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Dáil Éireann debate -
Tuesday, 14 Jun 1966

Vol. 223 No. 3

Adjournment Debate. - Provision of Medical Care.

On 8th June I addressed two questions to the Minister for Health in relation to the inadequacy of the health services provided in the Schull district of Cork to two persons there. The Minister, in his reply, refuted my allegations in both instances and as a result, and in view of the unsatisfactory nature of the Minister's statement, I asked permission of the Chair to raise the subject matter of both questions on the Adjournment. You will recall, Sir, that today you ruled this out and would allow only the subject matter of the first question, that is, Question No. 28 on the Order Paper of Wednesday, 8th June last, to be raised.

I have been a Member of this House for some 15 years and this is the first occasion I have had to impose on your time and on the time of the House to raise a matter such as that which I am raising tonight. It is with deep regret that I impose on your time and on the time of the House but I regard the principle involved as being so great that there is no alternative open to me if I am to discharge my duty conscientiously and faithfully as a public representative in this House for the constituency of South-West Cork.

In regard to the subject matter of Question No. 28, the facts are simple and incontrovertible. The position is that a holder of a medical card, a woman of some 75 years, on 23rd January last, suffered a stroke. It was the first time in a number of years that she had become ill and the first time she had to impose on the health authority or any officer associated with it in any way. The doctor was summoned and gave, I am sure, whatever assistance was necessary and informed the relatives that the first bed that would be available in the local hospital would be given to her. I may say at this stage that this woman lived within two miles of the local hospital and, while I do not want to go into the matter in detail, I must say that the conditions were not such as would warrant treatment at home. The woman resided in a relatively small house with an elderly brother and sister who themselves suffer from rather indifferent health and consequently were unable to give her the care that she needed.

Time moved on and, from 23rd January, with the exception of a visit of about one half-hour daily from the local nurse, who, I am sure, gave her every assistance she could, and within that short time visited her daily, the relatives were left to maintain the patient for the remainder of the time.

I came into the picture on 31st January when her brother called on me to request my help in getting accommodation for his sister in the local hospital as her condition was deteriorating and it was so difficult for him to manage her at home. The Minister and the House will appreciate that this is a request often made to public representatives. Usually, when the request is made to public representatives, they have little or no difficulty in dealing with it because in nine cases out of ten, the help and co-operation we all expect is readily forthcoming and, because of that, we can deal with these matters locally and without making any fuss of any kind. Unfortunately, such was not my experience in this particular instance.

In accordance with the request of this woman's brother, I thought the best thing to do was to phone the medical officer of the local hospital with a view to getting bed accommodation for her, if possible, in that hospital. Now my calls on doctors are rather infrequent but, having phoned this doctor, for reasons best known to himself, he did not propose to discuss the matter with me but he let it be known, through whatever assistant he had who answered the phone, that the first bed available in Schull hospital would be given to this woman. On that particular day I happened to visit Schull hospital myself. I am not trying to usurp the functions of any medical officer and I am not trying to give to the House the impression that I have any medical knowledge of any kind whatsoever but, from my own observations and because of the fact that a patient had died in the hospital that day—her remains were removed to the local church—I knew that accommodation was definitely available in Schull hospital.

During that week, I was away from home for three or four days. On my return, I was more than surprised to find that no hospital accommodation had been provided for this person. I was quite positive she would have been accommodated. Had a similar position obtained in any other hospital in West Cork, accommodation would have been provided without difficulty. Schull hospital was not taxed to its capacity and should have had no difficulty in providing hospital beds for pateints. In Skibbereen, extra beds were provided without any difficulty in order to meet increased demands for accommodation. But no extra beds were provided in Schull hospital. For some peculiar reason no extra beds would be provided even if an emergency arose.

I am particularly interested in ensuring that Schull hospital will give the best service possible because in the not too distant past the Minister's predecessor felt there was no necessity for continuing the hospital. When I raised the matter here on the Adjournment, the Minister said: "Do not talk about the hospital. We know the hospital has 17 beds. Most of them are occupied, not by acute cases, as the Deputy knows very well. I have the latest figures, but the excuse for keeping it open in 1961 was that it could be used as a maternity hospital. The number of deliveries there in 1959 was 11 and in 1960 it was four. The remainder of the beds are occupied by elderly people so that it is more a county home than a hospital." The Minister's predecessor stated that the hospital in Schull was used to a big extent for the accommodation of elderly patients or the chronically ill.

Having heard this woman was in a critical condition, and knowing she could not be removed to hospital, I raised the matter with the health authority at our local district meeting. Subsequently the health authority got a report, a rather peculiar report, in my opinion. The authority said in that report that there was no specific medical treatment for her condition. That was No. 1. Secondly, it was said that her condition took the prescribed course. I assume that, if her condition took the prescribed course, the diagnosis was that this poor old woman— God be good to her—was not going to live very long. Her health was steadily declining and her life was coming to an end.

One of the reasons why I raise this matter here is to ask if our health services are such that a medical card holder, visited by a medical officer who diagnoses that there is no active medical treatment for such a patient, that she is coming to the end of her life and likely to die within a relatively short period, must not be accommodated in hospital. If that is the correct position, if it is the attitude of the Department that sending a nurse to a house for half an hour a day, particularly in the family conditions in this case, constitutes adequate medical treatment, then it is about time we changed the regulations. The treatment meted out to this woman and the service provided were more appropriate, in my opinion, to the 19th century than to the 20th century.

After 16 days, on 8th February, this poor woman passed away and raising the matter here now is not of much advantage in this particular case. Despite the rather arrogant attitude of the Minister, when I raised this question on Wednesday last, the matter might have been cleared up with a few supplementaries, had the Minister's attitude been different. I have no personal animosity against anyone involved in this case. I raised the matter because I regard it as my bounden duty to do so and, as a member of this House and of a local health authority, I want to ensure that no other person will be treated in the way in which this old woman was treated. Our Constitution says we must cherish all our citizens equally. I maintain it did not apply in this case. She did not get the treatment to which she was certainly entitled. It was unfair and unjust—to use two mild adjectives—to leave this woman to be cared for by an elderly brother and sister, both in indifferent health.

We had some peculiar statements from the health authority. The main one was that, seeing there was no specific medical treatment, there was no need to bring her to hospital; in other words, leave her at home. In regard to the case of this woman who suffered from a stroke, the time at my disposal would not allow me to read in full this lengthy statement, but I wish to quote as follows:

It seems clear to me that she should have been admitted to the institution if accommodation had been available, even though I make due allowances for the fact that she would not have been under active medical treatment and that there was no specific medical treatment for her condition. Nevertheless I accept, with her social conditions and the stage of her illness combined, admission to the institution was necessary.

Therefore, no matter from what aspect this case is examined, there is no doubt that this woman, who was depending on a medical card for health services, did not get the treatment to which she was entitled. Schull hospital is not yet 30 years old, and when it was opened, as the speeches made at the opening ceremony tell us, it was supposed to be a boon to the people in the Schull district. No longer would they, except in the case of acute ailments, have to travel distances to find accommodation in other hospitals. In this rather sparsely populated district, the Mizen Head peninsula, this hospital would meet the full requirements of the people. That is what it should do, but this woman who, for the first time in her life, at the age of 75, required hospitalisation in that hospital which was within two miles distance of her small home, was unable to get it.

Surely that should not happen in 1966. I had hoped that when the Minister would have got the facts of this case he would have investigated it, as I believe it was mandatory on him to do. The Minister is the person in control of our health services. By virtue of his position he is responsible for the proper treatment of and facilities for the people, particularly medical card holders. He is the final tribunal for such people who appeal for assistance. However, the Minister dismissed this case lightly on Wednesday last. He stated that adequate treatment was provided, that there was no neglect on the part of any officer associated with it. If that is so, it is peculiar that we are spending so many millions of pounds in this country on health services. If we treated other people as this woman was treated, our health bill in Cork would not be £5 million annually to meet the requirements of the health services; the State bill would not be several millions of pounds annually to meet our requirements, and the Department of Health would not have to come to the rescue of the local ratepayers as they were obliged to do this year in order to meet the added cost of these services.

As I said at the outset, it is with the greatest reluctance that I raise a question such as this in the House, but I do so to ensure that no other such case will occur, and to bring home to the Minister responsible for our health services that such a position did obtain and that it is his bounden duty, during whatever time he is Minister for Health, to see that this will not happen again.

I could touch on certain other aspects of this matter but the time at my disposal does not allow me to do so. Let me say, however, that the Minister for Health should take a more active interest in what is happening up and down the country. He is the man in charge of health authorities and in charge of every person who is administering the health services. As a public representative, I have always given credit where credit was due to our health officers, be they professional or lay officers, for the capable discharge of their duties. I have never cared to make personal statements such as calling them "pigs" as has been done in regard to such professional people.

The Minister, to conclude.

If I have a grievance I am prepared to put my name and address to it.

I am calling on the Minister.

I am hopeful that as a result of raising this matter the Minister will give it the attention it deserves and will treat it in the spirit in which I have raised it.

Deputy Murphy has pursued this matter not only through three meetings of the Western Committee of the Cork Health Authority but at Question Time here and now on the debate on the Adjournment. I would not dream of questioning his right to do this. Indeed, if it was a question of neglect of the sick or some serious inadequacy in our health services I would agree that it was his duty and I would commend him for it. The broad facts of the case, which are not in dispute, show there is nothing of the kind at issue, and one must only wonder what the Deputy's motives are in this campaign of detraction directed against the service for which he and his colleagues in the Cork Health Authority are responsible.

The facts are that this lady, aged 75 years, living with relatives, suffered a stroke on the 23rd of January, of this year, and she was attended by the district medical officer who was also medical officer of the local district hospital. The relatives initially requested the admission of the lady to the district hospital. This was not possible at the time because there was no vacant bed in the hospital.

Why did they not do what they did in Skibbereen? There was a vacant bed on the 31st January.

The Minister should be allowed to reply.

Mr. O'Malley

The relatives then requested that arrangements for the patient's admission to the hospital would be made if she became in-continent.

That is not so. The relatives were not consulted.

Mr. O'Malley

This complication, in fact, did not arise. The medical officer visited the patient twice and arranged for the district nurse to visit the patient every day. Her condition deteriorated and she died on the 8th February, unfortunately. Some days before her death the relatives contacted the doctor and withdrew their request——

That is not so. That is false.

Mr. O'Malley

——for admission of the patient to hospital.

That is not so.

Mr. O'Malley

If this is not so, if my statement is incorrect——

The Minister's statement is based on the health authority's information.

Mr. O'Malley

——I shall order a sworn inquiry. If my statement is incorrect, I will order a sworn inquiry, a sworn inquiry, mark you. These are the statements.

The statements of the health authority.

Mr. O'Malley

I have challenged the Deputy, and in looking at this, I have I hope as much interest as the Deputy has in such type of case. My information is that some days before the lady's death the relatives contacted the doctor to withdraw the request for the admission of the patient to hospital. The Deputy says this is not so. If he will give me an affidavit from the relatives, I will immediately take the necessary steps to see that an inspector of my Department will hold a sworn inquiry. As a matter of fact, I am tempted to hold one anyway, very tempted.

I think it is the Minister who should get the affidavit and not Deputy Murphy.

Mr. O'Malley

The only complicating factor in this case is that a vacancy arose in the hospital. I am trying to be as dispassionate as possible. The complicating factor is that on 31st January a vacancy did arise This was allotted to another patient judged to be in more acute need of hospital treatment. She was a young lady with a heart blockage. This was a matter of medical decision and it was made in the full knowledge of the circumstances of the two patients at the time. Unlike the Deputy, I would not be so foolhardy as to question a judgment made by a competent and experienced medical officer in such a situation. Indeed, this tendency of the Deputy to assume the role of supernumerary medical officer seems to be the whole crux of the matter.

I never assumed such a role.

Mr. O'Malley

It is not the Deputy's function to regulate the admission of patients to Schull district hospital. I am satisfied from the reports I received——

Is the Minister satisfied that a woman who suffered a stroke should be left to die in her home without hospitalisation one way or another? The question is as simple as that.

The object of this debate is to hear the Minister. He should be allowed to make his statement without interruption.

Mr. O'Malley

I would say that the members of the Cork Health Authority with whom the Deputy raised this matter for all parties— Fianna Fáil, Fine Gael and Labour——

That is not so.

Mr. O'Malley

——seemed to feel that no injustice had been done and Deputy Murphy said he would raise the matter in another place, and this is the place.

As I am entitled to do.

Mr. O'Malley

Yes, as the Deputy is entitled to do and it would be most commendable of the Deputy to bring the attention of the House to a case of neglect of the sick. I would welcome it, and always will. I am satisfied from the report I received from the health authority that this patient received adequate medical and nursing care and that there was no neglect on the part of the medical officer and the district nurse who dealt with the case. In conclusion, I would say if the Deputy has further evidence——

The Deputy has given his evidence.

Mr. O'Malley

If the Deputy can prove——

The facts are simple and straightforward.

Mr. O'Malley

If the Deputy can prove that fact—and Deputy McAuliffe thought I should get the affidavit and not Deputy M.P. Murphy——

I suggest that an inspector of the Minister's Department should carry out an investigation.

Mr. O'Malley

The suggestion is that the county secretary and the health authority are not impartial, are biased.

The suggestion is that the health authority never took a statement from any of the relatives of this person.

Mr. O'Malley

The information I have is that the relatives——

It is all one-sided.

Mr. O'Malley

——contacted the doctor——

They were never visited by anyone from the Department or anywhere else.

If the Deputy persists, I shall adjourn the House.

The Dáil adjourned at 11.15 p.m. until 3 p.m. on Wednesday, 15th June, 1966.