No sepsis guidelines on labour ward where Annie Moylan died, inquest told

An obstetrician has told an inquest she did not immediately prescribe antibiotics after an unwell pregnant woman arrived at St Vincent’s Private Hospital because she and labour ward staff were unable to find sepsis management guidelines.

Vicki Nott, Annie Moylan’s obstetrician and gynaecologist, said that after she arrived at the ward – about an hour after Moylan arrived – she left for 20 minutes to go to her office in an adjoining building to obtain the sepsis document because she was unsure which antibiotics to prescribe as the cause of Moylan’s infection was unknown.

Obstetrician and gynaecologist Vicki Nott denies she knew Annie Moylan was seriously ill when she took the 37-year-old into her care.Credit:Jason South

The inquest heard that when Nott returned to the ward with the sepsis guidelines, a series of delays meant initial antibiotics were not administered to Moylan until 46 minutes later, and two hours after the 37-year-old first arrived at St Vincent’s, shortly after midnight on August 15, 2017.

“No one had raised the question of her being seriously unwell. Not one person said this lady was seriously sick,” Nott said.

The inquest heard for the first time on Thursday that Moylan was not diagnosed with sepsis until 1.30am, when Nott – who was on call from home – arrived at the hospital. Antibiotics were then prescribed at 2am, but the first of two varieties were not administered to Moylan until 2.46am, after staff prioritised helping deliver her stillborn baby first.

The second antibiotic was later discovered unused in the patient’s room after she was taken to an operating theatre at about 4am. It is unclear how that oversight occurred.

Moylan went into cardiac arrest at about 8am and died at about 2pm. She had been unwell for about 24 hours before she died.

The coroner is investigating the death after Moylan – who was 18 weeks pregnant – first arrived at Holmesglen Private Hospital’s emergency department with vomiting, diarrhoea and a temperature before being transferred to St Vincent’s when it was suspected she was going to miscarry.

During questioning on Thursday, Nott – who received two calls from Holmesglen’s emergency doctor, Hui Shi, between 11.20pm and 11.40pm – said she was not aware of Moylan’s level of ill health nor her high temperature when she was asked to accept the patient being transferred into her care.

From those calls, Nott told the inquest she believed Moylan was recovering only from a bout of gastroenteritis and suffering from a possible ruptured membrane, signally a potential miscarriage. The obstetrician said if she had been aware that Moylan had a “critical illness” she would have sent her to Monash Hospital instead.

Annie Moylan, 37, died in 2017 from sepsis after doctors failed to diagnose in time.

Moylan arrived at St Vincent’s via ambulance shortly after midnight and Nott about an hour later.

She denied being told that Moylan had a temperature of 40 degrees and said she only learnt of her high temperature and poor condition when she first assessed her at 1.30am.

Nott said she diagnosed Moylan with sepsis when she noticed her altered mental state – a key sign of infection.

During the following 1½ hours, Nott said she repeatedly asked that the intensive care unit accept Moylan but the staff there refused the request.

Nott said that as she grew increasingly concerned about her patient, she ordered that Moylan be taken into theatre, knowing they would intubate her, something she had hoped the intensive care unit would have done.

“I recognised soon after I saw her that she was at risk of cardiovascular collapse and would need intensive care, but you still expect that young people who get intensive care treatment will survive,” Nott said.

Moylan suffered a cardiac arrest at about 8am. Nott said it was only then that she first believed the 37-year-old’s condition had become life-threatening.

Moylan’s family said they were not informed of this until shortly before she died at 2pm.

Earlier, Raechel Marshall – who had been working as a midwife on the night – said she was so traumatised by what happened that she left the industry.

“I wish to offer my sincere condolences and sympathy to [Moylan’s] family for their loss,” Marshall said.

The inquest continues on Monday.

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