A woman’s family are “haunted” by the fear that her death, a day after suffering a miscarriage, could have been prevented if she had received sepsis medication faster, a coroner’s court has heard.
Leona Cusack (33), from Ballycasey, Shannon, Co Clare, died at University Hospital Limerick (UHL) on February 18th, 2024. She had been transferred there by ambulance from University Maternity Hospital Limerick (UMHL), as she was at risk of a heart attack.
Damien Tansey, a solicitor for Ms Cusack’s family, told the inquest it is “haunting the family that there were clear indicators of sepsis and cardiac issues, but when she went to UHL, the sepsis was forgotten about”.
“That’s what led to her death. She wasn’t treated properly,” Mr Tansey told the inquest hearing at Limerick Coroner’s Court.
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Medical witnesses involved in Ms Cusack’s care agreed with Mr Tansey that sepsis medication should be administered to sepsis patients within an hour.
Although Ms Cusack was flagged for sepsis by a doctor at UMHL on February 16th, she did not receive a “broad spectrum” antibiotic until about 4pm the next day.
Ms Cusack was five weeks into an IVF pregnancy when she went to UMHL with bleeding and cramps in the early hours of February 15th, 2024. She underwent blood tests at the hospital and then went home.
She returned the next day, vomiting and suffering from headaches and chest pain. A consultant gynecologist at UMHL, Dr Suhaib Akhtar Birmani, said he recommended Ms Cusack should be admitted and went on to attend other patients.
Ms Cusack’s husband Conor Cusack said it was recommended that his wife be admitted to UMHL, but that they overheard staff say there was no bed available at the time. He said they went home.
The couple returned the following morning after Ms Cusack’s symptoms worsened.
Dr Birmani told the inquest he believed Ms Cusack was admitted to UMHL: “I thought, she is in the hospital; she is safe.”
The inquest heard Dr Birmani noted Ms Cusack was “very anxious” and, although her vitals were normal, an ECG revealed she had a heart rate above 100 beats per minute. Dr Birmani agreed with Mr Tansey that Ms Cusack also had a raised temperature, and that her white blood cell count was elevated.
He said he was concerned Ms Cusack might have had an ectopic pregnancy. He agreed he suspected Ms Cusack was suffering from sepsis and he said he filled out a form to this effect and initiated the hospital’s sepsis protocol.
Dr Birmani said UMHL requested the services of a cardiologist from UHL. UHL told him Ms Cusack needed to be immediately transferred there by ambulance, and this was done, he said.
Dr Birmani agreed the correct treatment for sepsis is to administer a broad spectrum antibiotic. He said this was not done before Ms Cusack left the maternity hospital.
Upon arrival at UHL, Ms Cusack was seen by Dr Cormac O’Connor, a cardiologist.
Ms Cusack’s sister, Rachael Kirwan, who works as an advanced nurse practitioner, told the inquest she asked Dr O’Connor about her sister’s condition, and that he told her she had “the heart of a lion” and he was “surprised she is not shadow boxing in the corner”.
Ms Kirwan said Dr O’Connor said “he was addressing” her sister’s “cardiac issues”.
Ms Kirwan said: “I asked if her heart rate could be raised due to infection. He said if it was, they would deal with it.” Ms Kirwan said Dr O’Connor told her he was of the opinion that Ms Cusack’s heart rate could have been “anxiety driven”.
Ms Kirwan said: “We were given no reason for concern.”
Ms Cusack’s condition worsened and she died at UHL on February 18th, three days after initially presenting at UMHL.
Dr Adnan Abdalla, UHL medical registrar, was managing three critically ill patients, including Ms Cusack in ICU. He said he suspected Ms Cusack was “suffering from sepsis”. The inquest heard doctors were trying to locate the source of the infection because scans did not reveal it.
An emergency theatre nurse at UHL, Sara Khankashi, broke down as she described her and others’ efforts to resuscitate Ms Cusack. She said they sent for Mr Cusack after 45 minutes of CPR and resuscitation failed.
Dr O’Connor is to give evidence on Thursday.
