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‘We had to get the truth for Gráinne’

Gráinne Daly: The HSE admitted in court yesterday that aspects of the care she received in CUH 'did not reach the standards that could be expected'.

ALL they ever wanted from the HSE was the truth about why their beloved sister died. And an apology.

Instead, Gráinne Daly’s siblings — Kieran, Moira, Finola, Dermot, Lorna, Colm, Sinéad, and Ronán — were met with a wall of silence, forcing them into a traumatic and stressful four-year legal battle for answers about her death in Cork University Hospital in 2009.

Despite the risks associated with mounting a High Court case against the system, the tight-knit Cork family refused to back down. They felt they had to do it for Gráinne.

They were finally vindicated yesterday when the HSE admitted in court that aspects of the care Gráinne received in CUH "did not reach the standards that could be expected".

The HSE admitted liability and apologised unreservedly to the family.

The speed and simplicity of this final stage in the drawn-out legal process came in stark contrast to the legal nightmare the family has endured since Gráinne died.

Her sister, Sinéad Daly, said: "We’re grateful that we got the answers we sought. But we’re traumatised by the way we had to get those answers."

In Nov 2009, Gráinne, 45, fell ill with flu-like symptoms. When the symptoms didn’t clear, her GP referred her to CUH’s emergency department on Nov 4, and she was admitted.

Doctors treated her for pneumonia and while her breathing remained erratic over the next few days, by Nov 7 she was showing signs of improvement.

Sinéad recalls visiting her in a ward that night and leaving a few hours later, hopeful she would be discharged within a few days.

"She was sitting up, chatting to visitors and watching a Mamma Mia DVD when I left to go home," said Sinéad.

Little did the family know that 45-year-old Gráinne would be dead by the following morning.

That phonecall no family wants to get came in the early hours of Nov 8 — doctors said Gráinne had suffered a fit and was in a serious condition.

By the time Sinéad and Finola got to the hospital, a medical team was working frantically on their by now critically ill sister.

"We stood in the hospital corridor in utter confusion," said Sinéad.

"We were terrified and felt very much in the dark. For an hour-and-a-half, we were told that Gráinne was having a fit and that they were trying to settle her.

"The next thing we knew, a priest was sent to us and Gráinne was moved to the intensive care unit."

She suffered a series of devastating cardiac arrests over the next few hours and died at 8am.

The family was told her death arose as a complication of her childhood brain tumours.

Sinéad said a member of the hospital’s medical staff approached one of her brothers and said an autopsy would not be required.

"We were shocked and utterly confused as to what had happened," she said.

"The death certificate only stated that she died of a cardiac arrest. She was released for burial and we proceeded with her funeral in shock and disbelief."

It was some weeks later, when the initial grief and shock had subsided, that the family began to question the sequence of events in the hours before their sister’s death.

In the absence of an autopsy, they contacted solicitor Susie Elliott, an associate at Ernest J Cantillon Solicitors, who specialises in medical litigation, and asked her to examine Gráinne’s case.

Ms Elliot’s initial request for the medical records yielded an incomplete file.

Following a lengthy period of legal correspondence, a complete medical file was finally released.

It was only then that the truth began to emerge.

The family said one of the most upsetting details to emerge from the medical records was learning that in the hours before her death, Gráinne had, on several occasions, sat at her bedside, highlighting her discomfort.

Her family believes that because of her mild intellectual disability, linked to the removal of childhood brain tumours, she didn’t speak up, didn’t want to make a fuss.

Fighting back tears, Sinéad said: "We felt that if one of us was there, we would have spoken up for her but she wasn’t vocal enough, she would have preferred to sit in that chair and not bother anyone.

"We wondered if one of us was there to speak for her, would things have been different."

Ms Elliot then explained the legal avenues open to the family before they decided to present Gráinne’s entire medical file to independent experts to adjudicate on whether or not the care afforded to her at CUH was up to standard.

The file was examined by four UK-based experts — two experts in adult critical care and anaesthesia, one respiratory physician, and one consultant neurosurgeon.

All four categorically stated that the level of care was not appropriate and had led to Gráinne’s death.

The family learned her childhood brain tumour made her more susceptible to seizures. But crucially, they also learned that after she suffered the initial fit, a subsequent test on her blood gas levels provided clear results which should have led to her being intubated and mechanically ventilated.

This did not happen when she needed it, leading to a series of foreseeable, fatal, cardiac arrests.

Ms Elliot wrote to the HSE seeking an explanation, but said her correspondence was met with silence.

The Daly family then decided to proceed with litigation.

"We had to get the truth for Gráinne," said Sinéad.

Legal battle

On Nov 1, 2011, Ms Elliot lodged a fatal injury claim against the HSE under Part IV of the Civil Liabilities Act 1961, for Sinéad, on behalf of the entire Daly family.

A full defence was delivered on behalf of the HSE, denying all wrongdoing and putting the Daly family fully on notice that they would have to prove their case in court.

Undeterred, the family proceeded and a trial date was set for Dec 2013.

It was only at this point — with a court case looming — that the HSE finally admitted liability and apologised to the family.

The matter was finally concluded in the High Court sitting in Cork yesterday just weeks before the fourth anniversary of Gráinne’s death.

Sinéad spoke afterwards about the trauma, stress and heartache experienced by the family over the last four years arising out of the legal proceedings which they consider to have been entirely unnecessary.

"This was not a witch-hunt, and was never about money. All we ever wanted for Gráinne was the truth and an apology," said Sinéad.

"We don’t understand why we should have been put through four long years of stress and worry to get to this point.

"Had we received our admission and apology from the outset, we would never have taken legal proceedings and our grief would not have been compounded by the insult of waiting four long years for the decent thing to be done.

"We believe there should be a legal obligation on all doctors and hospitals to tell the truth in respect of what happened and why it happened, when adverse events occur.

"So much grief could have been avoided if such openness had prevailed in respect of Gráinne’s case. No other family should ever have to go through this again."

And she called on the health and justice ministers to introduce sweeping reforms to end what her family described as a culture of denial in the healthcare system and medical profession in the hope that no other family will have to go through the same ordeal they had to endure to get to the truth.

"We’re very angry at the system in Ireland today. We’re extremely angry at it. The system needs a huge overhaul," she said.

"I’m personally tired of picking up newspapers and reading about reports that have been done into the deaths of people, yet nothing changes. It’s just heartbreaking.

"We want to put this out there to acknowledge what happened to Gráinne, and to make sure that it doesn’t happen again.

"But deep in my heart, I know it will happen again. And that’s the tragic part of all this. There will be another story like this, and another tragedy for another family."

Family bond

In a close family of nine siblings, Gráinne Daly’s eight brothers and sisters doted on her.

In 1967, when she was just three, Gráinne underwent an operation to remove a brain tumour.

She recovered well physically but was left with a mild intellectual deficit.

Despite this, she lived a full and independent life, living in Cork with, and under the care, of her sister Finola.

"She had her innocence and vulnerabilities but was a sister who we sometimes felt protective of, but always and ever felt proud of," said Sinéad.

"Gráinne was a loving, caring, and totally unselfish person, protective of her family and friends, who were her priority.

"She would go to the ends of the earth to do anything for anyone, and had a truly unique kindness to her, displayed not only to family and friends, but to strangers on the street.

"She was absolutely gifted when it came to children and had an exceptional empathy for them.

"She was refreshing not only in her innocence but in her true and honest outlook and approach to life.

"Gráinne’s love was always and ever shown to her family and friends, but her bond with her nieces, nephews, and cousins alike was truly special — their love, respect, and complete attachment to her is testament to the memories and legacy they now cherish and remember of her to this day."

Gráinne also loved parties and loved being the centre of attention at family gatherings.

"And we loved having her there. No gathering is or ever will be the same without her," said Sinéad.

Legal view

The Dalys’ solicitor, Susie Elliott, an associate at Ernest J Cantillon Solicitors, who specialises in medical litigation, described the Daly family as victims of the current culture of non-disclosure.

"In the United Kingdom, the National Health Service have weaved in a term into their contracts with medical professionals to be open, honest, and forthcoming with information for patients, to include information in relation to adverse events," she said.

"Whilst this no substitute for a legal duty of honesty, it is certainly a step in the right direction.

"In Denmark, France, and Sweden, where ‘no fault’ systems are in place, there seems to be a far greater willingness to engage in dialogue when things go wrong.

"Whilst the vast majority of individual health professionals are open and honest, some practitioners and, unfortunately, most providers of healthcare, in this case the HSE, are not always as open and honest with patients or their relatives when things go wrong, as should be the case.

"Undoubtedly, this culture of non-disclosure impacts negatively on patient safety.

"In the end, this courageous family got justice and vindication for their sister, but that should have happened many years ago."