An inquest into the death of a 12-month-old child, who was in the care of Cavan General Hospital at the time, has heard he went 18 hours without a physical examination by a consultant despite his condition deteriorating.
The first day of the inquest into the death of Luke Kelly has concluded with witnesses set to resume giving evidence tomorrow morning.
His parents Barry Kelly and Helena Lyons from Shantemon, Co Cavan were present at the inquest.
They described their son as a "courageous little hero" who was the most "beautiful, smiley, placid child that any parent could ask for".
The inquest heard that baby Luke had Shone's syndrome, a rare congenital heart defect, and he underwent major surgery at Children’s Health Ireland (CHI) at Crumlin on two occasions.
Luke had his second operation at Crumlin in April 2023 and was discharged and allowed home the following month.
The inquest was told that at this stage, the medical staff at Crumlin were happy with his prognosis and recovery, and he would not have to be seen again for another six months.
The family said they were told to go to their local hospital should any further problems arise.
In the months that followed, Luke picked up several respiratory viruses, and he was brought to the Paediatric Assessment Unit (PAU) at Cavan General Hospital on a number of occasions.
The inquest into Luke’s death is centred around establishing the circumstances that led to his condition deteriorating at Cavan General Hospital over a five-day period beginning on 1 July, 2023.
Dr Sarah Hoolahan was one of a team of doctors and nurses involved in Luke’s care during this period.
She was the paediatric registrar working on call overnight on 4 July 2023.
Under questioning by Roger Murray SC, solicitor for the family, Dr Hoolahan agreed that Luke had not been physically examined by a consultant for about an 18-hour period.
Dr Hoolahan also agreed that Luke was a boy with "very severe and very difficult heart issues".
However, she said carrying out an examination of this nature when a child was stable and settled could result in them becoming distressed and their heart rate rising further.
A number of nurses who cared for Luke gave evidence before the inquest to say that his condition continued to worsen following his admission to the paediatric ward despite their best efforts.
In her deposition, Dr Hoolahan said she believed Luke’s "abnormal parameters were in keeping with a respiratory viral illness causing fever and subsequent tachycardia [a heart rate that exceeds the normal resting rate]."
However, after her concerns grew, she contacted the paediatric consultant on call, Dr Ann Leahy, early on the morning of 5 July 2023.
Dr Hoolahan said when Dr Leahy arrived at the hospital a short time later, she asked her to contact the Irish Paediatric Acute Transport Service (IPATS).
This was to arrange a transfer for Luke to the intensive care unit at CHI at Crumlin as they were both concerned his condition had deteriorated from a "cardiovascular perspective and was likely to requite intensive care management".
Mr Murray put it to her that "time was lost in reacting to a worsening situation" by doing this instead of getting a regular ambulance to take Luke from Cavan to Crumlin.
However, Dr Hoolahan said Luke would have been too unstable for them to transport him to Dublin themselves, and he required specialist intubation and ventilation.
Luke was pronounced dead at Cavan General Hospital shortly after 10.30am on 5 July 2023, less than two weeks short of his first birthday.
Cavan General Hospital had no formal afternoon handover process
The coroner for Co Cavan, Dr Mary Flanagan, was also told that Cavan General Hospital had no formal afternoon handover process in place at the time.
Dr Ali Eltoum, another paediatric registrar working at the hospital at the time, said he had twice tried to contact the cardiology team at Crumlin on 3 July 2023 to inform them about Luke’s condition.
However, there was no answer, and as it was just prior to his shift coming to an end, he said he handed over Luke’s clinical condition to the next on-call registrar.
Dr Salvador Ramirez was the paediatric registrar on call on the night of 3 July 2023.
He told the inquest that he was advised to only contact the cardiology team at Crumlin if Luke’s oxygen requirements increased or were escalated. Dr Ramirez said as this did not happen, he did not contact CHI at Crumlin.
The inquest was also told that no one at Cavan General Hospital made contact with the cardiology team at Crumlin the following day either.
Dr Ramirez, who no longer works at Cavan General Hospital, also accepted that he had discharged Luke from the PAU at the hospital a few days previous when a formal radiology report was not available to him.
However, Dr Ramirez said a review of the chest X-ray had shown "upper lobe inflammatory changes" but these were "similar to or equal to" Luke’s prior X-rays with service.
Hospital apologises for 'shortcomings' in care of baby
Earlier, the hospital offered an apology to Luke's parents over what it described as the "shortcomings in the care" that their son had received.
Conor Halpin SC, representing the hospital, read out the apology on behalf of the Acting General Manager for Cavan and Monaghan Hospital, Laura Waters.
"On behalf of the management and staff of Cavan General Hospital I wish to offer my deepest condolences to you both and to your extended family following the death of your dear son Luke," she said.
"I would like to extend my sincere apologies for the shortcomings in the care that your son received in Cavan General Hospital.
"We acknowledge that the experience was devastating for you and understand that this apology cannot negate the deep effect the loss of your son has had on your lives or in any way make up for this tragic loss.
"I wish to reassure you and your family that the hospital strives at all times to optimise patient care and that we will continue to ensure that best practice is at the forefront of our clinical service to all patients."
The inquest at Cavan Courthouse will enter a second day tomorrow with Dr Flanagan expected to return a verdict tomorrow afternoon.
There is expected to be a total of over 15 witnesses with four more due to give evidence tomorrow, including Dr Leahy.
