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Dáil Éireann debate -
Tuesday, 27 Nov 2007

Vol. 642 No. 3

Leaders’ Questions.

The provision of cancer services is the central issue in the debate about the current debacle that has highlighted the incompetence of the Minister for Health and Children. While I have asked questions about this matter on a number of occasions, little clarity has been given in response. I hope the communications difficulties in this regard have been resolved now that the Minister's job is on the line. I would like to ask specifically about reports that a review was commissioned into the work of a pathologist who spent six weeks working at Cork University Hospital in July and August of this year. According to an extract from the review, which was published in today's Irish Independent, the pathologist in question was guilty of “serious diagnostic errors”. The review goes on to state:

From a review of 166 cases, 15 were reported as negative or inadequate when in fact these samples contained malignancy or features suggestive of malignancy.

I want to make it clear to the Taoiseach that I am not referring to the Health and Information Quality Authority's report. I am referring to a report into the work of the pathologist in question that was commissioned by the hospital. It is separate from the authority's report. When was the report received? Does it confirm that there were 15 misdiagnoses? When were the patients whose cases were misdiagnosed informed of their misdiagnoses?

I can tell the Deputy what I know about the matter. I got some information from the statement issued by the Health and Information Quality Authority. The authority announced earlier this year that it was undertaking reviews of symptomatic breast disease services at the Mid-Western Regional Hospital in Limerick, including the pathology services at Cork University Hospital and Galway University Hospital. Those reviews commenced in June and September respectively. I am not aware of any other reports. These reviews are currentlyunder way and are expected to be completed shortly. One review is expected to be completed in December and the other in January 2008. HIQA is the organisation responsible for the reviews. It informed the Minister that if any patient identified in either review requires further review or follow-up treatment, this will be communicated to the HSE immediately which will provide appropriate services to the patient forthwith.

Since September the management at Cork University Hospital has been carrying out a review of the pathology services at the hospital. This is perhaps what was being referred to by Deputy Kenny.

Yes. This is a separate review from that of HIQA.

This began in September, three months after the review I mentioned. It was as a result of concerns about the work of a single pathologist who worked in the hospital on a locum basis for a short period. As it does not form part of the HIQA review, I presume it is the review to which Deputy Kenny refers. The Department and the Minister were informed of this review on 23 November. The Minister understands that in the course of this review, so far several patients have already been recalled for review and appropriate care by their doctor. The HSE has informed departmental officials that it will conclude this review shortly. The Minister understands that patients requiring review will be contacted and offered appropriate care as soon as they are identified. The HSE had informed the Minister that this pathologist no longer works in any of its hospitals. Steps have been taken to ensure that the regulatory authorities in this jurisdiction, where it is believed this person resides, have been informed so that appropriate action can be taken.

I am glad the Taoiseach's briefing note allows him confirm that this was not part of the HIQA report and that this was a special separate report commissioned by Cork University Hospital into the work of a pathologist. If I recall correctly, the Taoiseach stated that the Department was notified on 23 November that this review was in train. Can he inform me from his briefing notes when the first misdiagnosis was identified and when that first patient was contacted? Since this report into the work of a pathologist was first commenced, will the Taoiseach confirm that to date, 15 misdiagnoses have been identified by that separately-commissioned review? Of those 15 misdiagnoses, what was the period between the patients being identified and receiving treatment, counselling or other assessment that might be necessary? Will he confirm there are now five separate reports in train? I refer to the report from the review in Portlaoise, the HIQA report on Cork, the HIQA report on the pathology unit in Galway, the inquiry into Barrington's Hospital and this specially-commissioned report by Cork University Hospital on pathology. This information is fundamental to the motion of no confidence in the Minister for Health and Children. These questions must be answered. I was truly shocked to hear during the course of this week that the Minister for Health and Children was unable to acquire details about questions such as this.

The HIQA report announced earlier in the year was on a review of symptomatic breast disease in both Limerick Regional Hospital and including the pathology services at Cork and at Cork University Hospital. This was one part of the review. The CUH review is a separate review of the same hospital. There is also a review at Portlaoise. Other changes have taken place in the system during the course of the year, including decisions made about cases from Mullingar General Hospital being referred to the Mater Hospital and about which I answered questions some weeks ago. However, if I recall correctly, that decision came about as a result of the pending retirement of the consultant rather than a review of work.

The Department and the Minister were informed of the review on 23 November. It seems that the review began some time in September since when the hospital management at CUH have been carrying out a review of the pathology services at the hospital as a result of concerns about the work of a single pathologist who worked in the hospital on a locum basis for a short period. As I do not have an exact number of patients, I cannot confirm whether it is 15 patients as requested by Deputy Kenny. In the course of that review, several patients have already been recalled for review. It is not stated what the purpose of the review is but it is obvious some of the work was considered and these patients were recalled. They were given appropriate care by their doctor. The HSE has informed departmental officials that this review will be completed shortly and that patients who need review will be contacted and offered appropriate care as soon as they are identified. Anyone who has been identified in that review to date has been dealt with and the work is ongoing.

On 23 November 2004, almost three years ago to the day, the Minister for Health and Children introduced the Health Bill in this House. She stated that, "the two ways Government health policy should be judged; better outcomes for patients and better value for taxpayers' money. To achieve them, we badly need clarity of roles and accountability, political responsibility for the Minister and management responsibility for the management." She specifically stated, "as it is, the Minister and the Government is responsible for setting overall health policy and it is essential that the Minister has the power to inform the executive of policy decisions made and to direct it to carry out its duties in compliance with Government policy. The executive is also required to provide the Minister with any information or statistics relating to the functions of the executive which may be requested."

Whatever we got in recent weeks, or whatever the Minister got from the Health Service Executive, she appears to have got very little information or statistics. Later this evening, we will come to the question of the political and management accountability that she herself so accurately described and set the parameters for when she introduced the Health Bill three years ago.

When the scandal in Portlaoise came to public attention, both Deputy Kenny and I raised questions with the Taoiseach in the House about what happened in Portlaoise. He told us that Dr. Ann O'Doherty had been appointed to carry out some kind of an inquiry or review into what happened in Portlaoise and that he could not give us or the public any explanation for the events in Portlaoise and the misdiagnoses until that report was completed and available.

On 6 November 2007, the Taoiseach informed us specifically that the review would be completed that week and would be published by the end of the month. Is it true that the report has been completed and, if so, where is it? When will it be published? Why has it not been published before we debate this issue in the House this evening? Is it true that Dr. O'Doherty did not interview the consultant radiologist who has been put on administrative leave? Three months after it came to the attention of the Minister for Health and Children, do we now have an explanation for the misdiagnosis which took place in Portlaoise and which has been added to by the truly horrific addition of 97 other cases in the course of the past week?

A number of questions were asked about Portlaoise. The Minister learned on Wednesday of last week about the existence of a separate review of ultrasounds that was under way in Portlaoise, in addition to what had been previously announced, namely, a review into radiology services in the hospital being undertaken by Dr. Ann O'Doherty at St. Vincent's Hospital. That review is being undertaken by a team led by Peter Naughton, a consultant surgeon in Portlaoise. Deputy Gilmore is aware of the circumstances of how that came to light last week.

I previously stated in the House that Dr. Ann O'Doherty is examining the earlier cases, and that is the position. That report is not completed but is in draft form. I cannot give Deputy Gilmore information on who Ann O'Doherty spoke to. I will inform him when we see the completed report. I understand the report will be published but, obviously, as with all medical reports, it will have to be examined for the purpose of legality and redacting of issues. That will not happen until the final report is available.

The Health Service Executive has appointed an advanced nursing practitioner who will co-ordinate the initial nine cases. Dr. Ann O'Doherty's job was to go through the 3,707 mammograms. As Professor Arnie Hill said yesterday, extraordinary work was done by Dr. Ann O'Doherty. It would be considered a very good work rate for a top class professional to do that many in a year but she did that in a short period of time. I do not think Deputy Gilmore meant it, but I do not wish it to be implied in any way that there was a delay of three months. Dr. Ann O'Doherty did the work of any other top class professional in a very short time and I praise her for that. She went through 3,707 mammograms and nine cases require to be followed up. An advanced nurse practitioner has been appointed to co-ordinate further treatment for these initial nine cases as a result of the review of the mammograms in the hospital.

As I said on Friday, I thank Professor Arnie Hill and his team for working all day on Saturday. They saw more than 80 patients in that time. Those whom they thought would require further clinical treatment were sent to Beaumont Hospital where a breast clinic was set up on Sunday morning. Staff were also on stand-by in St. Vincent's Hospital. The other people whom they were not able to contact were seen yesterday. A final special clinic will be provided by surgeons this evening for the remaining people who have been contacted and are available. A small number of people still require surgical review and this will be provided on a priority basis.

Given that this is something which came to light on Wednesday night or Thursday, it is an indication of the extraordinary dedication by the team involved to have contacted, seen and undertaken a review of the clinical records and diagnostic assessments of these people, with the remaining few being seen tonight. I thank the team involved. I thank also the person who brought all this to light in the first place. Otherwise, we would have known nothing about it in late August.

I am not reflecting on Dr. O'Doherty, as the Taoiseach well knows. The Minister stated in the House in a reply in early November that Dr. O'Doherty's investigation would examine the mammographies and the ultrasounds. By whom or where was it decided that there should be a separate investigation by Peter Naughton into the ultrasounds? The issue I raise does not relate to Dr. O'Doherty's work, but when we raised the matter with the Taoiseach earlier this month, he told us Dr. O'Doherty's report would be ready in a week and that it would be published by the end of the month. It is now three months since the Health Service Executive and the Department of Health and Children first became aware of the problem in Portlaoise and neither the Taoiseach nor the Minister for Health and Children appear to be in a position to give the House or the public any coherent explanation as to what exactly happened in Portlaoise. All we seem to find out is that the problem is getting worse with each passing week.

Later this evening we will address the Minister for Health and Children's accountability for all this. If the Taoiseach were to give his Deputies a free vote on this issue this evening in the House, I do not think there would be any doubt about the outcome.

This House does not have confidence in the Minister for Health and Children, nor does the public and the staff of the health service. When will an explanation be given to the public and to the women concerned about what happened in Portlaoise, or is the Taoiseach's concern now related to protecting the Government and the State from any possible claims for compensation that might arise?

My only concern from the outset, as it is with any medical, surgical or health issue, is for the individual, that we provide the best service at any time and the best medical standards we can, and, if something goes wrong for whatever reason, that we try to correct that to the very best of our ability in the interest of patient health and safety. That is my only concern.

I do not know why Mr. Peter Naughton, the consultant surgeon in Portlaoise, decided to carry out a review of ultrasounds separate to the work being done by Dr. Ann O'Doherty on the mammograms. I am not a consultant but, from what other consultants have said, I assume Dr. Peter Naughton was trying to be sure. He was checking and going back over issues where he thought perhaps something was missed. That is what it seems he was doing. That does not appear unwise, given that other people were involved and in the circumstances of somebody's work being called into question. Dr. Ann O'Doherty is an expert in this area and she has been praised by all her colleagues for the work she has done. I accept Deputy Gilmore would add his praise to that. I am sure she has been trying to go through the 3,707 mammograms. Writing the report is important but it is secondary to that job. When we have her report, we will deal with it. I will not put pressure on her, other than to do that. We will have the report when it is available and then we will deal with the issue.

I do not wish to take great issue with Deputy Gilmore, but if he checks the record of what I said on the first day when this came up, I said I would not stand up in the House as a non-medical expert and start making comments about what one did not have to be much of an expert to see. The consultants who examined this did not believe that the service given by somebody who had misread a number of these mammograms was satisfactory. That was their view and that is what I said. However, I said that was not a judgment I was in a position to make, nor was I going to blame somebody I did not know. I was not competent to do so. What I said was that I believed there were issues surrounding the medical competence of somebody reading these mammograms and it appeared that others, who were experts, believed that this rate of error was not acceptable. Rather than a judgment being made by me or any other lay person, Dr. Ann O'Doherty was brought in to make it. We will see what that judgment is in due course. That is the position.

I do not agree that this was left sitting for months. Decisions have been made about moving services, reviewing cases and bringing in experts to assist the unfortunate people who had to go through the shock and hurt of what happened, for which everybody has expressed regret. I do not believe that the Deputy's comments are fair.

If Deputy Gilmore had a free vote on his side of the House, a large number of his Deputies would vote for the Minister, Deputy Harney, tomorrow night. That is my view.

(Interruptions).

Why does the Taoiseach not try it?

That is a good challenge. Throw down the gauntlet.

There would be the meeting of the year after that.

In my view, Deputy Gilmore would be holding them back at the door.

I accept that challenge.

The time has expired.

Let us have a free vote on the issue.

Deputy Gilmore has already made his intervention. The Taoiseach is some way over his time limit.

Tonight and tomorrow night we will return to the amazing amount of good reform being carried out by the Minister for Health and Children.

She speaks of it, but does not implement it.

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