Review of gynaecology at Donegal hospital after delayed cancer diagnoses

The State's health watchdog is to assess gynaecology services at Letterkenny University Hospital to check changes have been made following a review of failures that led to delayed cancer diagnoses.

Nine months after an external review was completed into the services at the Donegal hospital, the Health Information and Quality Authority is to carry out a review of management and oversight arrangements to see if recommendations made in the review have been implemented.

The independent review carried out by Northern Ireland consultant obstetrician and gynaecologist Dr John Price and hospital group Saolta, at the direction of the Health Service Executive, found "unsatisfactory" care in the treatment of women with endometrial cancer.

The report, published last August, found in six cases over a nine-year period where women suffered suspected or delayed diagnosis of endometrial cancer that there was a common theme of delay in diagnosis caused by poor triage, administration and follow-up practices.

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It found that it was clear in all cases that the women received “unsatisfactory” care and that the gynaecology triage system was “cumbersome, inefficient and represents a significant opportunity for error and delay”. The failures were compounded by ineffective communication.

A wider review by Saolta and Letterkenny University Hospital found that of 133 women diagnosed with endometrial cancer between 2010 and 2019, a total of 38 women had to wait longer than 100 days from initial referral to diagnosis. If detected early, endometrial cancer is curable.

The follow-up Hiqa review will include an on-site inspection of the service, interviews with key staff at hospital, hospital group and national HSE level and a review of documentation.

Seán Egan, head of healthcare at Hiqa, said that the health service failures at the hospital were “quite serious” and that a number of women were “harmed as a consequence of this”.

In the cases of 23 women there was no reasonable explanation given as to why they experienced the delay in their diagnosis and that there were two deaths that might have been avoided with earlier diagnosis, he said. At least seven women had to undergo chemotherapy.

Mr Egan said that notwithstanding the impact of the Covid-19 pandemic Hiqa felt that nine months was enough time to assess whether the hospital had made the changes recommended in the review to ensure that proper oversight and management of the service was now in place.

“It is essential that women accessing gynaecology services are assured that the service is safe and that they are being protected and safeguarded,” said Mr Egan.

“This review will assess the effectiveness and sustainability of the governance and oversight arrangements to ensure that high-quality gynaecology services are provided at Letterkenny University Hospital.”

Concerns about the gynaecology service were raised by Donegal-born doctor Margaret MacMahon whose late sister Carol’s endometrial cancer was missed for two years.

Hiqa was contacted by Dr MacMahon in 2018 and later by a number of other individuals who had experienced delays in the diagnosis of the endometrial cancer at the hospital.