Madam, - I refer to the news report by Eithne Donnellan on October 29th about a recent management directive on inter-hospital patient transfer issued by the HSE North East following the tragic death of a patient in Monaghan General Hospital.
The effect of this type of hasty management response is to imply in advance of the inquiry that the current medical and nursing procedures on inter-hospital patient transfer are not being followed or are defective.
Scores of inter-hospital patient transfers take place safely every day in the northeast and from there to Dublin hospitals. During the past two years the transfer of large numbers of patients from Cavan and Monaghan hospitals with emergency surgical conditions was facilitated by the surgical and anaesthetic departments in Drogheda. It is the doctors and nurses in the referring and receiving hospitals who are largely responsible for the above. We are all concerned about recent events in Monaghan General Hospital and want to ensure that hospital transfer policies work safely and efficiently at all times.
This management directive however is ill-conceived and unsafe and should not have been issued without advance consultation with consultants in the region. Were it to be strictly applied, it would put patients at risk and would compromise the exercise of professional discretion and judgment by doctors. All transfers should be medically or surgically appropriate.
Following patient assessment by a senior doctor the most suitable receiving hospital should be identified. Many surgical patients with emergency neurosurgical, cardiothoracic or vascular conditions need to be transferred directly to Dublin hospitals. Consultants, nurses and managers in Dublin hospitals have not been issued with this directive! Consultants in the northeast expect managers to communicate and consult with them and to listen and take advice from them on all matters relating to patient care. The burden of clinical responsibility we shoulder in small under-resourced hospitals is very significant.
The forthcoming inquiry needs to focus also on the structural and management deficits in this region. The management deficits in the acute hospital sector that have occurred since the advent of the HSE have been very damaging and disruptive.
It is now universally acknowledged that the tragic death of Patrick Walsh should not have happened. The reason why must first be established to ensure that the proper corrective measures are introduced. - Yours, etc,
F LENNON,
Lead Surgeon,
Joint Department of Surgery,
Drogheda/Dundalk Hospitals.