THE MOST basic failure of governance in one of the State’s premier teaching hospitals raises serious doubts yet again about the quality of our public health system. There had been a sense that the various breast cancer scandals of 2007 and 2008 represented a nadir in the litany of failures involving healthcare; the revelation that some 58,000 x-rays remained unreported within Tallaght hospital’s adult x-ray department for a prolonged period means that public confidence in the health service has been dented even more severely.
Over the last 10 years, many health system reports, including the National Health Strategy, have alluded to the need for strong governance structures within our hospitals. The report of the Commission on Patient Safety drew particular attention to this issue. All of which makes the complete absence of oversight of the work of a major hospital’s adult x-ray department for over five years such a serious issue.
Perhaps even more worrying is the lack of appreciation of the significance of this fundamental problem by politicians and health administrators alike. Relying on reassurances that, to date, just two misdiagnoses have resulted from the failures in Tallaght is to completely miss the point. That those responsible take pride in the efficiency of the remedial catch-up programme to read the backlog of x-rays while simultaneously ignoring the implications of such basic failures in patient care does not augur well for the future.
There must be no doubt in any patient’s mind that the only satisfactory conclusion to a request by a doctor for an x-ray is the production of a formal report by a fully qualified radiologist. They are the specialists in the interpretation of x-rays and other investigations such as CAT and MRI scans. Many other hospital doctors will look at a patient’s x-ray and may even plan the person’s initial management based on this preliminary assessment. However, the only diagnosis that counts is the one committed to paper by the expert radiologist.
People sent for tests from a hospital outpatient department and those referred by their general practitioner for an x-ray are especially vulnerable to delays within a radiology department. This is because there may be a considerable time lapse before the individual is seen again for further review, and the failure to issue a timely report may not come to light until a person’s illness worsens. And within hospitals, a chest x-ray, carried out to check for pneumonia or as part of a preoperative assessment, may contain subtle signs of a lung cancer that may only be visible to an experienced radiologist.
The thousands of people affected by this failure are entitled to feel aggrieved that they were not contacted by hospital authorities as soon as the problem was identified. This may have been difficult but by not ensuring it was a priority, unfortunately various State bodies have compounded the initial error.
Finally, the conduct of the whistleblower in this scandal should be acknowledged: without the intervention of Prof Tom O’Dowd, this appalling scenario may never have come to light.