A narrative verdict has been recorded in the death of a 22-year-old woman who died at St James’s Hospital in Dublin on March 1st, 2023.
Dr Clare Keane recorded the verdict at a hearing of Dublin District Coroner’s Court on Tuesday.
Oseremen (Reme) Onolememen presented at the hospital’s emergency department (ED) on the evening of February 27th in severe pain with symptoms of gastroenteritis, the inquest heard. Onolememen had a stroke as a young child and had sickle cell disease, a serious blood condition that required regular hospital treatment throughout her life.
Medical staff who treated Onolememen at St James’s said she declined their requests to insert a peripheral IV cannula so they could give her fluids. Onolememen explained that her veins were difficult to access and she had experienced multiple failed attempts at inserting IV lines in the past, the inquest heard.
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Onolememen had a port-a-cath – a device inserted under the skin to give medicine or fluids to patients whose veins are weak – and wanted to receive fluids through this. She was informed on multiple occasions that inserting an IV line would be quicker as medical staff in the ED were not trained in accessing the port, so a staff member from elsewhere in the hospital would have to be called.
The inquest heard that Onolememen was registered at the ED at 8.18pm. She was triaged at 9.17pm and was deemed to be a “category 2” patient – meaning her condition was urgent and she should be seen within 10 minutes. Pearse Sreenan, acting on behalf of Onolememen’s family, said Onolememen was in the waiting room for about 47 minutes before being registered and her mother Esther “went to the desk four times” seeking help.
Dr Paula Cuddihy, the ED registrar on duty, said she first saw Onolememen at about 9.30pm, 13 minutes after she was triaged. “My biggest concern was that she was absolutely in a crisis and also was possibly suffering from dehydration with high heart rate and low blood pressure,” Cuddihy said.
Louise Garry, a clinical nurse manager, said she requested a nurse from another ward to come to the ED to access Onolememen’s port-a-cath. Garry said she explained to Onolememen it was “very important to get fluids into her”, but she would “never force anyone” to have an IV line inserted.
Dr Siobhan O’Brien treated Onolememen overnight. She said Onolememen described having severe pain in her thighs. Onolememen was also suffering from shortness of breath and required oxygen, O’Brien said.
The port-a-cath was eventually accessed at 1.52am, but Sreenan said a written note indicated fluids “had just started” at 3.19am. The cause of this delay was not clear.
Dr Emma Tuohy, a consultant haematologist, said Onolememen was in “severe” pain when she examined her at about 10am on February 28th. Onolememen received fluids and medication and was monitored regularly, the inquest heard. Tuohy said Onolememen was seen by various doctors “15 times in the 20 hours she was in the ED”.
Onolememen’s condition deteriorated and she was transferred to the intensive care unit at 5.27pm, the inquest heard. Dialysis was carried out but did not improve her condition.
Onolememen was pronounced dead at 3.25am on March 1st, surrounded by her family. Tuohy said Onolememen was a “lovely” young woman and she expressed her sincere condolences.
Professor Linda Mulligan, acting state pathologist, said the cause of death was acute chest syndrome following vaso-occlusive crisis (VOC) due to sickle cell disease. Acute chest syndrome can cause low oxygen levels and abnormal substances in a patient’s lungs. VOC causes severe pain due to tissue oxygen deprivation.
Onolememen is survived by her parents Esther and Felix and siblings OJ, Debbie and Jesse.
