Dan Neville (Limerick West, Fine Gael)

I thank the Ceann Comhairle for allowing me to raise the important matter of the review into the death of Róisín Ruddle, Kilmacow, Kilfinny, Adare. I am a fellow parishioner of the Ruddle family and have known Róisín's mother and father, grandfather and great-grandfather, who have been highly respected members of our community. I thank the Ruddle family for their co-operation with the review into the sad case of the death of their daughter, Róisín, and sympathise with Gerard and Helen. I commend the regional health authority, its staff and the staff of Our Lady's Hospital.

On 27 March 2003 Róisín Ruddle was placed on the elective cardiac surgery list of Our Lady's Hospital for insertion of a Glenn shunt. Her surgery was scheduled for 30 June 2003. Róisín was admitted to Our Lady's Hospital on 25 June 2003 for her pre-operative investigations and discharged home on 26 June. She was admitted on Sunday, 29 June in preparation for her planned surgery the following day. On Monday, 30 June, Róisín's operation was deferred because there was no staffed intensive care bed available for her following her surgery. Róisín and her parents left the hospital at approximately 12 noon on 30 June and returned home.

Róisín died at home in the early hours of Tuesday, 1 July. She was due to undergo the Glenn shunt procedure on 30 June. This procedure was a palliative operation which was part of a staged strategy in the management of Róisín's cardiac condition. She underwent the normal pre-operative investigations as I have stated. On 30 June her surgery was deferred because no staffed intensive care bed was available.

The autopsy indicated that Róisín's death was due to acute cardio-respiratory failure associated with the presumed development of a cardiac arrhythmis. This view was supported by the medical opinion presented in the course of the review. If the Glenn shunt procedure had gone ahead as planned on 30 June, it would most likely have improved Róisín's oxygen saturation and this may have reduced the likelihood of her condition. Nevertheless, it is the view of the panel that if Róisín's operation had gone ahead as planned on 30 June, the likelihood of her survival would have been greater.

Given the centrality of the ICU to the operation of Our Lady's Hospital as a whole, the shortage of nurses to staff the unit does not appear, according to the review, to have been seen by hospital management at the time as a prior issue warranting significant management attention. From the evidence presented, it is clear that the problems relating to the recruitment and retention of specialist nursing staff were considered matters to be addressed solely by the nursing director and her staff. Although aware of the problems, there is no evidence that hospital management or the committee of management gave any active support, other than the approval of financial resources, to helping the director of nursing with the problem of devising initiatives that were clearly needed to address the recruitment issue that is central to the report and to this highly critical area of the hospital's activities.

It is the opinion of the panel that insufficient focus was placed by Our Lady's Hospital management and the committee of management on the resolution of this issue. As a consequence, there was a lack of urgency in applying and distributing available resources for resolving the problem. The panel pointed out that despite significant efforts made by the staff, the difficulty arises regarding the area of nursing. The fundamental reason for the deferral of Róisín's surgery is clearly stated by the panel. It was due to the inability of Our Lady's Hospital to recruit or retain sufficient experienced ICU nursing staff to support the available ICU beds. Among the factors contributing to the shortage of paediatric ICU nurses was a change in the system of nurse education in the mid-1990s. It was a fundamental managerial planning issue that when such changes are considered by the Department and the Minister, a planned approach should be taken to ensure that these problems do not arise.

I will raise the issue of the development and investment in Our Lady's Hospital on a future occasion. I am amazed that despite the difficulties with recruitment, the hospital does not have a recruitment website. The panel recommends such a website.

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