A brain bleed highlighted in a University Hospital Limerick (UHL) patient’s CT scan was missed when it was read remotely in the early hours by a company to which the work had been outsourced by the HSE, the High Court has heard. When PJ O’Connor’s condition deteriorated, and he needed to be transferred to another hospital for treatment, he had to wait four hours for an ambulance. The 71-year-old was treated in an intensive care unit after the transfer but died nine days later on December 6th, 2021.The HSE last February admitted a breach of duty in the failure of its radiology services to detect the brain bleed and the consequent provision of contraindicated treatment. It further admitted a breach in the provision of timely onward ambulance transportation to a Cork hospital for neurosurgery and delay in providing appropriate reversal treatment to O’Connor, which it accepted caused his wrongful and untimely death.In a letter of apology to the O’Connor family, the HSE and the hospital said “it is with regret” that the care provided to the farmer, from Capparoe, Nenagh, Co Tipperary, at UHL on November 27th, 2021, “fell below our standards and best practice”.“We acknowledge that these failings led to the untimely death of Mr O’Connor. We extend our sincere apologies to both you and your family for the distress and upset that this has caused, and we do not underestimate the heartbreak and upset caused by the death of a much loved member of your family,” said the letter, signed by Ian Carter, chief executive of Acute and Older People Services HSE Mid West.The letter was read out in court as O’Connor’s family settled a High Court action over his death.Speaking outside the Four Courts afterwards, O’Connor’s son James said it had been a long legal battle.“It was extended out and it prolonged our grief, compounded our loss as we were dragged through the courts,” he said.His sister Katerine Kirby said they took the case to highlight failings in the health service in the hope “another family does not have to go through this”.“It is important for us to acknowledge how much we miss my father and Carmel’s husband and the substandard care he received that means he is not here with us today,” she added.The family’s counsel Patrick Treacy, instructed by Cian O’Carroll solicitors, told the court the events have had an “enormous traumatic effect” on PJ’s wife Carmel and their four children. On November 26th, 2021, he said O’Connor was admitted to UHL with right facial droop and a working diagnosis of acute stroke was made.A CT scan of his brain was taken. Counsel told the court the scan was read remotely out of hours by a radiologist, as the HSE had outsourced radiological reporting to a company.Counsel said the radiologist got the scan after 2am and had reported back at 2.30am. Treacy said a possible explanation was offered by the reporting radiologist that O’Connor’s brain was assessed in the brain soft tissue window and may not have been assessed in the head bleed window. The radiologist had said it was possible he did not do the head bleed step and he was not sure if it was related to the time of night or because he was distracted by the appearance of the vertebral arteries.Counsel said the brain bleed was missed and O’Connor was started on emergency treatment to dissolve blood clots and to restore blood flow. His condition deteriorated and it was decided to transfer him to a Cork hospital. However, counsel said there was an “inordinate delay” and an ambulance booked at 11.30am did not arrive until 3.30pm.A call review report relating to the ambulance transfer noted significant challenges with emergency ambulance availability due to service level demand and hospital delays.Noting the settlement and approving the division of the €35,000 statutory mental distress payment, Judge Paul Coffey extended his deepest sympathy to the O’Connor family.