ANALYSIS:Patients forced to rely on their instincts until red tape-riddled body gets its act together, writes EITHNE DONNELLAN
NEWS OF yet another patient safety scandal at Our Lady of Lourdes Hospital in Drogheda will be greeted with disbelief across the country.
Yesterday it emerged that a woman who went to the Co Louth hospital’s early pregnancy unit for a scan eight weeks into her pregnancy in July 2009 was told there was no foetal heartbeat and that she had had a miscarriage.
Melissa Redmond from Donabate in north Dublin was advised to return for a DC procedure to have the “dead” child removed two days later and was given the abortive drug Cytotec to take on the morning of the operation.
The devastated mother of two, who had a number of previous miscarriages, couldn’t believe what she was hearing as she had an intrinsic feeling she was still pregnant. Luckily for her she acted on her gut feeling and went to her GP. That visit confirmed the baby in her womb was very much alive and she gave birth to a healthy boy, Michael, in March this year.
What happened in her case is bound to send shockwaves through every woman who has ever had a miscarriage but most especially those who attended the Drogheda hospital.
A junior doctor made the mistake and it goes without saying that anyone can make an error. However, the findings of a review in this woman’s case highlight other contributory factors including a scanner which was used for another six months despite clear shortcomings and the lack of permanent trained scanning staff in the unit, as well as the absence of a specialist sonographer to confirm a diagnosis of miscarriage. Despite the fact that all this happened almost a year ago, a sonographer still won’t be in place until next month.
What has happened in this woman’s case unfortunately mirrors what has happened to others at the same hospital.
Just over three years ago in March 2007 Tania McCabe (34) presented at the hospital’s maternity unit saying her waters had broken. She was expecting twins and having had an earlier child at a Dublin hospital knew the sensation of her waters breaking.
However, tests carried out by doctors at the hospital suggested she was mistaken. A bad kidney infection was diagnosed and she was sent home with antibiotics. Two days later and still concerned she returned to the hospital by which time she was 5cm dilated and required an immediate Caesarean section. One of the babies, who were born prematurely, died shortly afterwards and Tania herself died early the next morning. A serious infection had set in when she was left hanging around for so long after her waters had broken which contributed to her death.
A verdict of medical misadventure was returned at the inquest into her death in December 2008, by which time – some 20 months later – the HSE admitted that not all of the 27 recommendations made by a review group into her death had been implemented.
That review again drew attention to staffing deficits at the hospital, which the HSE took over from the Medical Missionaries of Mary in 1997.
The Lourdes Hospital Inquiry report, published in January 2006 after an investigation into the high level of Caesarean hysterectomies carried out at the hospital over a 25-year period by the now-struck off obstetrician Michael Neary, also noted that the maternity unit was “still under-resourced and under-staffed” and its author, Judge Maureen Harding Clark, was “unimpressed by the unwieldy bureaucracy” around replacement and recruitment of staff.
Were she to return now, with a recruitment embargo in place, she would be even less impressed.
Sources at the hospital maintained yesterday that staffing deficits were still an issue, with too few senior doctors supervising junior ones and a continuing over-dependence on locums including in radiology. This despite a separate scandal in 2008 when it emerged that nine patients in the northeast had their diagnosis of lung cancer delayed as a result of errors made by a locum consultant radiologist who worked at the Lourdes Hospital and Our Lady’s Hospital in Navan from August 2006 to August 2007.
After all the controversies in which the hospital has been mired over the years – which also included the case of surgeon Michael Shine who was struck off for inappropriate behaviour towards three male patients – there were hopes the past would be left behind when the HSE published a blueprint for change of acute hospital services in the entire northeast region in 2006. That plan, drawn up by Teamwork consultants in the UK, recommended a new hospital for the northeast region. The HSE confirmed last year it may not be built until 2020.
Teamwork also recommended, in the interim, that certain hospital services for the northeast region be centralised at Drogheda and Cavan. Some of these changes have gone ahead without adequate infrastructure being put in place in advance and it has led to increased workloads for staff, a fractious working environment and an erosion of morale among employees on the ground, something known to contribute to error rates.
Undoubtedly all these issues are combining to ensure the Lourdes hospital continues to hit the headlines for all the wrong reasons, whether for poor showings in hygiene inspection reports, or the “near tragedy” for the Redmond family, as an internal HSE review put it.
Undoubtedly people will ask why is the HSE not learning from its mistakes? The truth is the HSE is aware of risky practices all over the place – highlighted in umpteen reports – but seems either unable or unwilling to act on them. The shortage of resources in the current climate is major hindrance – but even in good times it showed a complete lack of urgency in implementing findings of reports.
However, a further factor in its slowness to respond to the recommendations in this latest case – for example, that a scanner which was producing images which were “not adequate to accurately assess early pregnancies and their complications” be updated – is that decisions which should be made locally and speedily are actually made centrally in the bureaucracy that is the HSE. This leads to delays and, in the process, further patients are put at risk. If HSE management listened more to what staff on the ground were telling them they would undoubtedly reap dividends.
Melissa Redmond has highlighted to patients the importance of listening to their instincts. Some of the women who were operated on by Michael Neary will wish they too had listened to theirs, just like the family of an eight-year-old Dublin boy will wish they protested more vociferously when they feared Crumlin hospital were removing the wrong kidney from their child in 2008. Their instincts were right but, unfortunately, they weren’t listened to.
The important message for all patients is not to be afraid to speak up and to trust your instincts.
Eithne Donnellan is Health Correspondent for The Irish Times