Dáil debates

Wednesday, 5 November 2008

10:00 pm

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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Nine patients in the north east had a misdiagnosis of lung cancer, thus losing valuable time for their essential medical treatment. At least one of these patients would have had a major chance of their cancer being cured. Others had their lives shortened by a valuable period of months. Eight of these patients have now, sadly, died. There is, therefore, a need for an independent inquiry into why a clear warning, given seven years ago by a consultant radiologist in Navan, that the radiologists in the hospitals concerned were under intolerable stress, that a dangerous situation existed for patients and staff and that mistakes would be made, was ignored by the HSE.

The inquiry began in 2007. I have a letter dated 9 October, correspondence from Dr. John Kiely, regarding two missed diagnoses of serious lung pathology on radiographs. The core issue is confirmation in this letter that there were significant abnormalities on two patients' radiographs that were reported as normal. That appalling error had fatal consequences for eight of the nine people concerned.

How clear was the warning in 2001 and is there any way the HSE could say it was not adequate? The letter stated that staffing in the Louth-Meath group was inadequate and, in Mr. Towers's considered opinion, a dangerous situation had arisen for staff and patients. He warned that mistakes would be made by the situation created by the inability or reluctance of the HSE to appoint sufficient full-time permanent radiologists in Drogheda. He wrote that the radiologists were under intolerable stress and the radiology service in Drogheda was deficient for proper patient care. The unwillingness to fund proper staffing for radiology was at the core of the problem, according to Mr. Towers. The intolerable workload meant that teaching, administration and other activities have had to be discontinued. That description of the conditions obtaining in Our Lady of Lourdes and Navan hospitals was written seven years ago this month.

In 2006, when Judge Maureen Harding Clark investigated the Neary affair, the same issues arose. Her report clearly states:

The work of all doctors including highly regarded consultants has to be reviewed in an effective and dispassionate manner. Failure to engage in effective peer review and independent audit will ensure that history will repeat itself.

History has repeated itself in the Dr. Neary affair and again in the report published this week. It is a shame and a disgrace.

I would like the Minister for Health and Children to answer six questions. Can she confirm that the radiology department in the Louth-Meath group is now resourced with sufficient consultant radiologists and that the misdiagnosis of X-rays is no longer significant? Can she confirm that no concern regarding the number of radiologists employed in the group has been brought to the attention of the HSE in the recent past? Can she confirm that no concern regarding significant misdiagnosis of X-rays in the Louth-Meath hospital group has been expressed to the HSE since the locum consultant involved in the recent review left the region? Does the radiology department continue to depend on locums, including external radiologists employed by the HSE to report on X-rays, due to the department's workload? Has she been informed by the consultant radiologists that they are experiencing great difficulties in coping with the current workload of the three hospitals in the group? Is she or the HSE taking action on the repeated representations made by consultants regarding the inability of Our Lady of Lourdes Hospital to cope safely with the number of patients on trolleys? On Monday, 3 November, for example, 34 patients were on trolleys in the hospital.

We need a root and branch reform of administrative structures in the north east. This review is a whitewash in terms of how and why these events took place. It sets out the medical outcome for the eight people who died but it does not address the core issue of why the warnings given seven years ago this month were ignored.

Photo of Mary WallaceMary Wallace (Meath East, Fianna Fail)
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Yesterday the Health Service Executive published the review of chest X-rays and CT scans reported by a locum consultant radiologist at Louth-Meath hospitals group from August 2006 to August 2007. The review commenced in May 2008 and examined 6,000 X-rays and CT scans from 5,000 patients.

The review found that nine patients in Drogheda and Navan hospitals had their diagnoses of lung cancer delayed as a result of missed radiological diagnoses. Eight of these patients are now deceased and one is receiving ongoing treatment. The review acknowledges that the delayed diagnosis had varying impacts on these patients' care and treatment options. Along with my colleague, the Minister for Health and Children, Deputy Harney, I extend my deepest sympathies to the families of the patients who suffered delays in their diagnoses of lung cancer. These nine patients had been identified and diagnosed prior to March 2008. The review therefore did not find any previously undiagnosed lung cancer. The HSE and the radiologist whose work gave rise to this review have apologised to the families of the patients who were affected by these delayed diagnoses. The review will be forwarded to the Medical Council of Ireland and the General Medical Council in the UK.

While I understand that concerns were raised in 2001 in regard to radiology services in the north east, services have been enhanced in the intervening period. The HSE has confirmed that all radiology services in the Louth-Meath group are entirely consultant delivered. In 2001, five consultant radiologists were employed in the group. It is acknowledged that complexity and workload have increased in recent years and ten consultant radiologists currently work in the radiology departments of the hospitals in Drogheda, Navan and Dundalk. All the consultant radiologists have joint appointments to two of the three hospitals.

The importance of audit in a modern health care system is fully recognised and the HSE has informed the Department that peer reviews are conducted in the hospitals concerned. The radiologists hold separate weekly clinical radiology meetings in all three hospitals in medicine, surgery and breast radiology and regularly participate in grand rounds in Drogheda and Navan. Electronic conferencing is fully operational in Navan and is being developed in Drogheda.

In response to the matters described in the review, HSE north east hospital network is adding to its existing patient safety measures by beginning an additional process to enhance clinical governance in the radiology services of the hospitals. A good system of clinical governance in health care involves quality assurance systems aimed at reducing the likelihood of errors occurring and increasing the early detection of those errors which do occur. This will cover the five hospitals in the north east and will produce an agreed programme to improve clinical governance and, therefore, patient safety and quality of care. This process is underway and will result in an initial action plan in December to enhance the system and ethos of effective clinical governance in radiology services in the north east.

In regard to locum appointments, Louth-Meath hospital group's radiology department has in recent years employed no more than one or two locum consultant radiologists at any one time, out of a complement of ten consultant radiologists. This is due in part to the high degree of cross-cover provided among consultant colleagues in the hospital group.

The group's human resources department has in place a procedure for the recruitment of permanent staff and this is also used for the recruitment of temporary and locum consultant staff. In the case of the locum consultant radiologist involved in this review, all normal recruitment procedures were followed. Following an interview, registration with the Medical Council was confirmed and a reference was received from previous employers. Therefore, it is not considered that any specific issue arose in respect of this consultant's recruitment or appointment. However, given the overall requirement to provide assurance on the level and recruitment of locums in medical practice, the HSE issued national guidance in May 2008 which requires hospitals and facilities to accept locum medical staff only from medical recruitment agencies that meet a series of stringent requirements relating to the doctors they refer to the employers. These include ensuring that the doctor has full references and full CV, is a member of the relevant Medical Council register and has been given full occupational health clearance and police screening. Standards in recruitment and in levels of use of locum clinicians will continue to be reviewed and monitored by the HSE.

The HSE is committed to learning from this review and to driving change. In partnership with its clinical staff, it will do all it can to enhance patient safety at all levels.