The chief clinical director of University Hospital Limerick (UHL) group failed to have a back up system in place which could have dealt with the emergency department (ED) overcrowding connected to the death of student Aoife Johnston, the HSE has argued in the High Court.
Peter Ward SC, for the HSE, said the existence of an ad hoc system for dealing with overcrowding in the UHL was one of the factors which led to the decision to place Brian Lenehan, who was in charge of ED, on administrative leave.
Counsel was responding to questions raised by Ms Justice Siobhan Stack in the ongoing hearing of Prof Lenehan's action seeking that he be restored to his position.
His suspension arose out of the circumstances at UHL when Ms Johnston (16), a Leaving Cert student from Shannon, Co Clare, died two days after presenting at the ED.
The court heard Ms Johnston was sent by her GP to UHL on December 17th 2022, with a diagnosis of suspected sepsis which meant she should have received the necessary medication within an hour. She spent more than 13 hours on a trolley before medication that could have saved her life was administered, but died on December 19th.
Prof Lenehan says an unlawful decision was made in September by Bernard Gloster, chief executive of the HSE, to place him on administrative leave because of a belief that continuation in his role may give rise to an immediate and serious risk to the safety, health and welfare of UHL patients.
The HSE denies the decision was unlawful.
Opening the HSE's arguments, Mr Ward said accounts of Ms Johnston's time in ED made for harrowing reading and what occurred was a clinical failure on the part of the HSE in the provision of services and medical care which Aoife was entitled to on her presentation.
In October, her parents settled an action against the HSE over her death.
Mr Ward said following a systems analysis report by the hospital, Mr Gloster commissioned former Chief Justice Frank Clarke to investigate matters connected to the death of Ms Johnston.
Last July, following a six month investigation, Mr Clarke issued a report saying her death was almost certainly avoidable and it outlined 22 concerns about the clinical and corporate governance of UHL, counsel said.
Arising from the Clarke report, counsel said there was a clear and obvious responsibility of the HSE to respond to such events and "seek to pursue accountability where ever that accountability may lie".
It was asserted on behalf of Prof Lenehan that the Clarke report did not make any adverse findings against him, counsel said. But the Clarke report could never do that because it was designed to ensure that did not happen, he said.
The court has heard that Prof Lenehan and his executive management team had decided some weeks before Ms Johnston's death - against HSE instructions - to reimplement an "escalation protocol" for ED whereby patients on trolleys would be transferred to wards to await a bed.
He also said that for reasons unknown to him, he did not know why the escalation protocol was not implemented on the night Ms Johnston was admitted.
On Thursday, Mr Ward said, in response to questions from the judge, that the alleged failure being claimed against Prof Lenehan was that there should have been "safe pathways" through ED.
Asked by the judge was he saying that Prof Lenehan failed to put in place "some undefined protocol for dealing with overcrowding" or something to back up the standard "Manchester System" for triaging patients. This meant that certain patients would be seen ahead of others depending on how they were assessed.
Counsel said this was among a number of allegations which would have to be dealt with at a disciplinary hearing by Prof Lenehan.
There were also allegations of failing to ensure there was an appropriate number of staff on duty, that there were measures in place if more people started presenting in ED, and that there was an effective communication system with staff, he said.
The judge said it should be possible from reading the letter from Mr Gloster to Prof Lenehan placing him on administrative leave exactly what he allegedly did wrong or failed to do. It should also have been reasonably clear to him, in an interview with Mr Gloster before the suspension decision, what he had to deal with, she said.
The case continues.
