Serious concerns have been expressed at the highest levels in the health service for more than two years at the low volume of anaesthetic work being undertaken at Roscommon County Hospital, it has emerged.
Documents seen by The Irish Times show that the concerns were expressed in correspondence to the former Western Health Board, the interim Health Service Executive and the then minister for health, Micheál Martin, in April 2004.
In a letter to all these parties, the then chief officer of Comhairle na nOspidéal, Tommie Martin - who is now an adviser to HSE chief executive officer Prof Brendan Drumm - said he was concerned that the volume of anaesthetics at Roscommon hospital "is not sufficient to maintain the skills of the anaesthetic staff there, with a potential impact on patient care".
He said there was "a considerable imbalance in the anaesthetic workload" between Roscommon hospital and Portiuncula hospital in Ballinasloe, some 33 miles away. The number of anaesthetic procedures per consultant at Roscommon hospital in 2002 was 223 compared to 1,610 in Portiuncula and over the whole of that year there were 486 anaesthetic procedures undertaken at Roscommon compared to 4,510 at Portiuncula.
In 2004 some 567 anaesthetic procedures were carried out at Roscommon compared to 4,569 at Portiuncula.
The workloads of both hospitals have come into sharp focus in recent months since the HSE announced in August that it was creating a joint department of surgery between the hospitals.
It initially proposed moving all inpatient surgery from Roscommon to Portiuncula, leaving Roscommon to specialise in day-case surgery. This caused uproar locally and the Fianna Fáil TD for the area, Michael Finneran, threatened not to stand for his party in the next election if the decision was not reversed.
Then the HSE said in September that "given the strength of public feeling" on the issue, it hoped to retain inpatient surgery in Roscommon. It announced another review of services in the area, the findings of which have not yet been published.
The documents seen by this newspaper show that Comhairle na nOspidéal, which advises on consultant staffing, prepared a briefing document for the HSE's National Hospitals Office earlier this year in which it pointed out that the current cost of providing anaesthetic cover at Roscommon was prohibitive. "Given the low anaesthetic workload at Roscommon, the current cost [approximately €3,000 per general anaesthetic for consultant and NCHD cost alone] is simply prohibitive," it said. It added that joint appointments at the hospitals were the best way forward. It recommended the development of day-surgery services at Roscommon, saying this would actually increase the workload at Roscommon.
Minister for Health Mary Harney told the Dáil earlier this week that while a joint surgery department would be set up between the hospitals there were no plans to discontinue any surgical services at either hospital.
"Surgical activity was of a low volume at both these hospitals. In the case of Roscommon County Hospital, I understand there were as few as two to four procedures per week. The only way to ensure a safe environment for treatment is to maintain the skill base of surgeons through higher volume activity," she added.