Inquest into the death of Aoife Johnston at University Hospital Limerick to take place in April

The late Aoife Johnston.

AN INQUEST hearing into the death of schoolgirl Aoife Johnston at University Hospital Limerick (UHL) has been scheduled to run for four days in April of this year.

The 16-year old from Shannon, County Clare, died at the hospital on December 19, 2022, after she languished on a trolley for 12 hours waiting to be treated in the emergency department (ED) at UHL.

An inquest into her death will take place at the Limerick Coroner’s Court in Kilmallock, County Limerick, between April 22 and 25.

Ms Johnston was diagnosed with bacterial meningitis and later developed sepsis and died.

A crucial change of wording in a report commissioned by UL Hospitals Group, which emerged last month, shifted the emphasis away from management at the hospital.

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A draft of the internal System Analysis Report (SAR) on the circumstances of Ms Johnston’s death stated that “there is little apparent understanding of the risks and inefficiencies caused to patient care by an overcrowded environment by the executive management team in terms of the impact on the emergency medicine doctors assessing and managing patients and the nursing staff’s ability to provide safe care”.

However, in a final report presented to Ms Johnston’s family, the reference to the “executive management team” does not appear, replaced instead with “the hospital system”.

The report found there was a 12-hour delay in caring for Ms Johnston’s developing sepsis.

The report by two non-UHL doctors found that overcrowding was endemic at the hospital’s emergency department, there was only one ED consultant on call over the weekend while Ms Johnston was in the hospital, and there were insufficient ED nursing and medical staff to adequately monitor patients which resulted in “low experience levels and low situational awareness”.

On the day Ms Johnston died, UHL said it was trying to manage “unprecedented” demand on its ED, which led to the hospital cancelling all non-urgent elective surgeries.

The HSE said previously that only the final version of the report had been accepted, and it was “not appropriate” to comment on the draft report.

At the beginning of January, the HSE announced a framework for an independent investigation to be undertaken by former chief justice Frank Clarke.

The Johnston family were not consulted about the terms of reference in the investigation, however, through their lawyer, the family said they accepted that no party to the events had been consulted about the framework in order to ensure that the probe be fully independent.

“The family are looking forward to the inquest when an opportunity will be afforded them, through their lawyers, to seek explanations as to why what happened in Limerick happened,” Damien Tansey, senior counsel representing the family, said last month.