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Dáil Éireann debate -
Wednesday, 20 Apr 1988

Vol. 379 No. 7

Adjournment Debate. - Limerick Regional Hospital Death.

Deputy Michael Noonan gave me notice of his intention to raise on the Adjournment the circumstances surrounding the death of a man in Limerick Regional Hospital.

(Limerick East): I should like to thank the Chair for facilitating me this evening and I am glad the Minister of State at the Department of Health is here to reply to the points I will raise. On Good Friday a man was brought by motor car to Limerick Regional Hospital entering the casualty unit at approximately 2.40 p.m. He had a letter from his doctor which admitted him. After about two hours waiting in casualty his companion who had driven him to the hospital became restless and worried about his condition. A number of people in casualty had approached him and expressed the view that the man looked extremely ill. The driver of the car approached a doctor and a nurse and after a wait of about two more hours he was examined and the driver helped the man to re-dress. Four hours had elapsed from the time the man had entered the hospital. Another wait of approximately two hours ensued and at about 9 p.m. a member of the medical staff came back to him in casualty and the man was admitted to the hospital at about 9.30 p.m. He died on the following Thursday.

The issue was raised with the Mid-Western Health Board by a former Member of the House, Willie O'Brien, and local papers gave publicity to the incident. When the issue was raised with the Mid-Western Health Board, the deputy CEO of the board, Mr. Robinson, confirmed that the man had spent six hours waiting in casualty. He also said that the casualty unit was exceptionally busy on Good Friday. Extra staff had been allocated after the closure of Barringtons Hospital on the previous day. Two nurses and a doctor, according to the deputy CEO, half of the staff on duty, were involved in resuscitating a drug overdose victim for almost six hours. This patient, according to the Mid-Western Health Board, could not be moved from casualty. The deputy CEO also said that 65 persons were treated in the casualty unit on Good Friday, 28 of them had X-rays and 16 of them had diagnostic tests of one sort or another.

The publicity surrounding the revelation of these events has brought to light another case. On the same day a 79 year old man attended at casualty and was refused admission to the hospital. This decision was reached after a long delay. The man's family claim that the delay was approximately four and a half hours while the Mid-Western Health Board say that the delay was three hours. That man was taken home on Good Friday having been between three and four hours at the hospital but on the following Monday he was admitted to the hospital in a state of collapse. He died on the following Wednesday. His general practitioner stated that in his opinion he was in need of hospitalisation on Good Friday. The Mid-Western Health Board deny this.

Barringtons Hospital was closed by the Minister for Health, Deputy O'Hanlon, on Holy Thursday. I do not intend to redebate the Barringtons Hospital issue but despite a decision of this House the Minister, and the Government of which he is a member, closed the hospital. It was pointed out in the House that it would not be possible to make alternative arrangements for the very large numbers who were treated at the casualty unit of Barringtons Hospital. The closure of that hospital has had a devastating affect on the casualty services provided in Limerick City in particular and in the mid-west region.

At present the regional hospital cannot cope with the volume of patients attending its casualty unit. This is not the fault of the over-worked staff; it is the Minister's fault. The Minister failed to take the advice of the House and he ignored a majority vote of the House. He has also failed to fulfil commitments he made to the House in the course of the debate on Barringtons Hospital. I should like to quote from that debate, as reported at column 2360 of the Official Report of 16 February. The Minister said:

The closure of Barringtons as a public hospital does mean that certain facilities at St. John's and the Regional Hospital in Limerick will have to be strengthened. This applies in a particular way to the accident and emergency departments at these two hospitals. I have already announced that I am making available a capital grant of £400,000 for this purpose — £150,000 at St. John's Hospital and £250,000 at the Regional Hospital.

These amounts are sufficient not only to provide a first-class casualty unit at each hospital but also excellent day hospital facilities in both hospitals which is in keeping with the best practices in modern day hospital management.

The two incidents I have outlined and many others I could go into which did not end as tragically will show clearly that the Minister for Health not only ignored a majority decision of this House but failed to fulfil the solemn commitments he gave this House in the course of that debate.

In the course of that debate on 16 February 1988 the Minister for Health, talking in the context of the number of people being treated in the three hospitals in Limerick, in out-patients and in casualty, contrasted them with the fewer numbers being treated in Galway, saying, and I quote from column 2362 of the Official Report as follows:

These figures deserve some explanation and I will be having immediate discussions with the Mid-Western Health Board as to how the Limerick figures can be reduced. It would seem that many of those who go direct to the casualty units in Limerick do so for rather trivial reasons and should have been more properly treated by their general practitioner.

Has the Minister had those immediate discussions with the Mid-Western Health Board? Have the Mid-Western Health Board been putting pressure on the staff in the casualty units in the Regional Hospital in Limerick and in St. John's Hospital not to admit anybody they think might constitute a trivial case? Under the instructions of the Minister for Health and of the health board, are not the staff fearful that they will be held responsible for the admission of trivial cases with the direct consequence of incidents such as those I have outlined here this evening?

It is not acceptable that such things should happen. I know there are problems encountered in many institutions, that no system is infallible, but when two serious mistakes occur in the one day the Minister for Health who took the decisions must bear heavy responsibility.

I am demanding an inquiry by the Minister for Health into those two incidents. I want an inquiry initiated and a report to this House by the Minister on the adequacy of casualty services in Limerick now that he has, in his stubborn fashion, closed the hospital which was providing casualty services for the majority of those requiring them. I want those results brought into this House so that they can be debated.

The Mid-Western Health Board have been an efficient health board. The staffs in their hospitals are above reproach but now the Mid-Western Health Board is under the auspices of a new chief executive officer. I understand that person has a very good record, is a very effective, efficient public servant but he is also the chief executive officer of the Midland Health Board. It is not appropriate that a person who is already responsible for one health board area should be assigned to another in a temporary, part time capacity. That is not satisfactory. I demand of the Minister for Health and his Department that they make an immediate permanent appointment to the position of chief executive officer in the Mid-Western Health Board.

It gives me no pleasure to come into the House this evening and raise these issues. I am not by nature an alarmist; I do not become involved in the politics of propoganda or of the latest tragedy, but these incidents are of serious concern. I urge the Minister of State present not to give me a glib answer, pretending that eveything is right, because everything is not right. I would like action this evening and if such is not forthcoming I shall pursue the matter further.

I understand Deputy Noonan's concern in relation to this matter. I request him to give further details of the second case on which we have not yet received a report.

(Limerick East): The Mid-Western Health Board are inquiring into it.

Deputy Noonan raised a second case here this evening in relation to an alleged discharge of a patient in Casualty on Good Friday. I have asked the Mid-Western Health Board to investigate the circumstances of this case.

(Limerick East): Details of the second case were in the public press two weeks ago.

We have now received a preliminary report from the health board. That report indicates that while the number of attendances at the Casualty Department at Limerick Regional Hospital was not exceptionally high on that day the medical staff did have to spend several hours treating an extremely serious emergency case. That patient required constant attention from approximately 1 p.m. until after 6 p.m. I am sure the Deputy will appreciate that such a life and death situation will always receive priority treatment in a casualty unit. Unfortunately in such circumstances other cases, which may be serious but not of such immediate urgency, will have to put up with a certain amount of delay.

The patient referred to by the Deputy arrived at the casualty department at approximately 2.40 p.m. but following initial registration was not seen by the doctor on duty until after 4.30 p.m. mainly because of the other emergency case. After examination a number of tests were ordered, the patient was then seen by two doctors from the surgical team on duty that day. It was decided that he should be admitted as an in-patient after an X-ray had been taken. Finally he was admitted to a ward at 9 p.m.

I accept that even allowing for pressure in the Accident and Emergency Department and the X-ray Unit on that day the waiting period experienced by that patient was unduly long. I might add that the improved staffing arrangements for the casualty department, already announced, are now in operation. Furthermore, the health board have asked the hospital administration and the matron, together with the medical registrar in the casualty department, to review existing procedures in order to ensure that patients who are definitely going to be admitted to hospital are not kept waiting an undue length of time before admission. At present the health board are preparing a comprehensive report on this incident which I understand will reach my Department by Friday next. When the Minister, Deputy O'Hanlon, examines this report we will communicate further with Deputy Noonan in regard to this incident.

I am fully confident that the arrangements now being made for improvements to the casualty unit at Limerick Regional and St. John's Hospital will ensure that a satisfactory level of emergency services are available to the people of Limerick. I am also sure that Deputy Noonan is aware of the condition of the individual involved but I will not disclose confidential information regarding a patient.

We have no details in relation to the second case. The person was refused admission on Good Friday but he was subsequently admitted. I will, of course, ask for a report on the case and I will communicate with the Deputy in due course.

I cannot accept that the casualty department in Limerick Regional Hospital is failing to cope with the workload. Both cases to which the Deputy referred occurred on 1 April and the undertaking given to the House in relation to St. John's and the Regional Hospital have been fulfilled. Contrary to what the Deputy implied, no pressure has been put on the staff to depart from the normal medical guidelines in relation to the diagnostic treatment of patients.

I appreciate the Deputy's concern in relation to this case but he will realise that there was an emergency case being treated on that day. I hope there will not be a recurrence of the situation in this or any other hospital.

The Dáil adjourned at 8.55 p.m. until 10.30 a.m. on Thursday, 21 April 1988.

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