Overview of the case
A coroner’s court in Limerick has heard that a woman’s death, occurring the day after a miscarriage, may have been preventable if sepsis treatment had been administered more promptly. Leona Cusack, 33, from Ballycasey in County Clare, died at University Hospital Limerick (UHL) on February 18, 2024, after the ambulance transfer from University Maternity Hospital Limerick (UMHL) where she had initially sought care for bleeding and cramps during an IVF pregnancy.
The inquest has highlighted concerns about the timeliness of sepsis management and whether critical information was acted upon as Ms. Cusack’s condition deteriorated. Her family’s solicitor said they are haunted by the belief that clear indicators of sepsis and cardiac issues were not adequately addressed at the time of transfer to the hospital with a view to preventing her death.
Timeline of events
Ms. Cusack presented at UMHL on February 15, 2024, five weeks into an IVF pregnancy, with bleeding and cramps. After initial blood tests, she left the hospital with symptoms improving temporarily. She returned the following day with vomiting, headaches and chest pain. A consultant gynecologist at UMHL recommended admission, but, according to her husband Conor Cusack, there were reports of no beds available, and they went home.
On February 17, Ms. Cusack’s condition worsened. Dr Suhaib Akhtar Birmani, who attended her, stated that he suspected sepsis and noted concern about the possibility of an ectopic pregnancy. He filled out a sepsis form and initiated the hospital’s sepsis protocol. However, he said a broad-spectrum antibiotic was not administered in time before her transfer to UHL by ambulance, as advised by UMHL’s team.
Transfer and hospital care
At UHL, cardiologist Dr Cormac O’Connor assessed her, while in the ICU. Family accounts describe a period of uncertainty about the seriousness of her sepsis versus cardiac issues. Ms. Cusack’s sister, an advanced nurse practitioner, told the inquest she pressed clinicians for an explanation about her sister’s condition, including whether infection was contributing to a raised heart rate. She said responses suggested the heart rate could be anxiety-driven, which the family found troubling given the sepsis concerns raised earlier.
Medical staff acknowledged the need to identify the infection source, as scans failed to reveal it. By February 18, Ms. Cusack died after prolonged attempts to resuscitate her in the ICU. A hospital registrar noted that sepsis was suspected, but the question of whether earlier antibiotic treatment could have changed the outcome remains under examination.
Key issues for the inquiry
The inquest has focused on whether Ms. Cusack received timely sepsis treatment. Medical witnesses indicated that the standard of care is to deliver broad-spectrum antibiotics within an hour of recognizing sepsis. The concern raised by the family’s solicitor is that such treatment was not provided within the critical window, particularly during her initial admission at UMHL and the subsequent transfer to UHL.
What the doctors said
Dr Suhaib Akhtar Birmani testified that he believed Ms. Cusack had sepsis and that a broad-spectrum antibiotic should have been given sooner. He described the transfer process to UHL as appropriate once sepsis was suspected and agreed that the sepsis protocol was initiated at UMHL. At UHL, Dr. O’Connor and ICU staff faced the challenge of managing multiple critically ill patients while trying to pinpoint the infection’s source.
Impact on the family and next steps
Ms. Cusack’s family continues to search for clarity about whether the care she received met the necessary standards in the context of a suspected septic condition. The coroner’s court will assess all evidence, including whether delays in initiating sepsis treatment were a contributing factor to her death. The case highlights ongoing concerns about the recognition and management of sepsis in maternity and general hospital settings in Ireland.
Societal and medical implications
Experts agree that timely sepsis intervention can be life-saving. The inquest underscores the need for clear protocols, reliable bed management, and swift cross-hospital communication when suspecting sepsis in patients with pregnancy-related concerns. It also raises questions about how families are informed and involved when complex cases require rapid, coordinated responses across departments.
As the hearing continues, the family seeks reassurance that lessons learned will translate into improved care for others facing similar medical emergencies, including clearer pathways for sepsis identification and faster administration of antibiotics when sepsis is suspected.
