Stephen Donnelly: closing of hospital emergency services in midwest ‘not done correctly’

The reconfiguration of the A&E service in counties Clare, Limerick and Tipperary was “not done correctly”, Minister for Health Stephen Donnelly said when asked about the outcome of the inquest into the death of Aoife Johnston (16) at Limerick Hospital’s A&E in December 2022.

Since the downgrading of Ennis, Nenagh and St John’s (Limerick) hospitals in 2009, just one emergency department (ED) has served the three counties.

Mr Donnelly said the A&E services in the region were shut down before the significant extra investment that was required for University Hospital Limerick (UHL) was made.

The clear clinical view is the three hospitals where the EDs were closed are too small for the necessary level of specialisation for patient care, the Minister said.

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Nevertheless, he has asked the HSE for a review and was very aware that the people in the region believe it requires a second ED.

“I have asked for an updated view from the HSE in the last few months because I’m very conscious people are calling for an ED to be opened, be it in Ennis or wherever it might be.”

Ms Johnston died from purulent meningitis at UHL having presented at the hospital’s “gargantuanly overcrowded” ED two days earlier suffering from a suspected case of sepsis, Limerick Coroner’s Court was told.

[ ‘More people are going to die in that hospital’: Aoife Johnston’s parents call for action after inquest verdict ]

She arrived on a Saturday evening and the overcrowding was such that Dr James Gray, the emergency medicine consultant on call, described the ED at the inquest as “a death trap”.

Despite being triaged as a high-priority patient in need of care within 10 to 15 minutes of her arrival on the evening of December 17th, Ms Johnston did not receive “vital” antibiotics she needed until after 7am on December 18th. “Aoife Johnston had no chance,” Dr Grey told the inquest.

“I was quite taken aback by that testimony,” Mr Donnelly said. “I know some of his colleagues are saying very openly that it’s a lot better and safer now than it was when Aoife Johnston died.”

Mr Donnelly, who was speaking to reporters in Athlone on Saturday, said there was no question but the ongoing level of patients on trolleys in UHL was “not safe” and “not acceptable”.

He said the hospital had more investment since 2016 than any hospital in Ireland and had the biggest increase in staff of any hospital during the lifetime of the current Government.

In spite of this, the number of patients on trolleys is increasing whereas it is “falling and falling quite fast” in other hospitals. All hospitals, including UHL, have more people turning up at their EDs, he added. “So, what’s going on?”

The healthcare professionals at the hospital were very dedicated but morale is low and some of the testimony from the Johnston inquest was difficult for them, the Minister said.

Rostering arrangements for late evenings and weekends at the hospital’s ED that have happened since Ms Johnston’s death should have been in place when Ms Johnston died, and were in place in other hospitals’ EDs, he said.

However other urgent reforms still need to be implemented and “what is needed is clinical and administrative leadership,” Mr Donnelly said.

“The hospital has hugely dedicated healthcare workers. What we need to see at a senior level at the hospital is UHL implementing an approach to discharge and patient flow in the hospital that we know works in other hospitals.”

The fact that there is only one ED in the region is something, the Minister said, that “must be kept under constant review.”

Speaking to RTÉ radio on Sunday, HSE Chief Executive Bernard Gloster said he was willing to listen to proposals to open minor injury clinics in Nenagh, Ennis and St John’s on a 24-hour basis to ease the pressure on UHL.

“If the evidence is there, and if the staffing capability is there to extend the local injury units, there’s no question but that any proposal from the hospital to me would be considered,” he said.

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