Karen Kearney: Will there finally be accountability in the HSE?

Karen Kearney: Will there finally be accountability in the HSE?

Karen Kearney

Karen Kearney, partner at Cantillons Solicitors, comments on the coming investigation into Aoife Johnston’s death at University Hospital Limerick.

I listened with interest to an interview on Morning Ireland on 5 January 2024 with Stephen Donnelly, our minister for health. He was asked by Rachel English why the family of the late Aoife Johnston — the 16-year-old who tragically died in University Hospital Limerick (UHL) in December 2022 — didn’t have any input into the terms of reference of a new investigation which is to be conducted by former Chief Justice Frank Clarke “within the period of eight weeks or as soon thereafter as practicable”.

Mr Donnelly responded that in order to have a process whereby you could have accountability in the end, the advice that the HSE received was that no third parties could have input into the terms of reference. Accountability is clearly desirable, indeed essential, but I hasten to add that I do not accept that it cannot be achieved with the involvement of all stakeholders in the drafting of the terms of reference.

Rachel English queried what exactly accountability meant — did it mean that someone might lose their job? Mr Donnelly responded that if adverse findings are made then there are “processes that might follow from the investigation”. He advised that this is a new, different approach being adopted by the chief executive of the HSE, Mr Bernard Gloster.

My colleagues and I here in Cantillons Solicitors practising exclusively in the area of medical negligence have been banging this drum for many years. Until there is accountability, nothing will change. And change is certainly long overdue in UHL.

You really do have to experience the deplorable conditions in UHL to fully understand how deplorable they really are. My experience in its A&E in September 2016 instilled fear in me for the safety and health of the sick and elderly in my city and indeed in the Mid-West region encompassing counties Limerick, Clare and Tipperary. It was clear to me that it was not a functioning health system — rather a “pretend health system”, to borrow a phrase from an eminently qualified health practitioner working in the system at that time.

I can recall what was most striking and worrying was the demeanour of the medical and nursing personnel. Many looked like they were running on empty. I overheard one member of the staff say that he would give anything for a job in DoneDeal.

Aoife Johnston’s death was the subject of an internal HSE report and it made the following findings:

  • “Crowding, also known as overcrowding, is endemic in Hospital 1’s Emergency Department (ED).
  • The ‘boarding’ of admitted patients in the ED is a planned part of patient flow in this hospital and includes specific funded jobs for staff to care for these patients, which are yet to be appointed.
  • There is little apparent understanding of the risks and inefficiencies caused to patient care by a crowded environment by the Hospital System, in terms of the impact on the Emergency medicine doctors assessing, and managing patients and the nursing staff’s ability to provide safe care.
  • The use/misuse of the resuscitation area for all monitored interventions leads to crowding and an overemphasis on activity in this area. A monitored procedure room in Zones A and B/C with adequate staffing would ensure access to an EM Registrar in these areas and decompress resuscitation.
  • There are insufficient ED nursing staff to provide adequate monitoring and care to the patients in the ED.
  • There are insufficient Emergency Medicine doctors to care for the numbers and acuity of patients presenting in the timescale expected by the Triage system, the hospital and the community.
  • There is a high turnover of staff both Nursing and EM Non Consultant Hospital Doctors (NCHDs) which leads to low experience levels and low situational awareness.
  • There was only 1 Clinical Nurse Facilitator to support nurse integration and education at this time.
  • There is only 1 EM Consultant who is on-call for the whole weekend and, as they cannot be present all the time, this leads to them providing specific supports only. This has led to an expectation gap.
  • The National Guideline No. 26: Sepsis management in Adults and Maternity was not followed on the 17th December 2022 leading to a delay in sepsis care of 12 hours.
  • The escalation protocol was not adhered to on Sat 17th day or night despite numbers of patients awaiting an inpatient bed varying between 42 and 55.”

All of the above findings are unacceptable but not at all surprising. Indeed, when we investigate potential cases for medical negligence, we regularly come across these types of reports and findings. Up to now, they largely gather dust.

It is a terrible shame that 16-year-old Aoife Johnston had to die in such horrific circumstances but maybe her death will not have been in vain if, finally, there is accountability in the HSE, and consequently a safe hospital for the people of Limerick, Clare and Tipperary and increased patient safety for us all.

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