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It was instantly clear to a midwife that Annie O’Brien had greater than gastro when the pregnant mum was rushed from one Melbourne hospital to a different.
The lawyer and mother-of-one had taken herself to Holmesglen Personal Hospital’s emergency division with extreme gastro signs on August 14, 2017.
At 2.12am the following day she delivered her child stillborn at 18 weeks. Ms O’Brien’s life assist was turned off at 1.55pm after sepsis led to multi-organ failure.
Her household has known as on Victoria’s State Coroner John Cain to make suggestions for systemic modifications to personal hospitals, believing her dying was preventable.
Holmesglen’s sole emergency division physician Hui Li Shi identified Ms O’Brien with gastroenteritis and was treating her with paracetamol and fluids.
She began feeling unwell after a hen sandwich and Dr Shi informed an inquest into her dying that she did not contemplate sepsis as a result of Ms O’Brien’s presentation fitted the gastro analysis.
When her membranes spontaneously ruptured, she was urgently transferred to St Vincent’s Personal Hospital the place Gillian Codd was the midwife in cost.
“She was not essential, however very unwell,” she stated of the 37-year-old’s situation on arrival.
“It definitely seemed greater than gastro. That was our concern, this not seemed like gastro or meals poisoning.”
She was distressed and her temperature was 39C – down from its earlier peak at 40.3C.
Ms Codd informed an inquest into Ms O’Brien’s dying that she suggested her obstetrician Vicki Nott that she was severely nervous – a technical time period – about her affected person’s situation.
“With ruptured membranes and a temperature of 39 it is a pretty important an infection,” she stated.
“I’ve by no means seen anybody with a temperature of 39C with simply gastroenteritis.”
In an announcement Ms Codd stated Ms O’Brien hadn’t left her ideas since that evening and provided her condolences to her household.
She stated she believed the workforce did all the things attainable and the perfect they may given the circumstances.
St Vincent’s Personal Hospital now has a maternal sepsis package in supply rooms, together with a replica of the hospital’s sepsis pointers.
Employees are educated yearly and the kits are checked day by day for his or her presence and a extra detailed verify that all the things is inside date is performed month-to-month, she stated.
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