The death this week of a two-year-old girl whose surgery was cancelled because there were no nurses to look after her has brought home the pitifulcondition of the State's main hospital for sick children, writes Eithne Donnellan, Health Correspondent
Five-year-old Declan Smyth had to change rooms three times one weekend in Crumlin hospital because of an ant infestation. Two years on, his dad can remember the incident clearly. "There were ants all over the place and the staff had to move us around while the place was cleaned up."
That was the summer of 2001 when Declan from Lusk in north Dublin was diagnosed with leukaemia. He spent weeks in the hospital undergoing chemotherapy and his father, Declan Snr, won't forget the time he spent there in a hurry.
He was shocked by the conditions at this, the national children's cancer centre.
Here, bone marrow, taken from children while they undergo chemotherapy, is stored in a Portakabin, to be later reinfused into the children; children with suppressed immune systems regularly have to use commodes simply because they do not have ensuite facilities in their rooms and to venture out to a toilet down the corridor would place them at risk of infection; and operations are regularly cancelled due to lack of beds and a shortage of intensive care nursing staff.
The hospital, built almost half a century ago, is out of date and in need of major modernisation. But at every turn it seems to encounter difficulties. Before seven operating theatres, built at a cost of €30 million, were handed over to the hospital by builders this week, Dr David Mannion, consultant in anaesthesia and intensive care, had said 29 extra staff, mostly nurses, were required to run them. However as the Government capped the numbers which can be employed at the hospital, no staff can be hired unless others are let go.
But following the death of two-year-old Róisin Ruddle within hours of her heart operation at the hospital being cancelled, an Our Lady's Hospital management committee meeting directed the hospital's chief executive to recruit the extra 29 staff needed, even though the budget simply isn't there. In the words of Dr Mannion, patient care had to be put first.
Since then, apparently the Eastern Regional Health Authority has expressed support for the move.
Dr Mannion insists all the staff in the hospital are needed and others couldn't be let go to make way for theatre staff. "We have nobody employed that is sitting around playing the tin whistle," he stressed.
Declan Smyth Snr is loud in his praise of the Crumlin staff. "They are second to none. The help and support we received from them was unbelievable. But the facilities are another thing altogether."
At one stage, his son's chemotherapy was put off for a week because there was no bed. On another occasion, the child had to receive his chemo while sitting on a chair in the day ward, again because there was no bed. Once when the child was in a bed and Declan Snr leaned over to assist him, his knee broke the wooden boards beneath the mattress.
He wasn't very impressed with the fold-up beds provided for many parents either. "They're certainly not built for large adults."
Another parent, who has spent time with an ill child in Crumlin, says the floor mattresses for parents were "like the sort of thing you would expect to see the Red Cross kick out of the back of a plane in Afghanistan".
"Staff are brilliant. They have to work in the worst possible conditions. You get the impression the place is held together with sticky tape," he says.
Marie Palmer from Rochfortbridge recalls sleeping on the floor in the hospital's playroom several times when in 2000 her 14-year-old daughter, Yvonne, found a lump on her neck and was diagnosed with a rare nasal cancer. She could have stayed in a special 47-bed accommodation unit for parents on campus but says it was too far from her daughter's high-dependency ward.
When Yvonne left that ward, she would usually be in a two-bedded room, next to a baby. Both children's parents would drag in mattresses to sleep on the floor beside them at night, leaving little room for nurses to get around.
Furthermore, with only a curtain between the children's beds, parents could hear everything a doctor or nurse said to the family next to them.
Marie Palmer also experienced the ant problem. "They were around the kitchen and some of the rooms. That was scary. It would turn your stomach," she says.
Last year, the hospital was sued by the family of a teenage girl who was traumatised by an infestation of ants in her hospital bed in 1998. The girl was awarded more than €8,000 in the Circuit Court.
Since then, the hospital has upgraded its pest control procedures. However, ants are apparently a problem in the area in general.
Marie Palmer also recalls that there was only one shower for parents. "They expect parents to stay over but you could be queuing for half an hour in the morning for a shower. I often wondered if we didn't stay how would they manage. They would need to double the staff," she says.
Pauline McHugh from Inchicore whose daughter, Katie, was diagnosed with leukaemia at 15 months, knows her way around Crumlin like the back of her hand. She says the Government has a lot to answer for. "They spend millions on this and that when they should be spending it on the hospitals. I think the likes of the Lotto money that is going around should be pumped into hospitals like Crumlin," she says.
"It's crazy that very ill children have to share rooms when there is a danger of cross infection," she added.
Many of the newest facilities at the hospital have been paid for by fundraising and generous donations. A special bath and shower in one ward was provided by the Waterford-Tipperary Friesian Breeders' Association.
Things have become so critical, even staff have started to speak out about the conditions. Last month, consultant haematologist Dr Owen Smith said they were of east European standard or below.
Yesterday, consultant paediatric haematologist Dr Aengus O Marcaigh said the fact that bone marrow was stored in a Portakabin was "far from ideal". "It should be housed in a secure bricks-and-mortar building. It's taken out so we can deliver a high dose of chemotherapy that would normally irreversibly damage the bone marrow. Then it's given back after chemo. It's very important that it's protected properly," he says.
"The laboratory where it was being stored was expanding and it had to be moved out to a Portakabin. However, the temperature in the Portakabin is monitored and it is alarmed. There is also somebody next door in the laboratory 24 hours a day so it's more secure than it sounds," he adds.
"We have had several different generations of plans to extend the laboratory but every time we look for money it's not there. It's not like we haven't been drawing people's attention to this," Dr O Marcaigh says. He confirmed about 100 patients' bone marrows would be stored in the cabin at any given time.
Hospital management and even the Department of Health now accept the hospital is out of date and needs major redevelopment. A team is to draw up a development control plan, which is due to be completed by the end of this year.
But where the money will come from is unclear given that the hospital's budget was already cut "in real terms" by €5 million this year. This has resulted in 25 beds being closed and elective surgery is regularly cancelled.
However, funding hasn't to date been identified as the main factor behind the decision last Monday to cancel elective heart surgery on Limerick girl Róisin Ruddle. The child was sent home after it was discovered there would be no intensive care nurse available to look after her in Crumlin. She died within 24 hours.
The Minister for Health, Micheál Martin, ordered an urgent report on her case. It is expected to identify the shortage of intensive care nurses as the major factor in the child's surgery being postponed.
Whether surgery would have made a difference will never be known. However the What If? question is likely to haunt her family, given that doctors had said they were optimistic about her chances if she underwent surgery. However, they also said her death, which was completely unexpected, could have - given her condition - occurred suddenly whether she had surgery or not.
The little girl's death, however, if it achieves anything, will be in focusing attention on the desperate need to improve facilities at the largest children's hospital in the State and the need to recruit and train intensive care nurses. If this is not done, as Dr Freddie Wood, the surgeon who was due to operate on little Róisin, put it earlier this week, other children will continue to be put at risk.
Crumlin crisis: History of a chronic case
Our Lady's Hospital for Sick Children was built in the 1950s. It is the national paediatric treatment centre for children needing bone marrow transplants, cancer treatment and cardiac surgery. It also houses the national children's burns unit. The hospital has 243 beds, 25 of which were recently closed due to financial problems. Its budget allocation this year was 78.4 million, cut by some 5 million in real terms partly because it carried a deficit of €2.4 million over from last year.
These difficulties led to the hospital, earlier this year, mapping out a 26-point possible cost cutting plan. It included:
• No admission of patients over the age of 16 who could be treated elsewhere
• Billing other hospitals or health boards for treating patients from their areas
• No elective surgery after 5.30 p.m. to cut down on overtime
• Less contract cleaning
• And reducing staff numbers through early retirement, career breaks, job-sharing and redeployment
Over the years the hospital, which saw 19,585 inpatient and day cases last year, has complained it is grossly underfunded. It says a State investment of 30 million in a new theatre block, which has just been completed, was the first Government funding on capital developments at the hospital for several years. Much of the cost of developments at the hospital, including the national burns unit, was met from fundraising. Yet ironically the Taoiseach, Bertie Ahern, was invited to open the unit last year.
The campaign to have facilities upgraded moved up a gear in February when an independent consultants report on the hospital was published. Commissioned by The New Crumlin Hospital Group, the Pollock report unveiled a litany of problems at
Crumlin. It described the main intensive care unit as "woefully inadequate".
Furthermore Dr Ronnie Pollock, a London-based design consultant, said: "I can see hardly any scope for improvement through patching the present framework and absolutely no way in which currently accepted standards can be provided. The hospital is now seriously outdated. It should be replaced".
He found:
Ward provision seriously inadequate
Facilities provided for bed areas and supportive facilities are seriously below accepted standards
There are virtually no facilities for parents and relatives either in the form of rest rooms and refreshment facilities or in provision for overnight stays beside an ill child
The outpatients department has grossly insufficient space for the range and quality of work it undertakes - it should be trebled in size
Diagnostic rooms are too small.