An inquest into the death of a 16-year-old girl at University Hospital Limerick in January 2024 has recorded a verdict of medical misadventure.
John McNamara, presiding coroner at Limerick coroner’s court, said Niamh McNally’s death was a “tragic and rare event” that unfolded and led to a tragic outcome.
Niamh was admitted to the midwest hospital on January 9th, 2024, after she began coughing up blood. She remained there for 14 days and was treated for a collapsed lung and pneumonia. She was discharged on January 23rd.
The teenager, who had a congenital heart defect and scoliosis, was readmitted to hospital on January 29th by ambulance - once again coughing up blood.
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She suffered a cardiac arrest that night and died.
A postmortem determined the cause of death as asphyxiation second to pulmonary haemorrhage which was “most likely” caused by the “erosion of a collateral artery” of the heart.
Mr McNamara said “losing a child is obviously the deepest of tragedies”.
“I’ve no doubt Niamh’s memory will continue to live on in all who loved her.”
Speaking outside of Kilmallock courthouse on Thursday afternoon, Carolyn O’Neill, Niamh’s mother, said she hopes “no other family has to go through what Niamh experienced in UHL”.
“There were missed opportunities that could have been taken into account, especially for cardiology,” she said.
“If they actually acted upon doing a proper cardiology checkup on Niamh, she would be alive today, that I’m convinced of.”
[ Mother of Niamh McNally (16) recalls her death in Limerick hospitalOpens in new window ]
Describing her daughter, Ms O’Neill said Niamh was a “lovely girl” who was “just coming into her own”.
“She was turning into a beautiful woman. She loved everything, she was such a fighter, she was fantastic. She never let her disability get in the way,” she said.
Ms O’Neill said her husband died almost 12 years ago, and so she was “mother and father” to her daughter.
“I used to call her my sticking back; she was continuously just glued to me. We were just so close.”
Prior to Mr McNamara’s verdict, across the two days of the inquest, images of the quantity of the blood Niamh was producing were presented to the various medical experts, all of whom agreed the quantity of blood was “significant”.
Niamh underwent three open heart surgeries as a child - aged 9 months, 18 months and at 8 years old - and underwent spinal surgery for her scoliosis.
Her mother said she was doing well in relation to these diagnoses and doctors at UHL were made aware of her medical history.
Damian Tansey SC, representing Ms O’Neill, asked the medical experts why cardiology was not more involved in the teenager’s care, given her medical history.
The primary focus of her treatment was on the upper respiratory tract, the inquest heard.
The inquest heard that Niamh’s only interaction with cardiology was to determine whether she had infective endocarditis, which is a bacterial infection of the lining of the heart.
On Wednesday, Dr Saadat Khan, the cardiology registrar, said there was “no medical signs of infective endocarditis” and he was not asked to examine any other potential cardiac complications.
Mr Tansey said the family is “troubled” that so much emphasis was put on respiratory concerns, and they did not consider wider diagnoses such as the heart.
On Thursday, Dr Brian Casserly, a respiratory consultant at UHL, agreed the failure to recognise the source of Niamh’s symptoms being the heart is a “failure”.
“It is undoubtedly a failing. I would agree absolutely there was too much emphasis put on a pulmonary cause of the problem,” he said.
He added some tests on the heart were carried out - including an echo and CT scan - but said these did not point to heart-related concerns.
“There should have been a bigger focus on cardiology,” he said.
The inquest opened on Wednesday with an apology from the Health Service Executive (HSE) for the “failings” that ultimately led to the Limerick girl’s death.
The organisation said it was implementing 15 recommendations made by an independent review team following Niamh’s death.
Ms O’Neill, in her evidence on Wednesday, recalled harrowing details of the hours leading up to her daughter’s death, including the teenager saying “mammy, I can’t breathe” moments before she died.
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