'A profound tragedy': Verdict returned at inquest into death of girl, 16, at Limerick hospital

THE MOTHER of a 16-year-old girl who died at University Hospital Limerick (UHL) has welcomed a verdict of medical misadventure into her death but pointed out that nothing will ever bring her daughter Niamh back. 

Carolyn O'Neill described her daughter as her “sticky back” - she said was always stuck to her. 

Niamh McNally from Ardykeohane, Bruff, died on January 29, 2024 from asphyxiation and what the coroner called a “catastrophic bleed” which led to cardiac arrest. 

The young girl had been in hospital for two weeks, was very unwell and coughing up large volumes of blood. She was discharged just six days before she came back to the hospital by ambulance after suffering a huge bleed at home, with the same symptoms she had during her two-week admission. 

READ ALSO: 'Mammy, I can't breathe' - young Limerick girl said as she was vomiting up blood before she died

In delivering his verdict, Limerick coroner John McNamara described the young girl’s death as a “profound tragedy”, adding that it brought “immeasurable shock and grief” to her mother and extended family. 

He said it was clear that Niamh had lived a full and happy life and that she was a “tough, intelligent girl.” 

Mr McNamara said: “Losing a child is obviously the deepest of tragedies” and he hoped that the findings of the inquest could bring some clarity. 

A respiratory consultant told the inquest that the “level of bleeding [experienced by the young patient] would have been exceptional no matter what the cause.”

Dr Brian Casserly could not give any explanation when questioned by Damien Tansey SC, representing the family, why no one on the medical team “came up with the idea that the source of the bleed was the heart,” but stressed that he is not an expert in congenital heart conditions. 

He did concede that it “would have been preferable” if the cardiology assessment had been broader and not limited to looking for a potential infection in the lining of the heart, which was not present. 

Dr Casserly pointed out that the ECG did not “suggest an acute cardiac issue” and a test of BNP, a hormone which would rise indicating that the heart was in distress, returned a normal reading and “did not signal the heart was under stress.” 

He said that a CT scan, which would look at cardiac and lung causes, also did not show any cardiac issues. 

Dr Casserly added that they did carry out a “battery of tests” and that unfortunately these did not reveal any cardiac issues, while he stressed that there “should have been a bigger focus on cardiology.”

Dr Mohammed Harb, a consultant in emergency medicine, told the coroner that on the night this young Bruff woman died, the resuscitation unit was at capacity and he made the decision to move Niamh out of the unit and into the corridor. 

He said she was anxious and upset, she didn't want to get a cannula put in or have bloods taken. 

“She didn't want to be admitted to hospital,” he said. 

When her heart rate lowered to between 110 and 120, down from between 140 and 150 on admission, he considered her as being suitable for being moved out of the unit. 

“She was managed and monitored with no further distress or acute bleeding,” the inquest heard.  

He added: “She didn't have any indicators to stay in the resus room, it's a very dynamic place in the ED.”

Dr Harb got a call from the senior house officer as assistance was required when Niamh was in cardiac arrest and after extensive CPR efforts, he said: “No further resuscitation efforts would change the outcome” and she was pronounced dead at 22.55 on January 29, 2024. 

Dr Saadat Khan, cardiology registrar, saw Niamh during her 14-day hospital stay, and told the coroner he was checking for infected endocarditis, which is an infection of the lining of the heart and that none was detected. 

Damien Tansey SC representing the family challenged Dr Khan that it was a “lost opportunity to identify Niamh's problem” and that the source of the bleeding from coughing was not found. 

Despite being aware of the young patient's history of a congenital heart defect and three open heart surgeries as a baby and young child, she was not referred back to Crumlin children's hospital. 

Dr Syed Musavi, a consultant in general medicine told the inquest that during the hospital stay, on January 18, five days before she was discharged and 11 days before she died, he described her as “clinically and vitally stable.”

He said they had a working diagnosis of a chest infection and that DiGeorge syndrome would compound health issues with compromised immunity. 

Dr Musavi said: “I was quite happy that we were going in the right direction - she was improving.”

He added that what led to Niamh's death was “unpredictable” and that they looked at various reasons for her symptoms. 

Mr Tansey said that the “family are haunted” by the lack of cardiological intervention. 

He argued that when Niamh returned to the hospital six days after her discharge, she presented with the same symptoms as before and was “back with the same thing and is not cured.”

Dr Musavi said that she “definitely improved when she was discharged.”

In his closing statement before a verdict was delivered, Damien Tansey SC said that the “congenital heart history is so complex, it needed to be covered.”

Speaking after the verdict was delivered, Mr Tansey said that Niamh “is very much a part of the family and will always remain so.” He added that her memory will very much be kept to the fore. 

May she rest in peace.