Dáil debates

Thursday, 30 April 2015

Topical Issue Debate

Medical Inquiries

4:40 pm

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Independent)
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As a consequence of suspected cases of misdiagnosis in seven hospitals, with questions raised over the skills of three locum doctors, thousands of scans have had to be reviewed and hundreds of patients recalled. This news comes some years after the issue of delayed X-ray diagnoses at Tallaght hospital and similar issues at Our Lady of Lourdes Hospital in Drogheda emerged. The HSE assured us in 2010 that procedures were in place to ensure X-ray readings would neither be delayed nor misread. Why then has the system let patients down once again?

When a patient has a test performed and receives an all-clear result, he or she is naturally relieved. Now, however, some patients not only have an anxious wait to find out if their all-clear result was correct but there is also the fear that a delayed diagnosis could lead to other complications. Why has it taken so long to identify this problem? Why are some of the patients who are affected finding out what is happening through the media?

The period in question is 2013 and 2014. We were assured in 2010, as I said, that national guidelines for radiological reporting were in place and being fully complied with by all acute hospitals throughout the country. As such, this issue should never have arisen. When it did arise, it should have been identified through the review process that was built into those national standards. That did not happen. The doctors in question moved from hospital to hospital within the State and have since moved outside the jurisdiction. Will the Minister indicate what is being done to protect patients in the United Kingdom and Australia who are now under the care of these doctors?

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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As I live in Drogheda, issues relating to Our Lady of Lourdes Hospital are of great concern to me and my constituents. As Deputy Naughten notes, we have been here before. In fact, there is a major sense of déjà vuabout the new revelations regarding cases of misdiagnosis. A report in the Irish Independentof 5 November 2008 related that nine cancer patients had their diagnosis delayed and one of them, who had since died, had missed a major chance of a cure for her cancer. This has been a problem for some time.

I am concerned at the lack of a dynamic within the HSE to deal with this issue. Heads must roll as a consequence of what has happened. How were the three consultants involved, one of whom worked in three or four of the hospitals, allowed into the system when they were not fit for purpose? A Google search of the literature indicates that significant mistakes can occur in reading around radiology, with an error rate of 2% to 20% indicated. However, we were assured that this would never happen again. Given that we know three doctors were involved, why has only one misdiagnosis case been reported in the media? Will the Minister explain that?

When was the Medical Council informed about this issue and what is it doing about it? Why is it the case, as reported in The Irish Times, that the doctors concerned cannot be brought back to this country by mandamusto be interrogated as to what happened? Either we are hiring consultants by way of a Google search or we have proper supervision and procedures in place. The fault here does not lie with the Minister but with the HSE, which is not delivering for patients in this regard.

Is the technology in these hospitals fit for purpose? In other words, is it possible that some of these errors occurred because the technology in use was not the best available in the marketplace? What protocols will be put in place to ensure that more than one set of eyes is cast over these scans, to use the Minister's phrase in an interview he gave earlier today? If it is necessary to send scans to specialists outside the State for a second read, then that is what we should do.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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As I mentioned in a radio interview earlier today, I was first informed of this issue this morning and may not have all the information. Indeed, I am not sure anybody does have all the information. However, I certainly will provide whatever information I do have.

As I understand, in 2013 and 2014 questions were raised by clinicians working in our acute hospitals regarding the work of three locum or temporary radiologists. The hospitals involved were Bantry, Kerry and Cavan-Monaghan. It is not believed that the locum or temporary consultants are linked in any way. These three reviews in the three hospitals have been completed and all patients who required follow-up investigations have been contacted. The HSE has provided assurance that if patients at these hospitals have not been contacted by the hospital or their GP already, they have no cause for concern.

I understand a significant number of X-rays - in the thousands, as Deputy Naughten noted - were reviewed and only a small fraction, 100 or so, required follow-up and a repeat scan. Regrettably, one incident of delayed diagnosis has been confirmed. The HSE is following up appropriately with the patient and will provide whatever support is necessary. There is full and open disclosure, in line with policy.

As part of the HSE's risk assessment process, a review may require an audit of work carried out by a locum consultant in other hospitals. As two of the locum consultants also carried out some work in other hospitals, reviews in those hospitals are being undertaken.

In the case of two hospitals, Wexford and Roscommon, I understand that no patient safety concerns have been identified. Drogheda and Connolly hospitals are currently carrying out a preliminary audit over a short defined period to identify any possible errors or safety concerns. This preliminary work is being undertaken to provide assurance to patients that their X-rays or scans have been correctly assessed and reported. In both cases, it involved somebody who worked in those hospitals for a four-week period in 2013. Reviews will be necessary in a number of other hospitals where the consultants also worked.

I have been assured by the HSE that none of the locums involved is currently working in any Irish hospital and reports, as appropriate, have been made to the Medical Council. The reviews were carried out in line with the HSE safety incident management policy and the faculty of radiologists quality assurance guidelines. All cases have been managed, escalated and reported in accordance with the HSE safety incident management policy. Where further action was recommended, patients have been supported.

Radiological services will be improved through the new hospital groups. Within groups, a networked approach will be adopted, allowing the major centres to direct and manage services. It will also allow for greater quality control, quality assurance and frequent audits to pick up errors and identify patterns of poor performance.

I would encourage Members to know all the facts - I do not know them all yet - before jumping to conclusions and calling for heads or assuming that people have done wrong when that is yet proven. As Deputy O'Dowd pointed out, even the best radiologist in the world will have an error rate of 2%. When one gets two radiologists together to look at the same scan, they do not always agree. No matter what guidelines or procedures are in place or what assurances may have been given in the past, we will always have errors. That is why we must have audits regularly, we must have reviews and why sometimes we have to recall patients, which is what has occurred in this case. So far, of 5,000 or more scans reviewed, only one delayed diagnosis has been identified and that relates to only one of the three consultants. That is an enormous tragedy and I feel for the person involved. They will have the full support of the HSE in getting their treatment and are getting that now. What we have is well below the error rate of 2% so far. Things may change, more things may happen and there may be more information in the future. The facts of this are only emerging but let us stick to the facts and not jump to conclusions or start hanging people or calling for various actions to happen before we know everything that happened.

4:50 pm

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Independent)
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The most worrying aspect of the Minister's response is that there are a number of other hospitals involved. Can he indicate in how many more hospitals these locum consultants worked? How many more patients will have to worry until they get clarification in this regard?

The reason this issue arises is because we are so reliant on locum consultants. As the Minister will know, consultant radiologist posts in Roscommon County Hospital have been vacant for a number of years. We have been trying to get approval to recruit consultants. We have no permanent consultant radiologist at that hospital. Can the Minister give me an assurance here that those appointments will be made?

I wish to make two further brief points. The first is that the Minister failed to answer a key question. If patients in Ireland were potentially put at risk in regard to these doctors, patients in the UK and Australia where those doctors are now working are also potentially at risk. I raised an issue here in the past regarding a consultant who was not up to standard here and who continued to practise in the UK. I want an assurance that no other patient is being put at risk, be it in this jurisdiction or any other jurisdictions, if these doctors are not up to scratch.

Photo of Frank FeighanFrank Feighan (Roscommon-South Leitrim, Fine Gael)
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We are running out of time, Deputy.

Photo of Denis NaughtenDenis Naughten (Roscommon-South Leitrim, Independent)
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Second, why are we not using the key quality indicators that were set out in the Royal College of Surgeons standards in 2010 which would have identified this problem at a much earlier stage?

Photo of Fergus O'DowdFergus O'Dowd (Louth, Fine Gael)
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The facts of all of this emerged not from a statement from the Minister or a statement from the HSE, but from a report in the national media in The Irish Times. Why was a statement in regard to it not made by the HSE? How can we believe the HSE when it obviously kept this information from public view? We would not know of it if The Irish Timeshad not put it into the public domain, and the Minister would not know of it either. He only learned of it this morning like ourselves. Let us be honest and factual about this matter. Such incidents have happened before. People have died before their time. The result of a previous inquiry stated that somebody would not have died if they had been caught in time and their X-ray had been read properly. That is a fact.

The Minister stated in his reply that "Drogheda and Connolly hospitals are currently carrying out a preliminary audit over a short defined period". We do not know what is going on. The Minister said that "reviews will be necessary in a number of other hospitals where the locums worked". What is going on? The Minister is badly served - as are we - by the statement he read out. I want to know the full facts as I live beside a major hospital that serves the north east. The commitments we were given that this would never happen again in 2008, 2009 and 2010 were absolute and they were accepted, but this is happening today.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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I do not have full information so I can only give the Deputies the information I have and I certainly will not withhold any information from them. I do not know the exact number of hospitals in which these three locums worked. That is being figured out at the moment. What I can say is that when it comes to the one locum associated with the one delayed diagnosis, all those cases have been traced. What is now being done, as I have been informed, is a trace-back of the two locums, against which no delayed diagnosis has yet been identified.

It is the case that we rely heavily on locum consultants in the Irish health service. The fact that we have now concluded an agreement with the IMO on salary scales will make it easier to hire full-time consultants and hospitals now have much more autonomy within their payroll budgets to hire people for full-time posts. We will, however, always have locums, particularly in smaller hospitals. A small hospital with, say, three or four radiologists or cardiologists or other consultants, is very much dependent on locums when one of the consultants is on maternity leave, out sick or away. It is different in bigger hospitals. If they have a rota of 15 or 16, it is possible to cover for one or two absences but that is not the case in smaller hospitals. That is an issue with smaller hospitals and we need to face up to it. The hospital groups will help. Additionally, when it comes to radiology, in particular, NIMIS technology will help because it has all scans on a digital screen. It is not in all hospitals yet but it will be. It allows for remote reporting and for audits to happen elsewhere. Measures have been taken to contact the hospitals overseas in which these three doctors are working. It is very important to bear in mind that no findings have yet been made against any of the locum consultants to whom we are referring.