The death of Leona Cusack has brought renewed attention to the critical importance of timely sepsis treatment and adherence to medical protocols. This 33-year-old woman from Shannon, Co Clare, died at University Hospital Limerick (UHL) on 18 February 2024, just three days after first presenting at University Maternity Hospital Limerick (UMHL) with concerning symptoms. An inquest revealed that despite being flagged for sepsis, Ms Cusack did not receive the appropriate broad-spectrum antibiotics in time—a breach of HSE protocols that may have contributed to her tragic death.
For families affected by medical negligence, particularly in cases involving sepsis, understanding what went wrong and exploring legal options becomes paramount. This article examines the circumstances surrounding Leona Cusack’s death, explains what sepsis is and why timely treatment matters, and outlines the legal rights available to those who have suffered due to medical negligence.
The Leona Cusack Case: A Timeline of Events
Leona Cusack was five weeks pregnant following successful IVF treatment when she first sought medical attention. Her case illustrates how quickly sepsis can escalate and the devastating consequences of delayed treatment.
Thursday, 15 February 2024
In the early hours, Ms Cusack presented at UMHL experiencing bleeding, abdominal cramps, chest pain, shortness of breath, and an unusual taste in her mouth. Initial examinations showed stable vital signs, though she had an elevated heart rate (tachycardia). After undergoing tests including two ECGs, the couple was told they could leave due to bed shortages, despite a doctor’s recommendation that Ms Cusack be admitted. The Cusacks understood there were no beds available and returned home.
Friday, 16 February 2024
Ms Cusack’s condition deteriorated significantly. She returned to UMHL in the morning, now vomiting and suffering from headaches and severe chest pain. Dr Suhaib Akhtar Birmani, a registrar in obstetrics at UMHL, examined her and noted she was “very anxious.” Her temperature was elevated, her white blood cell count was raised, and her heart rate remained above 100 beats per minute.
Dr Birmani suspected both a possible ectopic pregnancy and sepsis. He initiated the hospital’s sepsis protocol and filled out the appropriate form. Blood tests indicated Ms Cusack was at risk of a heart attack, prompting an urgent request for a cardiologist. However, the request for a cardiologist to attend the maternity hospital was refused, and Ms Cusack was transferred to UHL by ambulance.
Critically, Ms Cusack left UMHL without receiving broad-spectrum antibiotics—the standard treatment for suspected sepsis.
Saturday, 17 February 2024
Upon arrival at UHL, Ms Cusack was seen by cardiologist Dr Cormac O’Connor, who assessed her cardiac condition. During this time, she was informed by her obstetrician, Dr Humaira Amin, that she had suffered a complete miscarriage. Ms Cusack received this devastating news alone.
Throughout the day, her sister Rachael Kirwan expressed concerns about sepsis to the medical team, noting her sister’s vomiting, fever, and chest pains. However, the cardiology team attributed Ms Cusack’s symptoms to anxiety and stated there was
“no reason to be concerned.”
Dr O’Connor told the family that Ms Cusack had
“the heart of a lion”
and was surprised she wasn’t
“shadow boxing in the corner.”
Ms Cusack did not receive broad-spectrum antibiotics until approximately 4pm on 17 February—nearly two full days after sepsis was first suspected and the protocol initiated. By this time, her blood markers for sepsis had risen to
“extraordinarily high”
levels.
Sunday, 18 February 2024
Ms Cusack’s condition continued to worsen dramatically. Her sepsis blood markers became
“doubly extraordinarily high.”
She was transferred to the intensive care unit and brought to theatre for a procedure to complete the management of her miscarriage. During the procedure, she suffered a cardiac arrest. Despite resuscitation efforts, she died at 7.39pm.
The post-mortem examination determined the cause of death was cardiorespiratory failure due to neutrophilic myocarditis—a rare condition that can be both caused by and a source of sepsis.
Key Findings from the Inquest
The inquest into Ms Cusack’s death revealed several concerning issues:
Breach of Sepsis Protocol: Medical witnesses, including UHL consultant cardiologist Dr Cormac O’Connor, confirmed that HSE sepsis protocols were breached. Ms Cusack was initially given only benzylpenicillin, a narrow-spectrum antibiotic, rather than the required broad-spectrum antibiotics.
Critical Delay: All doctors and nurses involved agreed that sepsis should be treated within one hour of diagnosis. A delay of six hours can increase the risk of death by as much as 50%. Ms Cusack’s delay of approximately 48 hours was catastrophic.
Communication Failures: The family’s concerns about sepsis were not adequately addressed when Ms Cusack arrived at UHL. As her sister noted, medical staff
“forgot about the sepsis and devoted all of their attention to the heart.”
Inadequate Follow-through: Despite the sepsis protocol being initiated at UMHL, the necessary treatment was not administered before transfer, and there appears to have been insufficient communication about the sepsis concern to the receiving team at UHL.
Limerick Coroner John McNamara recorded a narrative verdict, acknowledging the breach of sepsis protocol. The Cusack and Kirwan families have indicated that civil proceedings will follow.
Understanding Sepsis: A Life-Threatening Emergency
Sepsis is a medical emergency that claims over 3,000 lives in Ireland each year, making it a leading cause of mortality. Understanding what sepsis is, how to recognise it, and why timely treatment matters can literally mean the difference between life and death.
What Is Sepsis?
Sepsis occurs when the body’s response to an infection spirals out of control, triggering widespread inflammation that can lead to tissue damage, organ failure, and death. Rather than fighting just the infection, the body’s immune system begins attacking its own tissues and organs.
Sepsis can arise from various types of infections, including:
- Bacterial infections (most common)
- Viral infections
- Fungal infections
- Infections from wounds or surgical sites
- Pneumonia
- Meningitis
- Urinary tract infections
- Abdominal infections
Recognising the Signs and Symptoms
Early recognition of sepsis is crucial for survival. Key indicators include:
- High fever or unusually low body temperature
- Increased heart rate (tachycardia)
- Rapid breathing or difficulty breathing
- Confusion or disorientation
- Extreme pain or discomfort
- Clammy or sweaty skin
- Blotchy skin or rash
A simple way to remember sepsis symptoms is the acronym used by the UK Sepsis Trust: SEPSIS
- Slurred speech or confusion
- Extreme shivering or muscle pain
- Passing no urine (in a day)
- Severe breathlessness
- It feels like you’re going to die
- Skin mottled or discoloured
Who Is at Risk?
Certain groups face higher risks of developing sepsis:
- Elderly individuals and young children
- People with chronic illnesses (diabetes, kidney disease, cancer)
- Those with weakened immune systems
- Patients undergoing chemotherapy
- Recently hospitalised individuals
- People with indwelling medical devices (catheters, breathing tubes)
- Pregnant women and those who have recently given birth
Diagnosis and Treatment
Diagnostic Tests for sepsis include:
- Blood cultures to identify the infection source
- Complete blood counts (CBC) to assess white blood cell levels
- Lactate testing to measure cellular stress
- Imaging studies (X-rays, CT scans) to locate infection sites
Treatment Strategies must be implemented urgently:
Immediate administration of broad-spectrum antibiotics: This is the cornerstone of sepsis treatment and should begin within one hour of diagnosis. Broad-spectrum antibiotics target a wide range of bacteria while specific cultures are pending.
Intravenous (IV) fluids: Large volumes of fluids help maintain blood pressure and organ perfusion.
Vasopressors: Medications to increase blood pressure if fluids alone are insufficient.
Oxygen therapy: To ensure adequate oxygen delivery to tissues.
Source control: Removal of infected tissue, drainage of abscesses, or removal of infected devices may be necessary.
ICU care: Severe sepsis or septic shock requires intensive monitoring and support.
The HSE has developed clear policies to guide healthcare providers, including National Clinical Guideline No. 26. Every hospital is required to maintain sepsis bundles—checklists that ensure critical steps are taken within the first hour of diagnosis. These protocols exist precisely because early intervention dramatically improves survival rates.
Medical Negligence in Sepsis Cases
When healthcare providers fail to meet the accepted standard of care, resulting in harm to a patient, it may constitute medical negligence. In sepsis cases, this can take several forms.
What Constitutes Medical Negligence?
Medical negligence, also called clinical negligence, occurs when a healthcare professional’s actions (or lack thereof) fall below the standard that a reasonably competent professional would provide in similar circumstances. For negligence to be established, several elements must be present:
Duty of Care: The healthcare provider owed a duty of care to the patient. This is generally straightforward in cases where a doctor-patient relationship exists.
Breach of Duty: The provider failed to meet the expected standard of care. This might involve failing to diagnose sepsis despite clear symptoms, delaying treatment, or not following established protocols.
Causation: The breach directly caused harm to the patient. It must be shown that, had the appropriate standard of care been provided, the outcome would likely have been different.
Damages: The patient suffered quantifiable harm as a result, such as prolonged illness, permanent injury, or death.
Common Forms of Negligence in Sepsis Cases
Delayed Diagnosis: Failing to recognise sepsis symptoms or dismissing them as less serious conditions. Given that sepsis can progress rapidly, even a few hours’ delay can prove fatal.
Failure to Follow Protocols: Not implementing the HSE’s sepsis protocols, such as the “sepsis six” bundle of interventions that should occur within the first hour.
Inadequate Antibiotic Treatment: Administering narrow-spectrum antibiotics when broad-spectrum coverage is required, or delaying antibiotic administration beyond the critical first hour.
Poor Communication: Failing to properly hand over information about suspected sepsis when transferring patients between departments or hospitals.
Insufficient Monitoring: Not adequately observing patients with suspected sepsis or failing to escalate care when their condition deteriorates.
In the Leona Cusack case, multiple potential breaches have been identified: the sepsis protocol was initiated but not properly followed, broad-spectrum antibiotics were not administered within the required timeframe, and communication about the sepsis concern appeared inadequate when Ms Cusack was transferred between hospitals.
The Importance of Medical Protocols
The HSE’s sepsis protocols exist for a crucial reason: they save lives. These evidence-based guidelines represent the collective wisdom of medical experts and are designed to ensure consistent, high-quality care. When protocols are breached—as occurred in Ms Cusack’s case—patients are placed at unnecessary risk.
Healthcare professionals have a responsibility not only to recognise and diagnose conditions like sepsis but also to implement the appropriate treatment pathways without delay. The one-hour window for administering antibiotics in suspected sepsis cases is not arbitrary; it’s based on extensive research showing that every hour of delay significantly increases mortality risk.
Your Legal Rights and Options
If you or a loved one has suffered harm due to medical negligence, particularly in cases involving sepsis, you have legal rights and options for seeking redress.
Understanding Your Rights
Patients in Ireland are entitled to receive appropriate and timely medical care that meets accepted standards. When healthcare providers fail in this responsibility, patients and their families have the right to:
- Seek answers about what happened and why
- Request full disclosure of medical records
- Pursue compensation for pain, suffering, and financial losses
- Hold negligent parties accountable
In cases where a family member has died due to suspected medical negligence, bereaved families may pursue wrongful death claims on behalf of their loved one.
Time Limits for Making a Claim
It’s crucial to be aware of the statute of limitations for medical negligence claims in Ireland:
Standard Time Limit: Claims should generally be initiated within two years of the incident or the date you became aware (or reasonably should have become aware) of the negligence.
Claims on Behalf of Children: If you’re making a claim as a parent or “next friend” on behalf of a child who has been injured, you can make a claim any time before their 18th birthday.
Claims Following a Child’s Death: If a child has passed away as a result of medical negligence, you have two years from the date of death to make a claim.
These time limits underscore the importance of seeking legal advice as soon as possible if you suspect medical negligence may have occurred.
Steps to Take When Considering a Claim
Seek Legal Advice Early: Consult with a solicitor who specialises in medical negligence. An experienced legal team can provide an initial assessment of your case and guide you through the process.
Gather Medical Records: Your solicitor will help you obtain complete copies of all relevant medical records, including hospital notes, test results, and treatment plans.
Engage Medical Experts: Medical negligence claims require expert testimony. Your legal team will consult with appropriate medical experts who can review the records and provide opinions on whether the standard of care was met.
Build Your Case: Your solicitor will work with you to document the impact of the negligence, including physical injuries, emotional trauma, financial losses (medical expenses, lost income), and effects on quality of life.
Negotiate or Litigate: Many cases are resolved through negotiation and settlement. If a fair settlement cannot be reached, your solicitor may recommend proceeding to court.
Types of Damages in Medical Negligence Claims
Successful medical negligence claims may result in compensation for:
- General Damages: For pain, suffering, and loss of amenity (quality of life)
- Special Damages: For quantifiable financial losses, including past and future medical expenses, lost earnings, and care costs
- Bereavement Damages: In wrongful death cases, compensation for the loss of a loved one
Claims Against HSE Hospitals
Claims involving negligent treatment in a Health Service Executive (HSE) hospital are typically made against the hospital under the government’s clinical indemnity scheme. In private hospitals, claims may need to be directed at the treating medical practitioners individually. Your solicitor will advise on the appropriate defendants for your particular case.
How HOMS Assist Can Help
At HOMS Assist, we understand that pursuing a medical negligence claim is about more than just compensation—it’s about seeking answers, accountability, and justice for you and your family.
Our Experience and Expertise
With over 55 years of experience in medical negligence law, HOMS Assist has developed deep expertise in handling complex cases, including those involving sepsis. Our dedicated medical negligence team has been recognised as Medical Negligence Law Firm of the Year, reflecting our commitment to excellence in this specialised field.
We’ve successfully represented clients across Ireland in cases involving:
- Birth and gynaecological claims
- Surgical negligence
- Delayed diagnosis and treatment
- Failure to follow medical protocols
- Wrongful death claims
Our Approach
What sets HOMS Assist apart is our blend of legal expertise and genuine empathy. We recognise that behind every case is a person or family dealing with trauma, loss, and uncertainty. Our approach includes:
Compassionate Guidance: We take time to listen to your story, understand your concerns, and provide clear, honest advice about your options.
Thorough Investigation: We meticulously gather medical records, consult with leading medical experts, and investigate whether the care provided fell below expected standards.
Clear Communication: We keep you informed throughout the process, explaining complex legal and medical issues in straightforward terms.
Determined Advocacy: We pursue your case with dedication and tenacity, whether through negotiation or litigation, to secure the best possible outcome.
Taking the First Step
If you believe you or a loved one has been affected by medical negligence involving sepsis or any other condition, we encourage you to contact us for a confidential consultation. Initial consultations are complimentary, allowing us to assess your case and provide preliminary advice without obligation.
Moving Forward: Seeking Justice and Accountability
The death of Leona Cusack serves as a tragic reminder of what can happen when medical protocols are not followed and symptoms are not taken seriously. Her family’s grief is compounded by the knowledge that her death may have been preventable had she received the timely, appropriate treatment she deserved.
For families facing similar circumstances, the path forward involves seeking answers, holding negligent parties accountable, and ensuring that lessons are learned to prevent future tragedies. While no amount of compensation can undo the harm caused by medical negligence, pursuing a claim can provide:
- Financial support to cope with medical expenses and loss of income
- Acknowledgement of the wrong that occurred
- Accountability for those responsible
- Improvements in medical practices to protect others
If you suspect that you or someone you love has been harmed by delayed sepsis treatment or other medical negligence, time is of the essence. The two-year statute of limitations means that acting promptly is crucial to preserving your legal rights.
HOMS Assist is here to support you through this difficult time. Our team combines extensive legal knowledge with genuine compassion, providing the guidance and representation you need to navigate the complex process of pursuing a medical negligence claim. Contact us today to discuss your case in confidence and take the first step towards justice.
