Delay in getting fluids to patient who died - inquest

An inquest into the death of a young woman with a genetic blood disorder heard there was a four-hour plus delay in arranging an alternative method of administering fluids to her after she refused to be fitted with a cannula after becoming dangerously dehydrated.

Oseremen Onolememen, aged 22, a final year student at Munster Technical University from Lucan, Co Dublin, died in the intensive care unit at St James's Hospital on 1 March 2023.

A post-mortem showed she died from acute chest syndrome – a life-threatening complication of her sickle cell disease, with gastroenteritis as a contributory factor.

An inquest into her death at Dublin District Coroner’s Court heard the deceased, who was known as Reme, had required regular hospital admissions during her life as a result of sickle cell disease.

Evidence was heard that Ms Onolememen, who was born in Nigeria, was brought to St James’s Hospital on 27 February 2023 by family members after repeated bouts of diarrhoea and vomiting since the previous day as well as experiencing severe pain in both her thighs.

A registrar in emergency medicine, Paula Cuddihy, told the inquest that Ms Onolememen was noted to have an elevated pulse and low blood pressure when triaged.

Dr Cuddihy said the patient had been registered in the emergency department at 8.18pm and triaged at 9.17pm.

She said Ms Onolememen was classified as a Category II patient which meant she was a "very urgent" case who should be seen in ten minutes.

Medical records showed she was examined by the registrar after 13 minutes.

Counsel for the deceased’s family, Pearse Sreenan SC, pointed out that Ms Onolememen had already been waiting in the emergency department for around 50 minutes before being registered.

Dr Cuddihy said the patient had been assessed as likely to be suffering from sickle cell crisis given her medical history and she was concerned about Ms Onolememen being dehydrated.

The witness said the patient was "very clear" in repeatedly refusing requests by medical staff to administer IV fluids to her because of past difficulties with cannulas, despite explaining the urgency of needing to be hydrated.

The inquest heard Ms Onolememen wanted any fluids to be administered through a portacath – an implanted device – with which she was fitted.

Dr Cuddihy said it was explained to the patient there would be a delay in administering fluids via the port as it required the assistance of a specialist nurse from another ward.

Asked about nearly an hour’s wait between the patient’s registration and being triaged, a consultant in emergency medicine, Ronán Murphy, said it was "not an uncommon issue unfortunately".

However, he said the hospital’s aim was that every patient would be assessed within 15 minutes of arriving in the emergency department.

Dr Murphy said the challenge with the patient was "consent".

A clinical nurse manager, Louise Garry, said she had tried very hard to get the patient to accept an IV line.

Under cross-examination by Mr Sreenan, Ms Garry said she was unaware that Ms Onolememen’s mother, Esther, was in a waiting room in the hospital

However, several hospital witnesses stressed that the patient was an adult, was alert and fully capable of making decisions.

Mr Sreenan said the patient’s mother had gone to the desk four times in their first two hours in the hospital to alert staff that her daughter was short of breath and unwell as well as seeking a wheelchair for her.

Medical records showed it took over four hours before a specialist nurse was available to attend the emergency department to access the portacath, despite repeated calls by doctors explaining the urgency of the situation.

A senior house officer, Siobhán O’Brien, confirmed that the nurse accessed the device at 1.52am after assistance was first sought around 9.30pm the previous evening.

However, the coroner, Clare Keane, was informed that fluids using the portacath were not administered to the patient until 3.20am.

In reply to questions from the coroner, a consultant haematologist who had treated the deceased since July 2021, Emma Tuohy, said there would "not necessarily" have been a different outcome if the patient had received the treatment earlier.

Dr Tuohy, who examined Ms Onolememen at least five times on 28 February 2023 noted that sickle cell disease is a complex disorder.

Counsel for St James’s Hospital, Caoimhe Daly BL, said the patient had been examined 15 times by doctors over a 20-hour period in the emergency department.

The inquest heard the patient’s condition deteriorated after being moved to the hospital’s ICU where she passed away at 3.25am on 1 March 2023.

The coroner recorded a narrative verdict which she explained was a factual summary of the evidence.

Offering her condolences to the deceased’s relatives on Ms Onolememen’s death, Dr Keane said the evidence had conveyed "a sense of how agonising it was for you".

She added: "There are no words that can help for the loss you have suffered."

Ms Onolememen’s family, who had previously made a public call for St James’s Hospital to conduct a clinical review of her care, declined to comment on the outcome of the inquest.