The surgical department at Cavan General Hospital had another high-level inspection yesterday when a team of executives from the Royal College of Surgeons in Ireland (RCSI) visited the unit.
Their inspection comes after a long list of clinical incidents at the unit, the most recent of which occurred only weeks ago.
Last month an elderly man had to be transferred to Dublin's Beaumont Hospital for emergency surgery after complications following gastro-intestinal surgery in Cavan. The North Eastern Health Board, which runs the hospital, confirmed this transfer was due to a surgical complication but refused to confirm more recent reports from sources close to the hospital of patients being transferred to Dublin's Tallaght Hospital and St James's Hospital for treatment after clinical incidents at the hospital.
The incident which resulted in the Beaumont transfer came just weeks after new guidelines were issued for the surgical unit by the RCSI. They stated that no patient should be operated on without two surgeons agreeing in advance that the surgery was necessary. Furthermore, they lifted an earlier restriction placed on major gastro-intestinal surgery taking place in Cavan. In March, following his review of 15 adverse clinical incidents at the Cavan surgery unit, Mr Finbar Lennon, the medical adviser to the North Eastern Health Board (NEHB), which runs the hospital, stated that major gastro-intestinal surgery should only be carried out at Our Lady of Lourdes Hospital in Drogheda, the largest hospital in the region.
However, the new RCSI guidelines said it was no longer necessary to transfer all patients in need of major gastro-intestinal surgery to Drogheda. Following media reports of the latest incidents and as doctors in the area were again expressing concerns about patient safety at the hospital, Mr Lennon has again advised that major elective or major emergency gastro-intestinal surgical operations should not take place in Cavan.
"Mr Finbar Lennon has recently (27/10/04) advised on the appropriate level of surgical service at Cavan and at Monaghan.
"This has been communicated to the consultant surgeons. He has advised that no major elective or major emergency GIT surgical operations should take place in Cavan. These cases should be transferred to Drogheda or on occasion to Dublin," a health board spokeswoman confirmed.
Now the RCSI, led by its president, Prof Niall O'Higgins, is going back to reassess the situation, and also to see if the unit is fit for surgical training of junior doctors.
The unit got back its accreditation to train junior doctors in July. This has also caused some concern locally. However, the RCSI warned in June that "should the training opportunities being offered to the trainees be sub-standard", the RCSI would have no choice but to withdraw training accreditation immediately. Controversy has surrounded the Cavan surgical unit since August 2003, when two of its three permanent consultant surgeons were suspended over "interpersonal difficulties".
They have been replaced by a series of locums, and concern has been expressed about the resultant lack of continuity of care for patients.
Concern was at its greatest earlier this year following the death of nine-year-old Frances Sheridan three weeks after an appendix operation at the hospital. A post-mortem found she died from complications of recent surgery. Gardaí investigated her death, and a file on the case is still with the DPP.