Mary Harney (Dublin Mid West, Progressive Democrats)

For the past few days I have been considering how best to address the serious issues that arise from the recent tragic deaths of Ann Moriarty and Edel Kelly following their treatment in Ennis General Hospital. I have met with the husband and the sister of Ann Moriarty and I intend to meet the family of the other woman next week. I wish to extend my sympathy to both families on their sad losses. Ann Moriarty and Edel Kelly were two young women, both mothers.

The expert clinical advice available to me is that a clinical review of other patients treated in Ennis General Hospital would not be warranted. I am also conscious that in the context of future lessons for cancer services, breast cancer services have now been transferred from that hospital to the designated specialist centre for the mid-west and Limerick.

Regarding the treatment of Ann Moriarty in St. James's Hospital, I am aware that she was diagnosed with breast cancer two years previously and that she continued to attend the follow-up clinic at the hospital. Ms Moriarty's most recent follow-up was in April 2007 and at that time a mammogram taken was reported as clear. Subsequently the hospital has not been able to locate this mammogram in order to have it reviewed.

Regarding Edel Kelly, both a biopsy taken at Ennis General Hospital in October 2006 and a histopathology report noted that no tumour was identified but read "clinical correlation recommended". This clinical correlation did not occur nor was there a multidisciplinary meeting to discuss Edel Kelly's health.

The key factor in Ann Moriarty's case was the failure of Ennis General Hospital to refer her to a designated cancer centre when it was known that she had a history of cancer. In the case of Edel Kelly, the absence of a multidisciplinary team approach resulted in her cancer not being diagnosed. Since we have now moved breast cancer services from Ennis General Hospital, I feel it is important to have a wider examination of the operation of the hospital that would examine the approach to issues relating to the diagnosis and treatment of patients. This includes arrangements for quality and safety and communications within the hospital and, in particular, with patients. I believe there are many lessons to be learned by Ennis General Hospital and by the wider acute hospital sector.

I am very conscious that the Health Service Executive has worked for some time to reconfigure services in the mid-west region. It has engaged with clinicians and other health professionals in the region to agree a practical, patient-centred plan for reorganising services between Limerick Regional Hospital, Ennis General Hospital, Nenagh Hospital and St. John's Hospital. Clinicians in the region have worked positively and have shown strong leadership towards this end. I am aware that the HSE has placed a particular emphasis on integrating accident and emergency services, with clear roles for all four hospitals, as part of a well-defined emergency care network. I am also aware that the Health Information and Quality Authority, HIQA, has reviewed documentation relating to the cases of Ann Moriarty and Edel Kelly. Last week representatives of the authority met Mr. Karl Henry, husband of the late Ann Moriarty, to establish whether a further investigation is necessary.

Notwithstanding this, I am now requesting the Health Information and Quality Authority, under section 9(2) of the Health Act 2007, to review the arrangements for providing services at Ennis General Hospital, with particular reference to the diagnosis and follow-up of patients and the communications systems in place in the hospital for patients and staff. The review, to be completed in three months, will include an explanation of how these arrangements work in the emergency department in particular. It would be particularly helpful if any of the conclusions or recommendations were applicable to the wider acute hospital sector.

The HSE is also putting arrangements in place for those patients who attended hospital breast clinics throughout the country in the past two years and who do not have a diagnosis of cancer but have concerns in light of recent events. A specified referral arrangement for these patients is being put in place and any woman with concerns should contact her general practitioner who will be able to refer her to a specialist breast clinic.

There is every reason to believe that the vast majority of women have received the correct and appropriate assessment but I believe it is important to offer patients the option of a specialised referral service, following discussions with a general practitioner.

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