Courts

Use of ad hoc system for dealing with overcrowding among factors for UHL director’s suspension, says HSE

Hospital’s chief clinical director claims administrative leave pending Aoife Johnston inquiry is unlawful

Prof Brian Lenehan, chief clinical director with University Hospital Limerick, at the High Court. Photograph: Collins Courts
Prof Brian Lenehan, chief clinical director with University Hospital Limerick, at the High Court. Photograph: Collins Courts
Thu Dec 05 2024 - 19:29

The chief clinical director of the University Hospital Limerick (UHL) group failed to have a proper system in place to deal with emergency department overcrowding at the time of Aoife Johnston’s death, the High Court has heard.

Peter Ward SC, for the HSE, said the existence of an ad hoc system for dealing with overcrowding in UHL was one of the factors that led to the decision to place Brian Lenehan, who was in charge of the emergency department (ED), on administrative leave.

Counsel was responding to questions raised by Ms Justice Siobhán Stack in the ongoing hearing of Prof Lenehan’s action seeking to be restored to his position. His suspension arose out of the circumstances at UHL when Ms Johnston (16), from Shannon, Co Clare, died two days after presenting at the ED.

The court heard Ms Johnston was sent by her GP to UHL on December 17th, 2022, with a diagnosis of suspected sepsis, which meant she should have received the necessary medication within an hour. She spent more than 13 hours on a trolley before medication that could have saved her life was administered.

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Prof Lenehan says HSE chief executive Bernard Gloster made an unlawful decision last September to place him on administrative leave because of a belief that continuation in his role may give rise to an immediate and serious risk to the safety, health and welfare of UHL patients. The HSE maintains the decision was lawful.

Opening the HSE’s arguments, Mr Ward said accounts of Ms Johnston’s time in the ED made for harrowing reading and what occurred was a clinical failure on the part of the HSE in the provision of services and medical care that she was entitled to on her presentation. In October, Ms Johnston’s parents settled an action against the HSE over her death.

Mr Ward said that following a systems analysis report by the hospital, Mr Gloster commissioned former chief justice Frank Clarke to investigate matters connected to Ms Johnston’s death. He said Mr Clarke issued a report last July following a six-month investigation which said her death was almost certainly avoidable. It outlined 22 concerns about clinical and corporate governance at UHL.

[ UHL chief clinical director claims his administrative leave pending Aoife Johnston inquiry is unlawful ]

Arising from the Clarke report, counsel said the HSE had a clear and obvious responsibility to respond to such events and to “seek to pursue accountability wherever that accountability may lie”.

It was asserted on behalf of Prof Lenehan that the Clarke report did not make any adverse findings against him, Mr Ward said, but the report could never do that because it was designed to ensure this did not happen.

The court has heard that Prof Lenehan and his executive management team had decided — against HSE instructions — some weeks before Ms Johnston’s death to reimplement an “escalation protocol” for the ED, whereby patients on trolleys would be transferred to wards to await a bed. He also said that, for reasons unknown to him, the escalation protocol was not implemented on the night Ms Johnston was admitted.

In response to questions from the judge, Mr Ward on Thursday said the alleged failure being claimed against Prof Lenehan was that there should have been “safe pathways” through ED.

[ HSE chief weighed decision to place University Hospital Limerick clinical director on leave, court hears ]

The judge asked if was he saying that Prof Lenehan failed to put in place “some undefined protocol for dealing with overcrowding” or something to back up the standard “Manchester system” for triaging patients. This meant that certain patients would be seen in advance of others depending on how they were assessed.

Counsel said this was among several allegations which would have to be dealt with by Prof Lenehan at a disciplinary hearing. There were also allegations of failing to ensure there was an appropriate number of staff on duty, that there were measures in place if more people started presenting in ED, and that there was an effective communication system with staff, he said.

The judge said it should be possible from reading the letter from Mr Gloster to Prof Lenehan placing him on administrative leave to know exactly what he allegedly did wrong or failed to do. It should also have been reasonably clear to him, in an interview with Mr Gloster before the suspension decision, what he had to deal with, she said.

The case continues.