A verdict of medical misadventure has been delivered in the death of a newborn after an inquest revealed multiple critical failures in resuscitation efforts during the first 15 minutes of her life at University Hospital Galway (UHG), reports Breaking News.
The baby’s family claimed that there were missed opportunities to identify and act on complications during the mother’s induction and labour, which they said made the death “entirely preventable.”
Catherine Rose Hurley passed away at the Rotunda Hospital in Dublin on October 17th, 2020, three days after her birth at UHG, reports Breaking News.
At the end of the two-day inquest held at Dublin District Coroner’s Court, counsel for UHG, Luán Ó Braonáin SC, delivered an apology from the hospital’s general manager, Chris Kane, to parents Marie Donnellan and William Hurley.
“We fully appreciate that no words can lessen your suffering at the subsequent loss of Catherine but wish to offer you and her extended family our deepest sympathies,” said Mr Ó Braonáin, reports Breaking News.
This same apology was issued to the couple in January 2024 after related civil proceedings against the HSE concluded in the High Court.
Medical evidence showed that Catherine, a healthy baby without infections or genetic abnormalities, died from severe brain damage caused by lack of oxygen, reports Breaking News.
Pathologist Dr Emma Doyle testified that while the exact timing of the injury couldn’t be determined, it most likely occurred around 72 hours before Catherine died.
She noted that a hypercoiled umbilical cord and abnormal blood flow from the placenta may have contributed, but were unlikely to have directly caused the outcome, reports Breaking News.
UHG did not contest the family’s call for a verdict of medical misadventure, and Mr Ó Braonáin chose not to cross-examine the parents, although he noted some discrepancies in recollections.
Ms Donnellan, a first-time mother, told the inquest she was induced at UHG on October 13, 2020, and despite reporting that she couldn’t feel her baby move, staff assured her that CTG readings were normal.
She said she experienced intense pain, cramps, and bleeding during the day, and when she asked for an epidural, consultant gynaecologist Úna Conway only agreed after she begged. No physical exam was done at the time, she claimed, reports Breaking News.
Later that night, she was told that her baby had to be delivered urgently. Catherine was born limp and covered in blood at 12:16am on October 14th, and Ms Donnellan was mistakenly told she had a boy.
Despite her repeated questions, she said she wasn’t informed of her baby’s condition until 1:45am, when staff finally told her the baby was seriously ill and being transferred to the Rotunda, reports Breaking News.
She recalled that when she and her husband met with Dr Conway later, the consultant was “very defensive” and said she wasn’t sure what could have been done differently.
Ms Donnellan fought tears as she described holding Catherine for the first time shortly before her daughter died in her arms at 9:03pm on October 17th, reports Breaking News.
Mr Hurley said his wife was “screaming and terrified” during the traumatic delivery, in which she lost about a litre of blood.
He described the chaos in the delivery room and said, “All was relaxed until everything went terribly wrong and nobody was ready.”
He was emotional recalling the decision he had to make between staying with his wife or traveling with their baby to Dublin. He said he cried the entire journey, reports Breaking News.
Mr Hurley insisted that his recollection of the events was vivid and accurate, responding to the hospital’s claim of differing perspectives.
Discrepancies included the timing of midwives’ awareness of Ms Donnellan’s pain and whether Dr Conway had examined her, reports Breaking News.
The couple said they hoped their ordeal would prevent other families from enduring similar trauma, with Mr Hurley describing it as “absolutely horrific.”
He noted that it wasn’t until the birth of their next child over a year later that they fully understood what they had lost with Catherine’s death, reports Breaking News.
Staff testimonies indicated that labour progressed rapidly just before midnight, with a sudden and severe drop in the foetal heartbeat at 11:45pm prompting emergency action.
Dr Conway said she had increased clinic visits because of the baby’s smaller size but had no concerns when Ms Donnellan vomited after induction. She believed both mother and baby were safe earlier in the evening, reports Breaking News.
She was notified just after midnight about a worrying CTG reading and returned to oversee the emergency delivery. She remarked that the pandemic created “a very, very challenging and scary time” for first-time mothers.
Some hospital staff became emotional on the stand, acknowledging the deep impact Catherine’s death had on them, reports Breaking News.
Ms McGurk, the family’s barrister, said the couple pushed for systematic changes at UHG to help prevent further avoidable tragedies. She confirmed that reforms had been implemented by April 2024.
Coroner Aisling Gannon said the inquest had been “harrowing” for the family and praised their “extraordinarily impressive dignity and integrity,” also acknowledging the emotional toll on staff, reports Breaking News.
Afterward, the couple thanked the hospital for its engagement and progress made, but expressed disappointment that some witness statements didn’t align with the collaborative spirit they had experienced.
“Our sole concentration since Catherine’s tragic, senseless and life-altering loss has been on working directly with the relevant stakeholders to achieve measurable, cultural and systemic change at UHG,” they said, reports Breaking News.
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