A Shannon woman who was flagged at two Limerick hospitals for “sepsis”, but who was not given the prescribed medication in time, died from cardiac respiratory failure, a day after suffering a miscarriage, her inquest has heard.
By David Raleigh
Leona Cusack, (33), Ballycasey, Co Clare, might have survived if she had received a “broad spectrum” of antibiotics. She died on February 18th, 2024.
However, it was agreed that, due to a “breach” in HSE sepsis protocols, while Ms Cusack was a patient at University Hospital Limerick, she was initially only given a “narrow spectrum” of antibiotics.
Following two days of evidence, the Limerick Coroner’s Court found that Ms Cusack died of cardiac respiratory failure due neutrophilic myocarditis, a very rare condition that, the inquest heard can be caused by sepsis or can be a source of sepsis.
Ms Cusack was eventually “loaded” with antibiotics after her blood markers for sepsis rose “extraordinarily high” on February 17th, and “doubly extraordinarily high” on February 18th.
Damien Tansey, solicitor for Ms Cusack’s family however, said, the loading of the broad spectrum of antibiotics on February 17th was “too late”, and had “no impact” on her condition.
The hearing heard that Ms Cusack was five weeks pregnant following IVF treatment when, supported by her husband Conor Cusack, she initially presented at University Maternity Hospital Limerick (UMHL), on February 15th.
Bleeding and suffering from abdomen cramps, Ms Cusack underwent blood tests at the maternity hospital before going back to her home, believing no bed available at the hospital.
The couple returned to the maternity hospital, the following day, February 16th, after Ms Cusack’s condition worsened. She was vomiting and had a raised white blood cell count.
A consultant gynaecologist at UMHL, Dr Suhaib Akhtar Birmani, had flagged a sepsis infection and he told the inquest that he ordered the HSE’s sepsis protocol at UMHL.
Ms Cusack should have received a “broad spectrum” of antibiotics within one hour, as per the HSE’s protocol, however the medication was not given at UMHL.
After attending the maternity hospital again on February 17th, Ms Cusack was rushed by ambulance to University Hospital Limerick, diagnosed with a fast heart rate and deemed to be at risk of a suffering a heart attack.
She was received by UHL’s coronary care unit under the care of cardiologist, Dr Cormac O’Connor.
During his evidence at the inquest, Dr O’Connor became emotional and apologised to Ms Cusack’s loved ones for “language” he used when speaking to Ms Cusack’s sister Rachael Kirwan, a qualified advanced nurse practitioner,
Ms Kirwan said she was upset after Dr O’Connor had told her Ms Cusack had “the heart of a lion”.
Dr O’Connor told the inquest, “I made the comment to try to comfort (Ms Kirwan), I apologise for any distress caused”.
Dr O’Connor said he could not recall telling Ms Kirwan that Ms Cusack was “shadow boxing” in the coroner of the room.
The cardiologist agreed with Damien Tansey that, the HSE’s sepsis protocol, was “breached” as Ms Cusack was initially given a “narrow” spectrum of antibiotics to treat her infection.
Dr O’Connor said, “the focus was on trying to find the source” of the infection. He disagreed that sepsis was ignored, and he said Ms Cusack was eventually “actively escalated with antibiotics”.
As her condition grew more critical, Ms Cusack was transferred out of the coronary care unit to the intensive care unit.
Damien Tansey told the inquest the escalation of antibiotics was “too late” for Ms Cusack and she died at UHL at 7.39pm, February 18th, four days after she had first presented at UHL’s sister hospital, UMHL.
All of the staff at UMHL and UHL which were involved in Ms Cusack’s care offered their deepest sympathies to her family.
Describing it as a “complex case”, Limerick Coroner, John McNamara, noted the “breach of sepsis protocol”.
Mr McNamara said he was not satisfied to record a verdict of death by natural causes nor death by medical misadventure.
He said the inquest was a “fact-finding” exercise and recorded a “narrative” verdict, in line with the chain of evidence heard.
Ms Cusack’s loved ones wept in court after the verdict was delivered.
Speaking afterwards, Conor Cusack paid an emotional tribute to his late wife, “Leona was the nicest bubbliest person you’d ever meet in your life, she was the love of my life.”
Looking at Ms Cusack’s parents and her sisters, Mr Cusack, said, “Sure Eamonn and Clare would tell you she was the best daughter, and Sarah and Rachael would say the same about being their sister”.
“She was loved by everyone,” Mr Cusack said.
