Limerick woman 'would not have died' if given anti-coagulant in hospital, expert tells court 

Intensive care specialist's report concluded that but for the failure to prescribe and administer the Heparin, Eve Cleary would not have developed a clot in her lung, would not have gone into cardiac arrest and would not have died

Eve Cleary's parents Barry Cleary and Melanie Sheehan Cleary outside the Four Courts. Picture: Collins Courts

If Eve Cleary, who died hours after being discharged from University Hospital Limerick, had been given an anti-coagulant it would have prevented her from developing the blood clot in her lung, which led to her cardiac arrest and death, the High Court has heard.

A medical expert told the second day of the civil action over the death of the 21-year-old Limerick woman that even if Ms Cleary had been given the anti-coagulant Heparin at the time of her hospital discharge or within an hour of it, it would have prevented the pulmonary embolism which is when a blood clot gets stuck in an artery in the lung.

Intensive care specialist Dr Christopher Danbury told counsel for the Cleary family Dr John O’Mahony SC if Ms Cleary even had the Heparin injection at the time of her 8.30pm discharge on July 20, 2019, or by 9.30pm, she would have avoided the pulmonary embolism which occurred after 11pm and which caused cardiac arrest and death.

Eve Cleary, 21, from Corbally, Limerick, died in the early hours of July 21, 2019, two days after she fell and hurt her leg and went to the A&E department of the Limerick Hospital and over three hours after she had been discharged from the hospital and told to go home and rest.

Her parents, Barry Cleary and Melanie Sheehan Cleary, and her sisters Kate, Elizabeth, Sarah, and Emma and her brother Sean, all of Corbally, Co Limerick, have sued the HSE over her death and also for mental distress.

It is claimed Ms Cleary was allegedly allowed to develop a deep vein thrombosis (DVT), a blood clot in her vein and that an opportunity had been allegedly missed at the hospital to put her on the anticoagulant Heparin on admission.

The HSE accepts a formal risk assessment in relation to blood clots was not done but has denied all other claims. The HSE, the court heard, does not accept the failure to carry out the risk assessment was a breach of duty. It says the treatment and management of Ms Cleary was reasonable and appropriate.

In a report prepared after reviewing the Cleary case, Dr Danbury concluded that if Ms Cleary had been given the anti-coagulant Heparin on the balance of probabilities it would have prevented her from developing a pulmonary embolism.

He further concluded that but for the failure to prescribe and administer the Heparin, she would not have developed a clot in her lung, would not have gone into cardiac arrest and would not have died.

Eve Cleary, 21, died in the early hours of July 21, 2019, over three hours after she had been discharged from University Hospital Limerick. File picture: David Raleigh

In his report, which was presented to court on behalf of the Cleary side, he said if a blood clot VTE risk assessment had been made at the hospital, the anti-coagulant treatment would have been prescribed and administered.

“I agree that on the balance of probabilities Ms Cleary had a deep vein thrombosis (DVT) secondary to the lower leg trauma she had suffered."

If the anti-coagulant Heparin had been given while she was in hospital, he said it would either prevented the formation of a DVT or stabilised the clot if it had already formed.

He reported when Ms Cleary was discharged home at 8.30pm on July 20, 2019, part of the DVT broke off the clot in the leg, passed through the systemic circulation, and became lodged in a pulmonary artery, causing a pulmonary embolism which caused a cardiac arrest.

“Therefore, it is my opinion, but for the failure to administer the Heparin Ms Cleary would not have suffered a pulmonary embolism, would not have suffered a cardiac arrest, and would not have died,” he said in his report.

Counsel for the HSE, Simon Mills SC, told the court it was the HSE case that Ms Cleary was triaged and it was a number of hours before she was seen by a doctor.

Counsel said Ms Cleary’s mother had previously told the court the hospital A&E department was a very unpleasant place for Ms Cleary to be unwell.

He said Ms Cleary did not want to be there.

Ms Justice Emily Egan interjected to say Mrs Cleary’s evidence had been that Eve spoke to her mother and said she wanted to go home but her mother advised her to stay.

Counsel said his instructions were that the evidence will be that Eve was so determined to leave that a discharge against medical advice form had been prepared. The blank form was not signed but had a sticky note on it.

Mr Mills said the emergency doctor and staff “were so alive to the difficulty of her plight”, Ms Cleary's leg CT scan was expedited.

The case before Ms Justice Egan continues.