Woman, 33, died at Limerick hospital just one day after learning she had suffered a miscarriage

A YOUNG woman who had a miscarriage, following an IVF pregnancy, told a doctor that she'd meet her again in the maternity hospital when she got pregnant again, but she tragically died the next day. 

The inquest into the death of Leona Cusack (33) of Ballycasey, Shannon, heard that Ms Cusack first presented to University Maternity Hospital Limerick (UMHL) on February 15, 2024, with a possible miscarriage. Three days later, she died at University Hospital Limerick (UHL), following cardiac issues and sepsis. 

The inquest heard that despite being distressed and anxious, Ms Cusack was told that she had lost her baby when she was alone. 

She had been five weeks and one day pregnant when she went into the maternity hospital, after a successful embryo transfer in January. 

READ MORE: Family of pregnant woman who died in Limerick hospital are 'haunted'

Ms Cusack went to the maternity hospital on February 15, and returned home, despite a doctor advising that she stay, but the Cusacks understood there were no beds and opted to go home. 

She then returned to the hospital the next day much sicker and one day later was transferred by ambulance to University Hospital Limerick due to fears she might suffer a heart attack. 

Ms Cusack's grieving husband Conor did not read his deposition, but instead it was read by the coroner John McNamara, as the solicitor for the family, Damien Tansey SC said the grief was still very raw. 

His statement said that he was told that her heart issues were “related to acute stress associated with morning sickness.”

After she was transferred to UHL, Ms Cusack’s sister Rachael called Mr Cusack to tell him that his wife was being taken for a small operation. Then he heard that she was having trouble breathing and that the hospital staff were concerned about sepsis. 

He recalls being told in the family room at UHL that his wife had a reaction and had suffered a massive heart attack. 

He said there were repeated references to broken heart syndrome and Grey's Anatomy. 

Reading her deposition, Ms Cusack’s sister Rachael, who is an advanced nurse practitioner in Glasgow, said she was home at the time for her father Eamonn's 60th birthday party. 

She spoke about questioning why sepsis was not being investigated by the UHL cardiology team. 

She said her sister was “extremely unwell”, vomiting, had a fever and chest pains. 

READ ALSO: Limerick businessman fears for future after parklets removed without warning

Ms Rachael Kirwan said the cardiology team told them that any heart issues were “anxiety driven” and that there was “no reason to be concerned.”

She added that when the obstetrician told her she had lost the baby, her sister “was alone receiving the news.”

Ms Kirwan said that the heart specialist, Dr Cormac O'Connor had said her sister “had the heart of a lion” and that he “was surprised she wasn't shadow boxing in the corner.”

She described those comments as being “disrespectful, condescending and inappropriate.”

All doctors and nurses who were witnesses on the first day of the inquest this Wednesday, agreed with Damien Tansey SC that sepsis should be treated within one hour of diagnosis and that a delay of treatment by six hours can increase the risk of death by as much as 50%. 

OBGYN Dr Suhaib Akhtar Birmani was commended for initiating a sepsis protocol, but broad spectrum antibiotics were not administered until 4pm on February 17, two days after she first presented at UMHL. 

He had also recommended that Ms Cusack stay in UMHL and said that a bed would have been made available. He did not know at the time that she was leaving the hospital and was not informed by the midwife. 

He had told Ms Cusack that “she was in the hospital now and she is safe,” to which Damien Tansey SC said that “she wasn’t well and went home, unbeknownst to you and was not in a safe environment.” 

Bloods had been sent to test for sepsis, but Dr Caoimhe Hartnett, who gave evidence via video link from Australia, said that blood results could take up to six hours and even urgent ones would still take two hours, as blood samples had to be sent from the maternity hospital to UHL for testing. 

READ ALSO: Limerick photographer brings 15 years' of Munster Rugby to book

The inquest heard that a number of inflammatory markers were elevated, which could indicate sepsis. 

These included a platelet count of 517, where the normal range would be between 150 and 450; an accelerated heart rate, and fever. 

Damien Tansey SC told the inquest that “the family are concerned that when she arrived to UHL, they forgot about the sepsis and devoted all of their attention to the heart.”

Dr Humaira Amin, OBGYN was on call in UHL when Ms Cusack arrived.

She saw Ms Cusack for a gynaecological consult on February 17 and gave her the news that it was a completed miscarriage and informed her of pregnancy loss supports within the hospital. 

Dr Amin described Ms Cusack as being “very tearful” and said she asked to call her husband. 

When she next saw the Cusack couple, Dr Amin said they were smiling and laughing and Ms Cusack said she would see Dr Amin in the maternity hospital when she gets pregnant again. 

Dr Amin described a “different person” arriving to theatre for an ERPC (Evacuation of Retained Products of Conception) on February 18, which was described to theatre staff as being urgent. 

She said Ms Cusack was agitated, breathless and pulling at her oxygen cannula. 

Dr Amin agreed with Damien Tansey SC that her CRP (indicators of infection) being 76, where the normal range is up to five, was “off the wall.” 

Medical registrar Dr Adnan Abdalla told the inquest that he had contacted Dr Amin to try to establish a possible cause for the sepsis, as he could not identify the source of the infection. 

At 5am on the day she died, Ms Cusack’s blood pressure had plummeted to 86/62 and she had a temperature of 38 degrees. 

When asked why an ERPC was being performed, even though Dr Amin had done an ultrasound and could see that there was nothing remaining in the uterus, she said that she had to “follow instructions” from the consultant Dr Hartigan, who did a further CT scan and decided the ERPC was not needed, when Ms Cusack was already in theatre. 

Ms Cusack was so distressed in theatre that she was intubated, her blood pressure continued to drop until she lost cardiac output, and after 45 minutes of CPR and resuscitation efforts, she died at 7.39pm on February 18, 2024. 

The inquest continues tomorrow, Thursday, at the Limerick Coroner’s Court.