A NIGERIAN WOMAN who died following treatment at Dublin’s Rotunda Hospital was believed to have been overstating her symptoms by at least one key member of staff, her partner has said.
It is among a litany of serious concerns raised by medical sources and confidantes of Bimbo Onanuga (32) over her death after treatment at the Rotunda in March 2010 after a foetal fatality over seven months into her pregnancy.
Pressure from maternal care advocates – who lobbied for Dáil questions on the issue and are now calling for an inquest – has led to the public release of recommendations by the HSE arising from a secretive Rotunda-led report. These have suggested:
- blockages to beds being moved “in a critical event”;
- the absence of emergency call bells or designated phones for emergencies in each room;
- insufficient training among some midwifery and nursing staff on the gynaecology ward;
- inadequate life support skills and management;
- out-of-date guidelines on medical management of women experiencing intrauterine death (death of the foetus in the uterus);
- no Obstetric Early Warning System, designed to allow early recognition of deterioration using physiological gauges (e. g. blood pressure, temperature); and
- a recommendation which “cannot be disclosed” as it contains “sensitive” information on the patient.
Specifically, Metro Éireann has also learned of:
- concern at the way Onanuga’s vitals were taken, with time lost looking for equipment rather than checking manually;
- speculation within maternal care circles that Onanuga may have been administered a controversial drug;
- Onanuga’s difficult birthing experience at another Irish hospital, on which she had sought legal advice from a solicitor in the field of maternal rights; and
- a harrowing account to Metro Éireann from Onanuga’s partner at the time of her death
Onanuga, from Lagos State, had arrived at the Rotunda on Monday 1 March 2010 after a GP referral. She was told her expected child had died in the womb and was advised to come back that Thursday for further treatment, but returned by ambulance on Wednesday 3 March in severe pain.
She stayed overnight at the Rotunda, where her partner issued staff with repeated warnings that her condition seemed to be deteriorating.
Abiola Adesina, who lives in England and had not been informed of the Rotunda’s findings, recounted to Metro Éireann: “I was actually shouting... I could see that something was wrong, but the nurse who was there with me was telling me she’s pretending, that was what she was saying.
“She didn’t use the word pretending actually, but she was telling me it’s no problem, that some people exaggerate – I think that was the word she used, ‘exaggerate’.
He continued: “I wanted to get out of the room to maybe get someone else to come and look at her, but Bimbo was holding my hand really, really tight. I was actually shouting until another person walked into the room, and that was the one who raised the alarm...
“She [Bimbo] was trying to say something to me but she couldn’t, and I was actually the first person trying to give her CPR, I was trying to make her breathe because I could see she was struggling to breathe.”
Onanuga was in very severe distress for “about 20 minutes”, according to Adesina, who says that Rotunda Master Dr Sam Coulter-Smith later admitted her life could have been saved during this period and that the hospital was responsible for her death.
“Even before then – before the nurse – there was a doctor that just came in and checked if she is in dilation or something, and I was telling the doctor as well that something is wrong, but she wouldn’t even listen, the doctor would not even listen. The doctor would not even look at my face.”
Onanuga was transferred that night (4 March) to the nearby Mater Hospital, where Adesina was told she was “clinically dead”.
Meanwhile, it is speculated that Onanuga may have been administered an anti-ulcer drug, misoprostol, at the Rotunda.
The drug is used in some countries to soften the cervix or induce labour, but has not been approved for these purposes. The FDA in the United States, for example, says no company has sent it scientific proof that misoprostol is safe and effective for these uses, and underlines potential “serious side effects including a torn uterus (womb), when misoprostol is used for labor and delivery”.
These side effects are “more likely” in women who have had previous uterine surgery, a previous Caesarean delivery or several previous births. The Rotunda has neither confirmed nor denied the use of misoprostol in this case or any other instances.
Misoprostol, under the brandname Cytotec, is not listed as authorised for softening of the cervix or labour induction by the Irish Medicines Board (IMB).
“If a medicine is used by medical professionals for purposes other than approved by the IMB, this is known as off-label use of that medicine. The IMB does not collect information on the off-label use of authorised medicines as this relates to medical practice,” said an IMB spokesperson.
Metro Éireann understands that Onanuga had experienced a difficult birth at another Irish hospital, following which she had taken legal advice. Her since deceased daughter had cerebral palsy, a condition commonly linked to birth trauma. It is not, however, suggested that Onanuga’s legal enquiries had any role in her subsequent treatment at the Rotunda.
In a statement to Metro Éireann, the Rotunda said that following the death it had instigated an “immediate internal and an independent external review” and that its master had met with family members, advising them of the reviews by letter on 25 March 2010. It also informed the Dublin City Coroner.
The internal final report had 11 recommendations that were submitted to the HSE. The Rotunda says 10 of these recommendations have been implemented and the 11th is in the “final stage of implementation”.
It said the external review report “did not recommend any changes in the management of this or similar cases on foot of that review”. A spokesperson said: “The Coroner was also advised and subsequently closed the case without holding an inquest.”
According to the HSE, which relayed “deepest sympathies” to Onanuga’s family last week, the Rotunda has advised it of another maternal death in March and “a review has commenced”. It is believed the woman was Polish.
Expressing concern with the overall maternity system in Ireland, the Association for Improvement of the Maternity Services (Aims) Ireland noted further anxiety regarding treatment of non-Irish patients.
The organisation believes an inquest must now be held to find out what exactly happened to Bimbo Onanuga, described by friend Funmi O Andrew as “friendly, tolerating and accommodating”.
Her hopes revolved around being “a good mother” and she had often referred to her young daughter as her “joy”. She planned to train in cosmetics and was, quite simply, “a nice person”.
