A consultant in emergency medicine at Sligo University Hospital has told an inquest he did not order a brain scan on a 19-year-old student in the early hours of the morning after her admission, because he did not think an emergency scan was needed at that time.
Lisa Niland was admitted to the hospital at 9.30pm on the evening of 17 January 2017 after collapsing and vomiting with a sudden severe headache while in a fast-food restaurant.
She died three days later in Beaumont hospital.
The coroner’s court has heard the cause of her death was a catastrophic bleed to her brain.
Dr Fergal Hickey told Dublin City Coroner’s court, that the decisions he made were made in good faith, in the situation he found himself in and within the confines in which they were working.
Dr Hickey said he received a phone call from the senior doctor on duty in the emergency department at 2.15am in the morning on 18 January.
He said the doctor – Katherine Langtree – raised the issue of whether or not Ms Niland needed a CT scan.
He said he agreed that one was required but his decision was that an emergency scan was not needed at that time.
He said Dr Langtree told him there were no neurological signs present at the time of her phone call, and there was no indication an emergency ct scan was needed.
Dr Hickey said he agreed that the most likely diagnosis at the time was a bleed to the brain, but he said he did not think there was anything to be gained by requesting the scan in the middle of the night.
He said in his 25 years of experience, Beaumont hospital would not admit someone in the middle of the night, even with a brain bleed, if there were no other neurological signs present.
The scan did not take place until just after 10am when the haemorrhage was identified.
However, Ms Niland had three cardiac arrests before she could be transferred to Beaumont by helicopter.
Surgery was carried out but her life support machines were turned off on 20 January.
Mr Hickey said he worked in a very imperfect system and the constraints were not determined by him.
The coroner’s court has heard that in Sligo hospital and other similar hospitals around the country, a CT scan could only be ordered by a consultant.
Mr Hickey said it was a factor in his decision making that if he had called in a radiographer in the middle of the night, that radiographer would not have been available to the hospital the following day.
Mr Hickey said on the basis of the information he had at 2.15am, and the absence of neurological signs, time was not as much of the essence as was being portrayed.
However, he said if he had been told of clinical signs which were evident more than an hour later, he would have requested such a scan.
Earlier, Ms Niland’s father, Gerry Niland, told the court his daughter was suffering from excruciating pain, had no balance and was screaming in agony during her time in the hospital.
He said he was asked by nursing staff if she had been drinking and was asked twice if she had taken drugs even though he was crystal clear that she had not.
Mr Niland said the surgeon in Beaumont told him he “couldn’t believe what had happened at Sligo”.
The first nurse who assessed Ms Niland at Sligo said she had asked her to be reviewed by a doctor within 15 minutes of her admission, to see if she needed a brain scan as she was concerned about a possible bleed.
Nurse Erin Lyons said Ms Niland had complained of a sudden onset of a headache and that had caused her to prioritise her as a “category 2” patient, the second most serious category for patients in the department.
Ms Lyons said that she discovered later that she had written “category 3” on Ms Niland’s chart but at all times treated her as a category 2 patient.
Ms Lyons said she also wrote on Ms Niland’s chart that she had had a few drinks the previous night.
But she said she did not believe that was a cause of her symptoms.
Dr Katherine Langtree said she had discussed the possibility of an emergency CT scan with Dr Hickey in the early hours of the morning.
But he said there was no indication such a scan was needed and Ms Niland should be admitted for one first thing in the morning.
Ms Niland was assessed again by the medical team more than an hour later where she was reported as being drowsy and having clumsy coordination.
Dr Langtree said she had seen no neurological signs during her assessment, and her concern was based on the sudden onset of Ms Niland’s headache and her pain.
The coroner, Dr Myra Cullinane said she intended to record a narrative verdict which sets out a summary of the facts.
However, this was strongly opposed by the family’s solicitor Damien Tansey who said the correct verdict should be one of medical misadventure.
Dr Cullinane said she would agree to adjourn the inquest until July to hear evidence from a witness from Beaumont Hospital before reaching a final decision.