Tallaght Hospital – dysfunctionality – X-rays and GP letters

Chronology

General Practitioner referrals.

February 2009. The problem of unanswered GP letters was raised at the hospital Board. The deputy CEO reported on the process by which referral letters were processed.

March 2009, Mr Lyndon McCann, Chairman of the Tallaght Hospital Board, is quoted as saying that the hospitals could not “spend time reacting to external factors which is negative and reactive.”

21st April 2009, Chairman McCann met Minister Harney at his request.

22 April 2009 Professor Tom O’Dowd, a GP in the Tallaght area, wrote to Mr Lyndon McCann as Chairman of the hospital Board stating that he had been told by a hospital manager that “two years of GP referral letters” had not been opened or reached the relevant consultant.

23rd April 2009, Chairman McCann met Professor Brendan Drum Chief Executive of HSE

27 April 2009, The O’Dowd letter stamped as received by Chief Executive’s office

May and June HIQA as listed below

10 March, 2010 Chairman states that he first knew of the O’Dowd letter on this day

Professor O’Dowd has claimed that a Tallaght hospital manager has told him that two years of GP referral letters have not been opened or reached the consultant to whom they were addressed. Tom O’Dowd wrote to Mr McCann twice without reply and is quoted by the Irish Times as saying “Does he see himself as the person to oversee the governance of a modern health care institution?”

Tallaght receives about 1,600 referral letters per day from local GPs.

Tallaght hospital have stated (admitted in March 2010) that 3,498 referral letters from GPs had not been reviewed by a consultant in October 2009. No information has so far been forthcoming with regard to the GP letter backlog in early 2009 when the issue was addressed at the hospital board and when Professor O’Dowd wrote to Mr McCann.

X-Rays

Over the past 3 to 4 years, radiologists in Tallaght had written over 40 letters to management about the X-ray issue

April 24 2009, Mr Jon Billings of Health Information and Quality Authority (HIQA) sent an e-mail to his staff asking about unopened GP letters in Tallaght in post room. He also said that a GP complained about a failure of radiology reporting for two years.

May 8, 2009, HIQA write to Tallaght CEO about GP letters going astray and also about backlog of radiology reporting.

June 2009, HIQA told by hospital that 4,000 x-rays not reported but issue would be resolved by July (1 Month)

HIQA did not receive a reply to at least two follow-up letters enquiring about the 4,000 X-Rays and a phone-call.

HIQA also asked about patient safety in A&E and also why were there sacks of GP mail unopened in the hospital mail room?

October 15, 2009, HIQA asked about OPD appointments for orthopaedic patients; backlog of radiology reports; haematology service; adverse event/delayed diagnosis in the radiology department.

26th November 2009, Issue reported to hospital Clinical Governance Committee by CEO Michael Lyons and “This indicated 700 issues of concern and that the issue was being resolved.”

14 December 2009, Professor Kevin Conlon takes over as CEO and receives a report that there were 57.921 unreported X-Rays

December 2009, Minister Harney told of problem but not told there was a significant patient safety issue and also the numbers involved. (Clearly, Ms Harney never asked!)

January 2010 HIQA told that 57.000 X-Rays had been unreported.

March 9th Story broke in Irish Times and Independent newspapers.

March Minister Harney is reported as claiming to be aware of the full extent of the problem only this week.

March 2010, hospital now clearing 2,000 unreported X-Rays per day for the next 10 weeks to clear the backlog.

Two patients died. One died in summer of 2009 with a 9 month delayed diagnosis which the hospital claim did not impact on the patients outcome.

(Independent enquiry please!)

The second patient has cancer and has been informed of the delayed diagnosis by her consultant.  It seems that public and private patient were involved.

To date about 35,000 of these 57,000 X-Rays have been seen.

Radiologists in hospitals

Usual workload about 11,000 cases per annum

Tallaght has 7 full-ime in post with a workload for 18 posts.
Beaumont has 5 radiologists with 65,000 fewer inpatients.
Tallaght has appointed one extra radiologist and sought two more from the HSE.

Error incidence in general radiology is between 2% and 20%.

Who behaved well in this fiasco? – Professor Tom O’Dowd – general practitioner who forced the floodlight to be switched on in the interests of his patients when he could not get patient results despite constant phone calls.

Comment – There are serious clinical governance issues in Tallaght hospital.

Factors which require examination are the inhibiting effects of administrative terrorism implicit in the wording of the gagging clauses in the Common Consultants Contract 2008 and also individual hospital policies on speaking out about the situation in various public hospitals.

It is clear that these policies operate in favour of institutional secrecy and cover-up and against the patient first requirement of clinical medicine.

Corporate Loyalty may often conflict with loyalty to the foundation principles of medicine as a profession.

Turning consultant in middle grade civil servant functionaries is a sure way to have regular recurrences of all of these clinical scandals in our hospitals.

Medical whistle-blowing is an ethical necessity in the new ethical guide of the Medical Council here in Ireland.

There is a strong hospital collective loyalty in my experience and those who use the media to campaign to right a wrong are feared, despised and often threatened in irish hospitals.

Enquiry

The HSE has set up an enquiry which must be independent and remain uninterfered – with by administrators during the course of their work.

The role of the different new contracts with regard to work on and off site should be examined with regard to Tallaght radiology.

I understand that there are 3 or 4 hospitals in the state who have taken a decision not to review all follow-up X-Rays for manpower reasons.

Solutions

PACS system for archiving x-ray pictures like looking at digital camera shots is being introduced in Limerick, Sligo and Beaumont now.

We need diagnostic imaging suites attached to our main hospitals serving primary and secondary care. Interventional radiology is super-specialised and must be supported as it makes a huge difference to error reduction in diagnosis and is essential in the modern treatment of many diseases through endovascular intervention.

More training courses for radiologists and the appointment of sufficient numbers of specialists to ensure safe practice.

I am told by my specialist colleagues that it is not usual practice for radiologists to re-read X-Ray follow-ups in orthopaedic and fracture clinics or to review most films from intra-operative films for guiding surgical intervention. Less than 2% of films unreported is a figure I heard for one big hospital and these would fall into the above categories.

Conclusions

Initial – Board of the hospital must resign or be dismissed.

Minister must fall on her Excalibur.

Otherwise – Is nobody out there ever responsible?

Fogra – HSE please note that Connolly Hospital has no MRI scanner, has only three radiologists and has no radiology training posts accredited – Shame on YIS

COWEN

Taoiseach Brian Cowen claims that Minister Harney has been a reforming minister for health. That is really true but ignores the brutal truth that REFORMATION and IMPROVEMENT are not necessarily synonymous.

The more likely truth is that Cowen needs her Dail vote now to stay in office as he enters a 30 kph race to the exit. On his way home to his economic undertakers office in Offaly, he should avoid the Quays or his driver may get penalty points! That is the one ignominy I am trying to help him avoid!