I’ve finally stopped blaming myself for Eve’s death
Melanie Sheehan Cleary’s 21-year-old daughter died in 2019 after a seemingly innocuous fall – one of a growing number of untimely deaths linked to University Hospital Limerick. After settling a court action with the hospital and the HSE, she says...
THINGS had just started to get a little easier this week for Melanie Sheehan Cleary. After an exhausting seven-day High Court case, she was beginning to feel stronger.
‘My voice was going the whole time through it all,’ she says. ‘But I noticed it was getting better, things were settling down.’
But then came the news on Tuesday that an inquiry has been launched into the sudden death of a young girl three weeks ago at University Hospital Limerick. The circumstances sounded all too familiar to Melanie and her husband Barry.
The 16-year-old youngster was reportedly rushed to UHL after suffering breathing difficulties. After being initially admitted to the resuscitation area, she was then declared well enough to be moved to a trolley in a corridor.
But her condition deteriorated and after desperate pleas from her mother, she was moved back into the packed resuscitation room where it took time before a berth became free for her. Despite doctors’ best efforts to revive her, she died.
While that tragic girl’s mother was begging medical staff to save her, Melanie Sheehan Cleary was in the High Court in Dublin, watching lawyers bring to a close her family’s four-and-a-half-year battle to get an apology from UHL regarding her own daughter’s death.
Eve Cleary was just 21 when she died in UHL’s resuscitation room in the early hours of July 21, 2019. The previous day she had slipped and fallen on a pavement in Limerick City, injuring her leg.
After spending 17 hours on a trolley in the ED, she was admitted to a ward for several hours before being discharged and told to go home and rest.
Less than four hours later she suffered a cardiac arrest, caused by a blood clot that had travelled into her lung.
Ever since, Eve’s parents have fought to find out how the eldest of their six children could have died from such a seemingly innocuous injury. An inquest in 2021 recorded a verdict of medical misadventure.
Just over three weeks ago, her family settled their High Court action, during which the HSE and UHL expressed ‘sincere condolences and deep regret’ on Eve’s ‘untimely death’. The High Court heard that the settlement is without an admission of liability.
‘I was looking yesterday at the date that young girl died, January 29,’ says Melanie. ‘Our case finished on the 30th. Four-and-a-half years later, it happens again, and this is the third that we know of.’
There are certainly echoes of yet another horribly tragic UHL case, the death less than two years ago of 16-year-old Aoife Johnston from Shannon, Co Clare, who spent 12 hours on a trolley in the emergency department.
Bacterial meningitis developed into sepsis as she waited in an emergency department that was so overcrowded it was later described as ‘endemic’ by an internal HSE report. This review into her death on December 19, 2022 led to an independent judgeled investigation that is currently under way.
Reports of chronic overcrowding at UHL is nothing new. For years, the rest of the country has watched horrified as heartbreaking stories of patients being left in corridors as staff struggle to get to them, have regularly emerged.
The warzone-like conditions have led to some dubious, undoubtedly desperate decisions being taken. Only two weeks ago, the Irish Daily Mail reported how security staff were called to move an elderly patient with dementia from his bed at 4am.
The man, in his 80s, was woken up to be told he was being discharged, but after he became agitated, medical staff called on security to help them move him.
However, they refused to step in given the level of distress the man was in. UHL later ‘sincerely apologised’ for the incident and said there was a delay in securing an ambulance to move the patient from the hospital back to his community setting. It also claimed that moving patients in the early hours of the morning ‘is not our usual practice’.
There is no doubt that staff and management at UHL have been dealing with untenable conditions, and like most days, on January 29, the day the unnamed teenage girl died, it was by far the busiest hospital in the country. Figures released by the Irish Nursing and Midwifery Organisation show 133 patients were waiting for beds, 53 of those were in the emergency department.
‘Seeing over 100 people on trollies in UHL has become normalised,’ says an INMO source. ‘Extra nurses aren’t rostered on for these additional people on trollies, so you can imagine the pressure and what kind of impact this has on staff. Morale is very low.
‘For a long time these conditions have been publicly called out as inhumane and it’s very hard for staff. Nurses are the first people you meet so they’re bearing the brunt of public anger. But it’s not their fault, all they want to do is provide safe care, but that’s just not possible in that hospital at the moment.’
In a lengthy response detailing steps it has taken to tackle the ongoing issues, UHL told the Irish Daily Mail: ‘This is not the standard of healthcare we wish to provide. It is a source of great regret for UL Hospitals Group and all its staff, and we apologise to all patients and their loved ones who have been impacted. During this exceptionally busy period, we have been encouraging members of the public to consider all care options, including their GPs, pharmacists and GP out of hours services before presenting to the Emergency Department.’
Campaigners in the mid-west region say serious issues at UHL began in 2009 when the local hospital system was reconfigured. The emergency departments of Nenagh Hospital in Co Tipperary, Ennis Hospital in Co Clare and St John’s Hospital in Co Limerick — all now Model Two hospitals — were closed in favour of one major and enhanced emergency service at UHL, a Model Four facility.
However, the recession delayed the promised investment, and it took until June 2017 before the new emergency department was finally opened. The largest and most advanced in the country, it cost €24 million to build.
With 3,850 sq m of floor space and almost 100 additional new staff recruited, there were high hopes that patient flow and outcomes were set to drastically
‘Safe care is just not possible in that hospital’
improve. But chronic ongoing bed and staff shortages have plagued the new facility from the start.
Conditions have been so bad for so long that UHL doctors have written at least twice to the HSE about their overcrowding fears. Just over a dozen signed the first one — that figure jumped to 72 names last year.
Nursing staff are also vocal about their fears. The INMO’s assistant director of industrial relations, Mary Fogarty, says their members are ‘tired’ of UHL constantly getting such negative press.
The ever-growing trolley numbers are ‘a huge concern’, she says, ‘way ahead of every other hospital in the country,’ but UHL ‘seems unable to improve the situation despite additional resources and developments’.
Like others, she points to the mid-west region being the only one in the country without a Model Three hospital, which would, she says, take some pressure off UHL.
‘We have three Model Twos, and UHL is a Model Four, so expanding the other hospitals’ bed capacity would help. It’s also to do with availability of rehabilitation and step-down facilities.’
She says this solution has been raised ‘repeatedly’ by UHL management. However, it would seem the HSE is depending on two new private hospitals to help alleviate the pressure.
‘The Bons Secours is opening a very large facility on the outskirts of the city, early next year, and I understand an American company is coming in, near Moyross,’ she explains. ‘The HSE is also developing a surgical hub in an old secondary school here, so that will be an elective public patient hospital.
‘Taking some of the private work out of the hospital will decrease demand on the public hospital.’
There is also a new 96-bed unit in the process of being built at UHL, although about half these beds are replacing current ‘nightingale wards’ scheduled to shut down.
UHL says: ‘The first 96-bed block is in construction, and preparatory works have started for the second block, and while we greatly appreciate the support of Government and the HSE in expediting these, the blocks are not available to immediately address the overcrowding and long waits for inpatient beds that are a regular feature in UHL currently.’
This unit is likely to have issues even after it opens, however.
‘The big challenge will be to get staff for that new building,’ says Gogarty. ‘We were informed only last week that there are 237 nursing vacancies in UHL at the moment, when we’re in the middle of a recruitment embargo.’
Naturally, the tarnished reputation of UHL makes it more difficult to attract new staff or even retain the nurses it has.
There has also been serious criticism about the management structure of UHL, some of it involving the recent inquiries into the tragic deaths of several young women.
‘There are work practises that need to be addressed as well,’ one well-placed source explains. ‘For instance, the presence of senior decision-makers on site for greater periods of time. That’s nothing to do with a staffing issue, it’s a management issue.’
Noeleen Moran of the Midwest Hospital Campaign group, says the only solution to tackling the grim statistics at UHL is reopening at least one, if not all three, of the emergency departments at the current Model Two hospitals.
‘The HSE don’t worry about staffing issues when it comes to a private hospital,’ she says. ‘Surely if a private hospital can pay staff to perform in a fully-functioning facility, why can’t that be done in the public sector?
‘Letting the private sector fill the void of the public sector seems to be their solution, which is grand for people who have health insurance but what about the people who don’t, where does that leave them?’
She says the current situation at UHL is ‘not acceptable’, adding: ‘The worst thing is, everyone knows what’s happening, the evidence of the young people dying is there for everyone to see, yet every political party refuses to call for the opening of at least one ED for the region.’
For Melanie Sheehan Cleary, the last four-and-a-half years have been spent wondering if there was anything she could have done differently to help save her eldest child from dying at UHL.
‘We believed she was OK to go home because that’s what they told us,’ she says. ‘At the High Court I finally felt some peace, I stopped blaming myself because I finally realised this wasn’t my fault. I’m not a medical professional, I couldn’t have known.
‘You always think as a mam, that you’d know if there was something seriously wrong with your child.
‘I carried that for a long time, until the High Court, then I listened to the experts. They told me the truth.’
During the trial, distressing details about Eve’s experience at UHL were detailed, much of it involving the chronic overcrowding in the emergency department. Her parents dropped her at the hospital after her fall, and her long-term boyfriend Mark stayed with her overnight. Melanie and Barry returned the next morning.
‘The smell of urine was the first thing to hit us,’ says Melanie. ‘Eve told us another patient had used the sink beside her as a toilet and it was just left there.
‘Another thing people aren’t really grasping about UHL, sick people aren’t able to lie down properly. There’s not enough room to lie all the trollies flat, and this was in 2019.
‘Eve was in a sitting position the entire time, she couldn’t straighten her poor legs. Then with the lights and all the noise, she never slept.’
She was admitted at 7.30am that morning but it took until 3.30pm for her to get on a ward. Despite concerns about the colour and swelling of her leg, she was discharged at 8.30pm after being told her scans and X-rays were clear.
‘We took her home,’ says Melanie. ‘She went to bed at 11.15pm, by 11.45pm she had her first cardiac arrest on the stairs.’
Eve was rushed back to UHL by ambulance.
‘The resuscitation team worked on her for 90 minutes, they did not want to give up,’ says Melanie. ‘But I could see she was gone.’
The Cleary family were already well acquainted with UHL — Barry was diagnosed with Granulomatosis with polyangiitis (GPA) 18 years ago, a rare disorder that affects his central nervous system.
‘It’s like a tumour in his brain that’s affected his hearing, his sight, his skin and limbs.
‘He got his chemo at UHL and his experience was always really good,’ says Melanie. ‘I was one of the people who said they were doing their best.
‘Of course, I’d heard all the stories but until I was in there with Eve, that’s when I quickly realised it’s as bad as everyone says.
‘I was thinking about that girl’s poor mother yesterday, I’m so sorry she lost her daughter. I just wished things had been made better sooner and none of us would be dealing with what we’re all going through right now.
‘Eve was a diamond, who always wanted to spend time with her family, she was a brilliant older sister and a wonderful daughter. I still can’t quite believe she’s gone.’
‘Eve was a brilliant a older sister and wonderful daughter. can’t believe I still she’s gone’
‘Sick people aren’t able to lie down properly’