System shutdown

‘My dad was a strong person – so if this can happen to him, what else is happening?’ Anne Marie Abbott tells Maeve Sheehan of her family’s anguish after their father was found dead on a floor in A&E

The camper van parked outside the family home was the embodiment of everything Martin Abbott dreamed of for his future. The van had given Martin and his wife Mary at least 10 years good service — and there was at least another decade to go.

They drove to Europe every year, mostly to France, often for a month at a time. At 65, he was looking forward to spending his retirement cruising around the Continent in a camper van, his wife by his side, the open road ahead.

“That was the plan,” his only daughter Anne Marie said this weekend, recalling the tall, strong man who had filled her life with love and fun.

The Abbotts live in Shannon, Co Clare, where Martin worked as a hackney driver. He had health issues. A kidney transplant in 2008 left him immunocompromised, more prone to infection than other people. Martin and Mary were both involved in the Irish Kidney Association, and the whole family took part in fundraising.

But Martin had quickly “bounced back” from the transplant operation. He was never someone who came across as being unwell, Anne Marie said.

“He always found ways and means to do what he wanted to do. He just lived for his holidays and the downtime. He’d work very hard for that.”

He was active man. He loved sports, especially rugby (which he used to play in his youth) and hurling.

A “proud Roscrea man”, he watched Tipperary beat Kilkenny in the All-Ireland hurling final in 2019.

But just months later, he died unexpectedly in the emergency department of University Hospital Limerick on Tuesday, December 17, 2019.

He was found face down on the floor of his cubicle. Attempts to resuscitate him failed. He had been dead for at least an hour. He could not be intubated as rigor mortis had set in around his facial and neck muscles.

At an inquest last week a coroner recorded a verdict of death by medical misadventure, after hearing evidence of deficits in his care. UHL has apologised to the Abbott family.

“My father was a hardworking man. He was looking forward to retirement with my mother and travelling. He was completely full of life,” Anne Marie said.

“To die like that, not to be given dignity, and to be taken when it wasn’t even his time, in a hospital surrounded by medical professionals… What chance do you have?”

She has cherished memories of her father from the days before he died. She went to Poland, to the Christmas markets, to celebrate her 30th birthday with her parents and her partner, John. More celebrations followed after they got back on December 6, dinner at home with extended family followed by drinks and cake.

Days later, Martin began to feel unwell. They suspected he had a viral infection. On the advice of his longstanding consultant Dr Liam Casserly — who Anne Marie said had been a huge support to the family — Martin attended UHL’s emergency department.

He registered late in the afternoon on Saturday, December 14. Anne Marie and her mother spent much of the next three days with him in a cubicle in Zone B, as he waited for a bed in the main hospital.

Anne Marie last saw her father alive on the evening of Monday, December 16. By then Martin had tested positive and was being treated for Legionnaires’ disease, a bacterial pneumonia he probably picked up on holiday.

Her mother had spent the day with him. Anne Marie took over the visit at 8.15pm after she finished work.

Monday night was his third night in the emergency ward. All day, Anne Marie felt increasingly uneasy about the overcrowding and the chaos there. She worried he was not being looked after and made phone calls trying to get him moved to a ward.

“I had a gut feeling that I just needed to get him out of A&E,” she said.

She brought her father ice-cream that night. He was annoyed that the nurses had removed a commode from the cubicle, as he now had to walk through the emergency department to find a bathroom. He said that was why his breathing seemed laboured. But Anne Marie was worried.

She went to the nurses’ station to ask a doctor review her father.

“It was chaotic,” she said. The nurses were busy and dismissive. One said she knew nothing about her father, as she had just come on duty. Another said her father was nothing to do with them; he was under the care of the medical team.

She finally persuaded a nurse to come to his cubicle to check his oxygen and blood pressure levels. She was told a registrar on call would come review her father “within the hour”. She waited but her Dad urged her to go home.

“Go on, I’ll see you in the morning,” he said — and so, just after 10pm, she left him still waiting for a doctor.

She issued him strict instructions that he was to call the nurses’ bell or her mobile if he needed “anything at all”.

“I was very upset when I got into car. It wasn’t that I thought he was going to pass away — I’d no concerns about him passing away. It was more the fact that he wasn’t being looked after correctly,” she said.

Martin died hours she left.

He was last checked on by a nurse at 3am, was found on the floor at 4.40am and was pronounced dead at 4.55am. He had been dead for at least an hour, his inquest heard. The primary cause of his death was acute heart failure, with pneumonia among the underlying factors.

Anne Marie recalls the 6am phone call from her mother to say gardaí were at her front door, the dash to the hospital, the many, many questions that went unanswered.

One of the first things Anne Marie asked was whether a doctor had seen her father, as she had requested.

She had to chase down the answer. No. The family’s trauma has been compounded by the errors in what the family was told about his death — from the morning that his body was found.

They only learned the hospital had launched an investigation into Martin’s death through a local newspaper report about an unnamed patient who had fallen off a trolley and “broken his neck”.

That Martin had a “broken neck” later confirmed at a meeting with the hospital. Anne Marie said the family believed this to be the case for two years — until a systems analysis review reported that he had suffered a neck injury, not a fracture. The mistake was blamed on a “miscommunication” that the review said added “a further layer of error to a case which already had major avoidable errors in care” .

Anne Marie’s most haunting question at the inquest into her father’s death was how many more people have to die?

Since he passed away, she has read of at least three more patients who died in UHL, including two teenagers in the A&E.

“Any time I read about these cases, my heart goes out to their families. I know what they’re going through. I’m increasingly angrier and angrier. This is not good enough — how many more people have to die?” she said.

“And I just have to ask the Government: what exactly are you going to do about it?”

Anne Marie, who works in administration at the HSE, believes change must start from the bottom up. The hospital needs to “listen” to staff, needs to have interventions on the ground — and, most of all, families like hers need to be treated with the respect she feels her own family were not afforded.

Anne Marie said the process of pursuing the truth about what happened — supported by their solicitor, Catriona Carmody of Carmody & Co — has left the family shattered.

More than anything, she is utterly devastated for her mother, who she says has been “robbed” of the wonderful future she had planned with her husband.

They still have unanswered questions about what happened to Martin.

“When you don’t have all the pictures or all the pieces of a puzzle, you can’t put it together. So it’s hugely frustrating.

“I’m also angry because my dad was a very strong person and always would have stood up for anybody. If this can happen to my dad, what else is happening?” she said.

“The system is broken.”

I had no concerns about him passing away — it was more that he wasn’t being looked after