Gloster.
In it, he made a formal apology on behalf of the HSE, for the failure in relation to her care.
The HSE says this was a failure of significant proportions with “clear and catastrophic consequences.”
The inquest also heard the content of a second letter to the Johnston family from the CEO of UHL, Professor Colette Cowen, in which she offered sincere apologies for the failings made prior to Aoife’s death.
She said the hospital acknowledged the “devastating consequences” that followed “missed opportunities”.
Ms Johnston’s father, James, was the first witness to give evidence.
He detailed how his daughter felt unwell on the afternoon of 17 December 2022. She was brought to a doctor on call service, who advised that she be brought to hospital.
The family arrived at the emergency department before 5pm and Ms Johnston was triaged after 7pm.
Ms Johnston’s skin was blotchy and she was vomiting. There was no trolley available.
Mr Johnston said his daughter was screaming in agony and he repeatedly sought further medical attention for her.
After she was taken for an x-ray, she was “physically unable to stand”.
‘Sicker and sicker and sicker’
She was reviewed by a doctor at 6am, on 18 December, who said she would be treated for suspected meningitis.
The family was advised that Aoife would be put into an induced coma.
She was moved to intensive care and the family were subsequently told her condition had deteriorated further and that “nothing could be done”.
Aoife Johnston died on Monday 19 Dec 2022.
Under cross examination by Mr Tansey, Mr Johnston said he was begging for help, as his daughter “got sicker and sicker and sicker” as the night went on.
Mr Johnston said hospital staff provided “no help whatsoever”.
Carol Johnston said she reviewed the admission letter provided by Shannondoc on the way to the hospital, on Saturday 17 December 2022.
She said there were a huge number of trolleys in the emergency department at the time they arrived.
Ms Johnston said her daughter was moved into what appeared to be a storage room.
She was “violently vomiting pure green liquid” and screaming in agony, with pain in her head and right leg, as people outside the room repeatedly asked nurses and doctors to assist her.
Soon after she was reviewed by a doctor at 6am on 18 December, she was no longer able to communicate and her limbs were moving involuntarily.
The family were told there was no brain activity.
Mrs Johnston told the court “we watched our daughter die. I wouldn’t wish that on anyone”.
She rejected suggestions that Aoife had shown some signs of improvement after her arrival in hospital.
“We told her she was in the best place for her, but she wasn’t,” Mrs Johnston said.
“I never thought Aoife was going to die.”
