Family of deceased Limerick woman believe hospital missed opportunities in her care

THE INQUEST into the death of a woman at University Hospital Limerick two weeks after she was admitted heard that her loss has “devastated” the family.

The 70-year-old woman from Limerick city died at University Hospital Limerick 14 days after she was admitted.

Addressing Limerick coroner John McNamara, one of her daughters said: “When she went into hospital, she believed she would receive the care she needed and return home to us.

“Instead we lost the heart and soul of our family.”

The family believes that opportunities were missed in the care of their mother.

The woman’s daughter said: “We hope that by speaking out, our Mam’s legacy will be one of positive change.

“She spent her entire life putting others before herself.”

The woman’s other daughter also gave evidence that she had been told that her mother was a “feeble old lady with co-morbidities”, but she argued that her mother “was in really good health”, was very active and would walk up to 20 minutes three or four times a week.

She said that if they had been made aware of how sick their mother was, they would have all been in the hospital “sitting beside her.”

The inquest at Kilmallock courthouse heard that upon arrival to UHL by ambulance in June, 2023, the woman was triaged as category two and was moved into the resuscitation unit.

Advanced nurse practitioner Stephen Carrig said: “I didn’t delay”, after explaining that the woman required urgent care and was vomiting with the possibility of gastro intestinal bleeding.

Dr Anastasia Saleh who gave her deposition via video link told the inquest that she suspected that the woman may have aspirated (breathed in) some of the vomit.

When asked if she considered elevating the patient to a higher level of care, Dr Saleh said that the patient was already in the resus area and was “clinically stable.”

The inquest heard that over the course of her hospital stay, the patient had an Irish National Early Warning System (INEWS) score of up to nine.

Dr Saleh accepted when challenged by Anne Marie Dunne BL who was representing the woman’s family, that results from a CT scan were available for more than an hour and that “nobody appears to have acted on them.”

Ms Dunne put it to Dr Saleh that the patient “was left in the resus department with a gastric outlet obstruction” without medical intervention, but this was not accepted by Dr Saleh, as she said she had contacted the surgical team for further consultation.

Ms Dunne described this as a “critical window of two hours” without a documented treatment plan or escalation plan.

Dr Man Yu Lim, a surgical senior house officer at the time, gave evidence via video link that she inserted a nasal gastric tube, which was later removed and that they opted for conservative management due to high risks associated with surgery.

The inquest heard that the woman was intubated the following day and brought to ICU, the day after she was admitted.

The Limerick coroner was told that the patient had a history of COPD, stroke, heart failure and a hiatus hernia.

Dr Lim told Ms Dunne, the barrister for the family, that she was not aware of an INEWS score of nine, but that she did accept that a score of nine would be a red alert.

Despite claims from Ms Dunne that the patient was deteriorating, Dr Lim felt she was “clinically stable.”

Dr Lim said: “When I saw her at the bedside, she was not that sick.”

Ms Dunne pointed to gaps in notes when decisions, such as the conservative management and the decision not to perform surgery, were not documented.

Dr Lim told the inquest that she had thought the nasal gastric tube would decompress the stomach and alleviate the vomiting.

The inquest heard that after the tube was removed, the patient suffered cardiac arrest and ultimately did not recover before she died in the first week in July.

There was also evidence that 1,000ml of gastric fluid was extracted, after it had likely accumulated in the stomach.

Consultant surgeon Dr Nisar Ali told the inquest that he was in theatre from around 10pm until 3am on the day after the woman was admitted was being updated by his team.

He said that he was not aware of an INEWS score of nine.

“The only chance she had of survival was conservative management,” he said.

Pathologist Dr Gabor Laskai, who has since retired, gave evidence via video link that the cause of death was cardiorespiratory failure and that no obvious signs of bleeding were seen during the post mortem.

All of the evidence has been heard and the inquest has been adjourned until November 19 for a verdict.