Dáil Éireann díospóireacht -
Wednesday, 18 Dec 1991

Vol. 414 No. 9

Adjournment Debate. - Heart Operation Delay.

Mr. J. Higgins

I thank you, a Cheann Comhairle, for selecting my question and I thank the Minister of State for coming in to reply.

The lady who is the subject of this question lives in Ballina, County Mayo. She is 48, married and has a young dependent family. She has a medical card. Her husband is a small farmer in receipt of social welfare.

The woman has a chronic heart condition. She was referred by her doctor to University College Hospital, Galway where the specialist attending to her said that a heart by-pass operation is an absolute necessity in her case. The patient was put on the waiting list for the Mater Hospital in Dublin. That was 18 months ago and she is still on the waiting list.

There is no sign as of now of her being called for the operation. Certainly neither she, her husband nor her GP seem to have any indication as to when she is likely to be called or, more important, when she is likely to be operated on.

In the meantime, this woman's condition has deteriorated rapidly. She is in considerable pain and is on very strong painkillers and additional medication as well. Her painkillers have been increased to the maximum sustainable level. The position is that she cannot do even the most basic, simple or mundane household chores.

The raw reality for this patient is that if she is not operated on soon — and I mean very soon — she will literally be gone beyond the point of anything being done for her, it will be too late and she will be too weak. I am talking about a relatively young woman.

I want to thank the former Minister, Deputy O'Hanlon, for his replies to my various representations, in particular for his reply to my letter in September, his reply of 26 September 1991, a reply to my plea that this woman be treated as a priority. Unfortunately, nothing has happened since and the woman's condition has now deteriorated to such an extent that, unless something happens within the next few weeks, she may die. I must reiterate my special plea to the Minister to see this case for what it is, for the priority it is, to see it as a matter of life and death so that this relatively young woman can be returned to normal health and play a full role as a wife, a mother and a member of the community.

Minister of State at the Department of Health (Mr. Flood)

I would first like to remind the Deputy that the success of new surgical procedures, such as by-pass operations, has resulted in an ever-increasing demand worldwide for these procedures. As a result waiting lists remain a problem despite the increase in facilities available. Even with the development of services hospitals worldwide are finding it difficult to keep up with the increasing demand for cardiac surgery and a wide range of other surgical and medical procedures.

I understand that the person referred to by the Deputy was put on the Mater Hospital waiting list for by-pass operations in November, 1990.

The Deputy will be aware that cardiac surgery is performed in two units, one at Cork Regional Hospital and one in the Mater Hospital, Dublin. Patients from the Western Health Board area are generally referred to the facilities at the Mater Hospital.

The facts of the present situation regarding cardiac surgery have already been spelled out on a number of occasions previously. Briefly, my Department have an agreement with the Mater Hospital going back to 1987 that an annual target of 750 by-pass operations should be aimed at and the hospital receives funding for these operations on that basis.

In January 1990 cardiac surgeons at the Mater Hospital advised the hospital that they would have to retain their cardiac patients there for the full duration of their post-operative stay. This change in practice had knock-on effects, it created a longer length of stay for cardiac patients than previously obtained and a consequent reduction in the number of patients being operated upon.

In response to this situation, the former Minister for Health instructed his officials to look urgently at ways and means of improving this situation with the authorities of the Mater Hospital with a view to restoring the activity of the cardiac surgery unit to the previously agreed levels. Special additional funding was approved for the provision of ten additional cardiac surgery beds, which came into operation on 2 April 1991. The total costs involved in the project were quite significant. The total capital cost was £421,000 made up of £235,000 for renovation and upgrading works and £186,000 for equipment. Furthermore, £400,000 additional annual staffing costs were approved which is, of course, a cost which must be provided on an on-going basis each year.

The chief medical officer of my Department was also requested to review cardiac surgery waiting lists in consultation with the cardiac surgeons and cardiologists. A number of discussions took place with a view to identifying how best to further increase the throughput of by-pass operations. Subsequently, the Mater Hospital and St. James's Hospital were invited to submit a proposal regarding their hospitals' ability to meet an increase from 750 to 1,000 by-pass operations per annum. An option appraisal of their proposals is currently being undertaken by my Department. Proposals for the extension of cardiac surgery in Cork have also been submitted to my Department.

As I have already outlined, significant additional resources have been allocated to cardiac surgery over the last two years in spite of the overall financial restrictions. However, the Minister and I are conscious, that more remains to be done. It is intended to allocate additional resources during 1992 to enable a start to be made on expanding services in Cork and Dublin.

I want to emphasise to the Deputy that if the patient to whom he refers is concerned about her condition, as would appear to be the case certainly from Deputy Higgins' plea this evening — she should, as is normal practice, contact her family doctor, or her cardiologist, directly who will be in the best position to emphasise the urgency of her case to a consultant at the cardiac surgery unit.