Some years ago, talking to a consultant in one of the major Dublin hospitals, I asked innocently why there was such resistance to allowing people see their medical records. He was genuinely horrified at the thought, saying that doctors would have to completely change how they took their medical notes, writes Mary Raftery
In what way, I asked. Slightly sheepishly, he replied that a range of shorthand comments about patients would have to be dropped. Common remarks like STL and TATP "swinging the lead" and "thick as two planks" would just have to be dropped.
It was a rare glimpse into the mentality so evident in the report published recently by Ombudsman Emily O'Reilly on a complaint made by the family of a patient who died in Sligo General Hospital.
Her report contains a long list of indignities and inadequacies in care experienced by the elderly man, who died of his illness in 2000 after two days at the hospital. The Ombudsman is highly critical of the treatment received by the patient and his family. Her report is peppered with phrases like "insensitive in the extreme" and "serious failure in communications".
Ms O'Reilly details the interviews conducted by her investigators with all of the key staff involved. She points to inadequacies in medical record keeping, shortcomings in nursing care, and an overwhelming lack of empathy with the family on their bereavement. Staff were unable to tell the man's children whether or not he had received the Last Rites, and they left his effects for collection by them in a black plastic sack under the hospital's Christmas tree.
This was not a case of medical negligence. Nor did it concern lack of resources or funding.
It was instead a massive failure of the care system to treat people with dignity, respect or even basic common decency.
The Ombudsman's decision to publish in full her report on this case is highly significant. Her willingness to give such exposure to the failures within the hospital system now provides patients with the important option that their complaints will be thoroughly and independently investigated, with recommendations made in public to ensure that the system learns from its mistakes and failures.
There is, however, one problem. The Irish Ombudsman is by law prohibited from examining complaints dealing with the clinical judgments made by hospital doctors.
Unlike her counterparts in Northern Ireland and the UK, she is confined to examining cases relating only to administrative matters. Furthermore, until recently, many of the large voluntary hospitals were excluded from her remit, all of which probably explains why so few patients and their families have to date taken their grievances to her office.
Now, through the publication of the Sligo hospital report, Emily O'Reilly has clearly signalled her intent to become actively involved in this area. "We are very keen to deal with these kinds of complaints," she says, "because who else is going to do it?"
Margaret Murphy is delighted the Ombudsman is so committed to examining patients' complaints. Her son Kevin (21) died tragically after a series of medical errors involving the treatment of his hypercalcaemia (an elevated level of calcium in the blood).
The condition is highly treatable, but following a litany of failures at almost every level of the healthcare system, Kevin died in 1999. His family sued a number of doctors and the Mercy Hospital in Cork, and finally won a €76,000 settlement which they gave to charity.
But all Margaret and her family wanted was to hold someone to account for Kevin's death, to ensure the lessons might be learned to prevent such a cascade of failures causing injury or death to anyone else.
"I feel the Ombudsman should be able to investigate all matters to do with how patients are treated, including clinical decisions," says Margaret, who has worked since the death of her son for more accountability within the medical system.
"If she makes her investigations public and if her recommendations are followed, then it's a much better option for patients and families who have been harmed than either going to court or to the Medical Council."
At present, it is the Medical Council which deals with complaints relating to clinical decisions. As the council is made up principally of doctors, questions have arisen about the ability of the profession to regulate itself in this manner. So much so, in fact, that former minister for health Micheál Martin said last year he intended to bring in legislation allowing patients to appeal Medical Council decisions to the Ombudsman.
While this has not yet happened, it clearly signals an acceptance of the principle that the Ombudsman should deal with complaints relating specifically to matters of clinical judgment. But rather than tinkering with a piecemeal system for investigating patients' grievances, it would be of much greater benefit to us all simply to extend the remit of the Ombudsman so she could pursue all complaints relating to all aspects of public medicine.