'Part of us died with her' - parents of Aoife Johnston speak out

The parents of Aoife Johnston have spoken out for the first time, to call for greater accountability and transparency from the HSE and State in relation to the circumstances that ultimately led to their 16-year-old daughter's death.

"I do firmly believe that if Aoife was in a different hospital, she would have survived that night," Carol Johnston told Prime Time.

16-year-old Aoife died at University Hospital Limerick (UHL) of meningitis on 19 December 2022 after being left without antibiotics, a "vital" treatment that could have saved her life.

The Leaving Cert student initially presented at the emergency department of UHL on 17 December with suspected sepsis having been referred by Shannondoc, an out-of-hours GP service for the midwest region.

There was a thirteen-and-a-half-hour gap between when Aoife was seen by a GP and when she received the required antibiotics for sepsis.

In their first interview, Aoife’s parents Carol and James Johnston told Prime Time a recently published report into the circumstances of her death was "pointless" and has not "revealed anything" about what caused their daughter’s passing.

"Aoife's nearly gone two years, and we've never really spoke much about it, but we're angry because we're thinking back about everything that's gone on and we expect more answers from the hospital," Aoife’s mother Carol told Miriam O’Callaghan.

The report by retired judge, Chief Justice Frank Clarke, was published on 20 September. It found that the emergency department at UHL was "grossly overcrowded" and there was a "lack of clarity" on sepsis protocols on the night Aoife died.

There was also a "significant" shortage of staff on the night of Aoife’s death according to the report, with five fewer nurses than were required and one less doctor.

It also found that Aoife died in circumstances which, on the basis of the medical evidence, "were almost certainly avoidable".

Aoife’s father James said "we didn't get anything out of it that we didn't know already. We don't know what happened to Aoife and they promised us that we would."

"I know from the report a lot of it goes back to overcrowding," Carol said. "I suppose as Aoife's parents, it's very hard to accept that as the answer."

"Aoife was missed. There's a reason why she was missed. Someone has to know."

In recent weeks, HSE Chief Executive Bernard Gloster said six people are facing disciplinary action over the circumstances surrounding Aoife’s death.

Speaking to RTÉ’s This Week programme on 23 September, Mr Gloster said that: "We can never tire of saying we failed Aoife, we failed her badly, our failure caused her death," and that the issue is "a question of accountability."

Mr Gloster also defended the decision not to name in the report any of the six individuals that are facing disciplinary action, and said they must be allowed a fair hearing in any future measures.

The Johnstons disagree with that position.

"For us, it's about accountability. I feel we have the right to know about what is happening. We need to know who is being held accountable. Aoife was 16. She can’t have died for no reason. You go into hospital. You don’t go in there to die. You go in there so you can live," Carol Johnston said.

Raised flag

On the day Aoife was admitted to hospital she had initially texted her mother from her bedroom in Shannon, saying she felt unwell and that she wanted some paracetamol.

She vomited and had a high temperature, so a decision was made at around 5.50pm on 17 December for James to bring her to Shannondoc as a precaution.

"I'd say we spent maybe ten, 15 minutes with him [the Shannondoc GP]. He said to me, 'I don't know what your next move is, but I recommend you go straight into the hospital in Limerick.’ And he wrote a referral letter. Aoife was still chatting away and we were having the banter," James said.

After coming out of the doctor’s surgery, James rang Carol who had stayed at home, to tell her the GP had recommended they go straight to the hospital.

James then collected Carol from home and the three drove to UHL. When they arrived, Carol opened the referral letter to see what the GP had written.

"I did spot ‘viral septicemia’ on it, and it did raise a bit of a flag," Carol said.

After checking in at the emergency department, Carol says that despite Aoife's worsening condition, she was still chatting away.

"Aoife was showing me pictures of grad dresses. She was sick, she was thrown down, but she was still talking. She was just talking about stuff, stuff she wanted to buy her boyfriend at Christmas, little things like that," Carol said.

Begging for help

Aoife, who was triaged as a high-priority patient, should have been seen by a doctor within ten to 15 minutes of arriving at the emergency department according to an inquest into her death at Kilmallock Corner’s Court in Limerick last April.

But with little progress being made after their arrival, Carol and James fashioned a makeshift bed out of two chairs for their daughter whose condition was now starting to concern her parents.

"Her temperature was continuing to stay high. Her skin was blotchy and still vomiting. Nothing had changed. And she had been put on a drip for, I think it was paracetamol and for fluids."

As the evening wore on, Carol and James began to panic.

"The two of us were going in and out, begging for help. It came to a point that we were arguing amongst ourselves. I just kept saying, ‘please help us,’" James said.

"There was other patients on trolleys and they were shouting for Aoife saying, ‘you need to go in and help that girl.’ But no one came in to us."

"All the signs were there. Well, I didn't know anything about sepsis, now I know everything about it. And the doctor never, ever came anywhere near us until whatever time, 13 hours later," James added.

Aoife’s inquest later heard that one doctor was left managing 191 patients in the department.

The Clarke report would describe the overcrowding as "more severe than it should have been" when the Aoife was admitted.

In evaluating what went wrong, Mr Clarke stated that the evidence ultimately suggests none of the nurses or doctors working in the relevant part of the emergency department that night were aware Aoife was a suspected sepsis patient.

He says the failure to implement a "decongestion protocol" to deal with overcrowding "made what would inevitably have been a bad situation much worse and thus materially exacerbated the difficult conditions in which staff were required to work."

A doctor eventually saw Aoife at 6am the morning after she had arrived at the hospital.

"I went down and let a big roar out, cursing, and everything that, ‘you need to go in there and help my daughter,’ because we knew that she was seriously ill. She was barely standing. And that's when they seemed to make a bit of a move," James said.

"There's not a day that goes by that I don't blame myself for not doing more. I just didn't think she was going to die. If I had known, I would have torn the place apart," he added.

‘Help my daughter’

When Aoife was eventually seen, she was prescribed antibiotics for suspected meningitis. But she continued to deteriorate. After an hour, James sought help from a doctor again.

"I went out and I lost the plot, basically. I was shouting that ‘you need to get in there and help my effing daughter,’" James said.

"Aoife was making wailing sounds and fitting out. I was told to hold on her legs and you [Carol] were told to hold on her arms. This is our daughter. While they were trying to get these machines hooked up to her, they kept telling us to talk to her. But Aoife was gone. She was just gone. It was horrible," James added.

When Aoife was transferred to the Resus area it dawned on Carol and James that they may be about to lose their youngest daughter.

"I know they put her into an induced coma. They told us they'd have to relieve a bit of pressure on her brain and start getting the medicine working. And then I think about half an hour later, we were told that that the swelling on the brain had increased within the small-time frame of the first scan," Carol said.

"And then we were in the waiting area in ICU, and I think around six doctors came in. And I remember my sister was beside me and I said, ‘she's gone.’"

'It’s different. It’s quiet’

Aoife’s death sparked outrage across the country about conditions at University Hospital Limerick, eventually leading to the inquest in April and former chief justice Clarke’s recently published report.

The Johnston’s major issue with the report is that they don’t feel it offers any real resolution as to why their beloved daughter died.

"I know it’s overcrowded. I know there's a lot wrong with the hospital. We can't just accept that. Definitely on the night, it went wrong in other ways, not just through overcrowding," Carol said.

"When Aoife died, a part of us definitely died. Our life has totally changed for the worse. I can't see happy days coming. I can't see them. We try our best. We try and just take each day, as it comes, but it's very sad. It's lonely. It's different. It's quiet.

"She was about to do her Leaving and start onto a new chapter in life. We see all her friends have moved on to those stages, and it's hard because you do think, ‘Oh, God, I wonder what Aoife would be doing now."

An interview with Aoife Johnston’s parents Carol and James is broadcast on the 3 October edition of Prime Time on RTÉ One and RTÉ Player at 9.35.