Thursday, 1 December 2016
Ceisteanna - Questions - Priority Questions
5. To ask the Minister for Health the status of the audit into spinal surgeries performed on 198 persons between January 2013 and November 2014 in University Hospital Galway; when the audit commenced; when it was completed; when the findings will be published; and if he will make a statement on the matter. [38242/16]
As the Minister is aware, the most serious issues have arisen concerning a substantial number of patients who underwent spinal surgery. Inappropriate procedures were carried out, and in one case the death of a patient was hastened. In addition, unnecessary and dreadful pain was caused. We learned of this through patients - I learned of it from the family of one patient - and through the press. It is entirely unacceptable to learn of this in such a manner. Will the Minister tell us about the audit and specifically when it commenced, the outcome and why it was delayed?
I thank Deputy Connolly for raising this very serious and important issue. I understand that following concerns over four spinal surgery cases detected through the quality and safety systems in University Hospital Galway in 2014, an audit of care provided by one consultant orthopaedic surgeon was undertaken. An external review of the four cases was then commissioned. On receipt of that report in November 2014, the Saolta University Healthcare Group initiated a wider audit of the operative practice of the surgeon which was carried out by two independent orthopaedic surgeons.
November 2014 was when the external review was reported. The Saolta group then initiated a wider audit of the practice of the surgeon which was carried out by two independent orthopaedic surgeons. The consultant involved ceased performing spinal surgery immediately. I am further advised that the consultant orthopaedic surgeon in question resigned his post in February 2015 and is no longer working in Ireland.
A total of 198 patient charts were audited and in 151 cases, no concerns were expressed with regard to patient care. Some concerns were raised in respect of 43 cases but the auditors did not consider that serious harm had resulted. The audit raised serious concerns about resulting harm to the original four patients.
The HSE has advised me that patients were contacted in early November and a patient helpline has been established. In addition, follow-up patient care is being provided by the spinal service at University Hospital Galway.
University Hospital Galway and the Saolta University Healthcare Group have expressed their regret regarding any distress this process may have caused to patients or their families. The HSE has provided assurance regarding the safety of the spinal services currently in place for patients in Galway. I would like to stress the importance of supporting the needs of the patients and protecting patient confidentiality during this time. That said, all of those patients whose charts were audited were contacted directly by the Saolta group on foot of legal advice.
I have asked when the audit began, when it concluded and whether it will be published. The Minister has spoken about protecting the patients but the system was and is being protected here. I ask again, when did the audit actually commence? Who carried out the external review in the first instance? Was that separate from the review carried out by the two external doctors? When was it completed and will it be published?
This is the most serious issue that has arisen in Galway city since the case of Savita Halappanavar. We are learning nothing, it seems to me. I am loath to criticise the public system because I am the greatest advocate of the public system. The Minister is nodding in agreement. I raise this as a matter of public importance. A statement should have been made by the Minister and the HSE, proactively, if they wished to reassure people, with all of the facts given. We should not be reliant on press statements and should not have to drag information out.
I fully accept Deputy Connolly's bona fides on the matter but I am sure she accepts mine as well. My primary concern is and will always be - as long as I hold this office - for the individual patients, their confidentiality, safety and sensitivity with regard to their own cases. They have a right to have their confidential patient information absolutely protected.
Let me put some more information on the record. I am more than willing to make all of the information I have available. As I said, there were concerns about four spinal surgery cases identified as part of the internal quality management systems in place within the Saolta University Healthcare Group. An independent audit of the spinal surgical practice of a consultant orthopaedic surgeon at University Hospital Galway was completed between 1 January 2013 and 14 November 2014. The four cases were notified and reviewed in the period March to July 2014 - those people were notified - whereupon an external review was commissioned. When Saolta received the report of the external review in November 2014, it then decided to initiate a wider audit and the surgeon involved was directed to cease performing spinal surgery immediately.
A communications process was commenced on 7 November this year to notify each patient whose chart was audited, even where there was no concern raised at all. Of importance is that Mr. Frank Dowling, external spinal and orthopaedic consultant, will provide a clinical review of the identified patients through specific scheduled clinics this month, December 2016. If patients require any ongoing spinal care or follow-up, this will be provided by the spinal service at University Hospital Galway.
First, I would like a comprehensive written reply. Second, the figures the Minister has given are accurate but the timespan is not. The audit was conducted between January 2013, as the Minister said, and November 2014. We are now in December 2016. Patients and families were only contacted in November of this year. There was no contact before that. I know that, intimately and personally. The spinal surgery carried out in the case of which I am aware was inappropriate, hastened the death of the patient and caused absolutely unimaginable pain.
It is unacceptable in the 21st century for a system to seek to protect itself, particularly if we are to learn anything and engender confidence in a public health system. I am asking the Minister to take a hands-on approach and to come back to me and explain how it could possibly take until November 2016 to communicate the relevant information. When will the general findings of the audit be published? What have we learned from it? What has been put in place? When we talk about quality assurance, we are talking about a small number of people who finally complained and whose actions led to concerns being expressed. In the particular case I highlight, no complaints were made and no quality assurance system picked it up. In that case, where death was hastened, unimaginable pain was caused and incorrect procedure was not picked up by any quality assurance system or on foot of any complaints.
I am very happy to share with Deputy Connolly the information I have available to me because this is a very serious matter and it is difficult, going back and forth, to put all the information on the record. However, I am endeavouring to do so. It is important to assure the public that an audit of the surgeon's non-spinal orthopaedic work was also carried out and that no concerns were raised. The Irish Medical Council has been made aware of the audit and the relevant information has been forwarded to it. A key finding from the audit was the need for structured multidisciplinary input into the decision-making about surgery and review of cases. The consultant orthopaedic surgeon resigned from his permanent post at University Hospital Galway in February 2015 and is no longer working in this country. The HSE advises that this doctor's only periods of practising in Ireland were when he undertook his internship in basic surgical training in the Saolta Group and following his appointment as a consultant orthopaedic surgeon with special interest in spinal surgery,, at Galway University Hospital on 21 January 2013.
I assure the public that this review has been carried out extensively and that it was audited by independent external consultant orthopaedic surgeons. I will, however, make available to Deputy Connolly the information I have in my possession.