Deputy Pattison gave notice that he would raise the subject matter of Question No. 36 on yesterday's Order Paper.
Adjournment Debate. - Death of Army Private.
On yesterday's Order Paper Question No. 36 was addressed by me to the Minister for Defence. I asked why an Army private whose name I now give, Private John O'Brien, whose home address was 14 Lower Staplestown Road, Carlow, who became ill on 6th December 1966 at Renmore Barracks, Galway was treated for gastric influenza when in fact he was suffering from appendicitis; why he was transferred to Athlone for hospital treatment and from there to the Saint Bricin's Hospital, Dublin in order to undergo an operation for appendicitis with perforated appendix; if, in view of the fact that this man died on 17th December, 1966, he has caused a full investigation to be made into all aspects of this matter; and, if so, with what result.
The reply I got from the Minister was not satisfactory. That is why we are here on the Adjournment this evening. The replies sent to the parents of this young man when they demanded a full inquiry were far from satisfactory. The parents and all others acquainted with the circumstances of his death feel that proper and adequate medical treatment was not afforded to Private O'Brien and that he was not treated with the urgency his condition demanded and that the procedure which the medical authorities within the Defence Forces arranged contributed to, if they were not the main factor in his death. These replies did not convince the parents of the deceased. Nor has the time which has elapsed since the death of this young man healed their sorrow and anguish, not to mention their severe loss.
I want to refer to a number of points in the Minister's reply. The Minister said that Private O'Brien had no symptoms of appendicitis when examined in Galway but I should like to ask on what basis was gastric influenza diagnosed? Was it high temperature or vomiting or pain in the stomach? I know that Private O'Brien was suffering from pain in the stomach and was vomiting at that time. Are these not the same as the symptoms of appendicitis? Everyone knows when we hear of somebody complaining of pain in the stomach and vomiting, the first thing you think of is appendicitis. It is the first thing everybody thinks of if they have not had their appendix removed before that.
Was there no suitable hospital in Galway where this man could be treated? What was the reason for sending him 60 miles to Athlone for hospital treatment? Of course when he was examined in Athlone, appendicitis was immediately diagnosed——
It was not.
The Minister appears not to agree with me on that point but at least appendicitis was strongly suspected. Even at that I think it was a serious matter to send a man a further 80 miles to Dublin. It is felt that he should have been attended to, if not in Galway, at least in Athlone because if appendicitis is diagnosed, immediate operation is vital and a long delay is always dangerous. It would be reasonable to assume that Private O'Brien would be alive today if there had been a more urgent approach to his condition.
Were there any surgeons at all in Athlone who could perform this relatively minor operation and if not, why have the Army not even a consultant surgeon attached to their hospital in Athlone? The Minister must be aware that the mortality from operations for appendicitis is very low and that the operation is a very minor one. We feel it is a shame that a young man in the prime of his life should succumb to a simple condition which is recognised by the medical profession as requiring a minor operation. I should like to hear from the Minister what steps have been taken since to ensure that something like this will not happen again.
Is the same procedure still being adopted when members of the Defence Forces become ill in Galway? Are they still transported to Athlone, and if it is not possible to treat them there, are they still transported across the country, from one post to another, to Dublin for treatment?
The parents feel that a second opinion should have been got, that the matter was taken too lightly when their son complained in Galway, and that he should not have been moved to Athlone at all. It was admitted in the Minister's reply yesterday, and it was told to the father of this young man by the surgeon at St. Bricin's, that he was in very bad shape when he reached St. Bricin's Hospital. If, as the Minister states, his condition in Athlone was one of suspected appendicitis, I wonder how in a matter of hours it would deteriorate to a point that, when he reached St. Bricin's Hospital in Dublin on the same evening, within minutes acute appendicitis with peritonitis was diagnosed. It seems very strange to me, a layman, that this would have happened so quickly and with fatal results.
The Minister also informed us in his reply that after the operation in St. Bricin's, the consultant surgeon was called in. I should like to hear what the consultant surgeon had to say and what report he made. The Minister made no reference to the fact that a second operation was performed some time after that, and I should like to know why that was deemed necessary. It is also important to know if there was a post-mortem carried out, and if not, why.
The procedure adopted by the authorities in notifying the parents of this young man's illness was also very unsatisfactory. They were not notified until he was in a very dangerous condition in St. Bricin's Hospital. Before the young man left Galway, he requested that his parents be notified, but they were not notified until—and here I should like to quote from the Minister's letter of 10th March, 1967, addressed to the father of Private O'Brien:
...In accordance with normal procedure written notification of his admission to St. Bricin's Hospital was addressed to you by the authorities at the hospital on the morning of 8th December, 1966, and after his condition was found to have deteriorated, the Garda Síochána in Carlow were requested at 5 p.m. on that date to inform you that he was seriously ill.
Those parents should have been notified when he was leaving Galway. It is another example, to my mind, of the very bad procedure which apparently is carried out when members of the Defence Forces become ill.
I should like the Minister to clarify all these points, because this situation leaves in everyone's mind a suspicion that privates in the Defence Forces are not, as far as medical attention is concerned, being accorded the standard of treatment they should get, that they are subject to the outmoded practice of being sent to military hospitals no matter how far away from these hospitals they are, with no one appearing to be in authority to say: "We will send him to the nearest hospital." The instruction seems to be: "No matter what the condition, convey the soldier to St. Bricin's Hospital." Of course in this case when the unfortunate man reached St. Bricin's, he was probably gone too far. All the evidence suggests that at that point there was very little that could be done for him, and that calling in the consultant surgeon or the specialist, as the case may be, after the operation was not going to remedy the situation at that point.
Even at this late stage, I would ask the Minister to have a full, independent, and impartial inquiry into all the circumstances surrounding this case. It is due to his parents. It is due to all the people who know the circumstances of this man's death; indeed the whole country knows the circumstances today. It is due to other members of the Defence Forces and to everyone concerned in this case that such an inquiry, where all the evidence, including that of the parents could be heard, be arranged by the Minister as soon as possible.
Neither the Department nor myself has at any time tried to conceal anything in connection with the circumstances of this young soldier's death. The Department has, by correspondence, given pretty full information about the circumstances surrounding his death. I think that Deputy Pattison's question is mainly or partly based on the information given by the Department.
There is a suggestion, veiled or otherwise, that there was negligence in the case as regards the diagnosis and that there was an unjustifiable amount of moving around of the patient by ambulance; there was also the suggestion that because he was a private he was treated with casual indifference. I most emphatically repudiate these insinuations. The patient was handled at all stages with every consideration for his wellbeing. Appropriate medical skills and care were directed to him throughout, and the actions proper to each stage of his illness, as diagnosed, were taken.
I have already endeavoured to make it clear that the medical officer in Galway had not evidence on which to base a diagnosis of appendicitis. By the time the patient had reached Athlone, symptoms had developed which were enough to raise a suspicion of appendicitis, yet not enough to make a definite and unequivocal diagnosis. The difficulty of diagnosing appendicitis at this stage may have been due in part to the fact, subsequently revealed at the operation, that the patient's appendix was in an uncommon pelvic position.
If the medical officer in Athlone had, in fact, sufficient evidence to support definite diagnosis of acute appendicitis, he would, in accordance with normal procedure, have sent the patient either to the private hospital in Ballinasloe or the county hospital in Mullingar for operation. Facilities for such an operation did not exist at the time in the military hospital or, indeed, in any other hospital in Athlone. As I have said, there was no positive diagnosis of appendicitis made in Athlone, and the medical officer made the necessary arrangements to have him removed to St. Bricin's Hospital.
The patient was examined within minutes of admission to St. Bricin's by the emergency medical officer on duty, who immediately summoned the assistant surgeon. These two doctors diagnosed acute appendicitis, and arranged for urgent operation which was performed with all possible speed. Some days after his operation the patient's condition worsened and he had a raised temperature and diarrhoea. An exploratory operation was carried out on 15th December, 1966. Deputy Pattison referred to this operation. It was carried out by the surgeon consultant. This operation disclosed collections of blood-stained fluid which were evacuated and drained in the usual way. Subsequent to this operation it was obvious to the surgeon that the worsening condition was not due to the original appendectomy but was an entro-colitis which was resistant to antibiotic treatment. It is completely incorrect to suggest that the patient died of peritonitis.
The patient was accompanied by a corporal of the Army Medical Corps in the ambulance all the way from Galway to Dublin. At no stage during the journey was there any presentiment that the patient was in need of urgent operative treatment. Otherwise he would have been diverted to a hospital on the way as an emergency case. There was absolutely no question at any stage of trying to avoid expenditure in an outside hospital at the risk of endangering the patient's health.
Reference has been made by a Deputy to the omission of any word of sympathy from a letter which was sent to the deceased soldier's father. The letter in question was dated 10th March, 1967—nearly three months after the date of death. I should like to say that very full expressions of sympathy were made to the deceased's father by a medical officer of St. Bricin's Hospital and other officers at the appropriate time.
There was no post-mortem. It was, presumably, not considered necessary as death was due to natural causes. I answered questions yesterday when I gave a full and factual account of all the circumstances in which the man was dealt with and treated by the various doctors in the case whose duty it was to examine him and pronounce upon him. I do not think I have anything further to add at this stage to the information I have already given. I have made a factual statement on every aspect of the case raised by Deputy Pattison.
May I ask a question? I should like to say——
The Deputy may not make a statement. He may ask a question.
In asking this question I want to make it plain that I am not endeavouring to cast a reflection on any medical officers. It is a question of administrative responsibility. I want to ask the Minister: who went with him in the ambulance from Athlone to Dublin? The Minister said there was no deterioration in his condition which would warrant his transfer to a hospital nearby. I want to know who would be responsible for making such a decision? The Minister said he died from natural causes. I will not comment on that statement but I should like to know what he means by natural causes?
The Deputy may only ask a question.
What does the Minister mean by natural causes?
It may be a medical term but I used it in a general way. The Deputy ought to know. He is a medical man.
What did the man die from if he died from natural causes?
I am not a medical man and I am not in a position to dogmatise. Doctors differ and patients die. In many cases one doctor will make a different diagnosis from that which his colleague made earlier.
I am not doubting the ability of the doctors but I should like to know what the Minister means by natural causes.
It is a medical term I presume.
The Dáil adjourned at 4.30 p.m. until 3 p.m. on Tuesday, 9th July, 1968.