Treatment time targets for checking patients at the accident and emergency section of Naas General Hospital are not being met, an inquest has heard.
At the inquest into the death of Margaret (Madge) Crampton (82) on 8 April, evidence was given that the A&E section was unable to meet targets.
Ms. Crampton was pronounced dead at the hospital at 1.16am on 29 March 2012.
She should have been seen within an hour when she arrived from Baltinglass hospital just after 5.00pm on the afternoon of 28 March, 2012, but it was five hours before that happened.
The inquest had opened briefly on 11 March this year and resumed on 8 April.
The Coroner concluded that Mrs Crampton, who had underlying medical difficulties, died from shock, secondary to bleeding.
He said he was concerned about the amount of time it took to see Ms. Cramption but that the evidence did not support a finding of medical error.
Questions were raised by the late Mrs Crampton’s family, Terry, Cora and Hilda about the waiting time to be seen.
During the course of his evidence, the Kildare Coroner, Dr. Denis Cusack said the issue of waiting time has arisen in previous inquests.
He also said: “They (staff at Naas AE) find it very difficult and distressing not to be able to deal with patients but will do their very best.”
The inquest heard that it appeared that Mrs Crampton was seriously ill on the day before she died.
After arriving from Baltinglass, Naas hospital considered that she was not in the most serious illness category.
She did not receive medical attention from arrival to around 10pm.
Dr. Cusack noted that there seemed to be nothing in the medical notes to say that Mrs Crampton was in an acute medical condition.
Sister Fiona McDaid, clinical nurse manager, Naas General Hospital, which was represented legally by the State Claims Agency, said Mrs Crampton’s poor condition became apparent “very suddenly” and became “a medical emergency.”
Terry Crampton said they accepted the staff tried very hard to treat her when they realised the seriousness of the situation.
His mother was on a trolley in the main corridor of the section and there were at least seven people ahead of her when he saw her.
The inquest heard there were 82 people on trolley’s and 52 of them were put in the same category of illness priority as Mrs Crampton.
Sister McDaid, outlined an international procedure for assessing patients, in which they were put in five levels or triage of medical seriousness.
The first is someone with a life threatening illness.
A second category was described as “urgent.”
A third category was “semi-urgent.” Sister McDaid said a lot of people fell into this category. They would be “sick and might need to be seen fairly quickly but not immediately.”
Mrs Crampton was assessed to be in this third category when she was admitted.
A fourth level was less serious and a fifth was someone with a condition which should be seen within seven days.
She then explained the recommended waiting time for a person in each category.
Mrs Crampton was admitted under category three and someone in this category should be seen within one hour. Someone in the second category should be seen within ten minutes.
The wait recommendation for the fourth and fifth levels are two hours and four hours respectively.
Sister McDaid said that she had erred in a letter sent in association with the case in stating that Mrs Crampton was in a two hour waiting category when, in fact, she should have been seen within one hour.
Dr. Cusack said according to the standard laid down, Mrs Crampton should have been seen within one hour but it was more than five hours.
He said these were standards the hospital was expected to achieve and questioned if they could “realistically” achieve them.
Dr. Cusack said it was not a matter of finding fault but the failure to meet the standards is something with which the hospital and the Coroner should be concerned.
He said that standards needed to be looked at, not just at Naas GH, but in other hospitals around the country.
Sister McDaid said the overall number of patients was close to normal for a Wednesday but it accelerated during the day.
Dr. Cusack asked if the standards were achievable and said there seemed to be “a recurring problem.”
Sister McDaid said: “You can meet them (the standards) some days but not on others.”
The Coroner asked if they were often in situations where they could not be met and she replied they did have “bad periods.”
Dr. Cusack said they had the same problems when he worked in a hospital 30 years ago. There was nothing we could do to help Ms. Crampton but I want to help the hospital.
The standards “simply cannot be met,” said Dr. Cusack. “You (Sister McDaid) are being put in an impossible situation.”
“I don’t know what the answer is but I will draw attention to the problem,” he said.
Dr. Cusack said the Crampton family were right to raise concerns.
Terry Crompton said he was unhappy to see his mother on a trolley for so long.
Cora Cramption outlined the family concerns stating that there was a big gap between one and five hours. She also said she understood her mother bled to death.
Dr. Cusack said the continuance of these timing failings are “a danger to the public” but “this was in no way a reflection on the staff, who probably work miraculously.”
He told Sister McDaid: “You and the staff are to be commended on what you do on a day to day basis.”
He added: “I am not pointing a finger of blame.”
The inquest also heard evidence on the method that messages from doctors outside the hospital were relayed to Naas General Hospital.
Dr. Cusack recommended the hospital reviews its system of messages. He said he was not suggesting there was anything wrong but it should be done for “clarity and consistency.”
He concluded that Mrs Crampton died from shock, following internal bleeding but that there was no identified source of the bleeding.
Dr. Cusack said he had concerns. He made recommendations regarding the triage or admittance system and on a review of communications systems between Naas General Hospital and others.
At the end of the two and a half hour hearing, Dr. Cusack said his verdict was “narrative” considering the complexity of the evidence, a route with which the State Claims Agency agreed.
Sympathy was extended to the Crampton family by the Coroner, the hospital and the Gardai.