Dáil Éireann díospóireacht -
Tuesday, 13 Jun 2000

Vol. 521 No. 1

Adjournment Debate. - Hospital Doctors.

Mr. Shatter

I wish to share my time with Deputy McGinley.

The Government has an obligation to immediately set up an inquiry into the circumstances which resulted in Dr. James Elwood working as a locum in Tralee, Sligo and Letterkenny General Hospitals between 1991 and 1999 and into the work undertaken by him. It is totally inappropri ate that a consultant pathologist whose age considerably exceeds retirement age for consultants working in Irish public acute hospitals be so employed. It has now emerged from a review of his work in England that Dr. Elwood may have been responsible for the misdiagnosis of approximately 230 people tested for cancer and other illnesses.

I ask the Minister for Health and Children to state what inquiries have been conducted here to date to ascertain the number and identity of patients diagnosed by Dr. Elwood, whether any such inquiries took place only as a consequence of Dr. Elwood's misdiagnoses first being identified in England, whether any inquiry into his work originated from patient concerns or concerns expressed by other medical or nursing professionals in the State, to detail any misdiagnosis identified as a result of the wrong treatment given and to state whether, as a consequence of such misdiagnosis, any patient died or any patient's life was placed at risk.

The Minister in a statement issued today said that in a small number of cases changes were made to the prescribed treatment for specific conditions of patients after a review had been conducted of a diagnosis by Dr. Elwood. The Minister should detail how many patients have had their treatment changed and the conditions concerned. He should clarify whether any patients' conditions deteriorated as a consequence of a misdiagnosis. He should also clarify whether all patients diagnosed by Dr. Elwood have had that diagnosis reviewed fully in each of the three hospitals and whether such reviews have involved the re-examination of a patient to ensure proper patient care has been or is being provided. The Minister should also clarify whether any patient unnecessarily underwent surgery in this State as a consequence of a misdiagnosis by Dr. Elwood, as we now know occurred in England.

It is essential that in this, as in all other aspects of our health service, we put patients first. I am concerned that a spokesperson for one of the health boards today stated that the health board concluded that patients whose conditions were diagnosed by Dr. Elwood need not be informed as there was a concern that patients would be unduly alarmed. If a diagnosis was correct, there is no reason why they should be alarmed. If there is any possibility that a diagnosis was incorrect, it is of crucial importance that this is brought to the attention of the patient concerned. It is time in the 21st century we moved away from the patronising "We know best" attitude of health bureaucracy and regarded patients as individuals with a right to be informed of any matter of direct relevance to their health and well being.

It is inevitable that patients who attended Tralee, Sligo or Letterkenny hospitals in recent years will be alarmed by today's reports. The Minister for Health and Children must ensure that a patient help line is immediately set up. He must assure the general public that no medical practitioner so substantially past retirement age will in future be employed as a locum in an Irish hospital. The Minister must also provide an assurance that any person identified to date as having been misdiagnosed has already been called back or will without any delay be afforded an appointment with an appropriate consultant attached to the hospital originally attended. A guarantee must also be given that any treatment now diagnosed as required will be provided immediately.

The Minister announced today that he is establishing a working group to consider existing recruitment procedures for locum consultants. This Government finds it impossible to make any decision about the health service without first establishing a committee or working group to deliberate for an unspecified period and ultimately to produce a report which inevitably gathers dust on the shelves of the Department of Health and Children. The Minister should make two decisions.

An Leas-Cheann Comhairle

The Deputy has less than a minute of his time left.

Mr. Shatter

I would like to conclude if the Leas-Cheann Comhairle does not interrupt me.

First, the Minister should instruct health boards that consultancy locum work should not be given in any of our hospitals to very elderly retired consultants in future. One English hospital has made a decision that no locum work will be given to any medical practitioner over 70 years of age. The Government should take immediate steps to establish a central register in which hospitals are compelled to detail any serious medical misdiagnosis, mistakes or incidents that occur to ensure that should a history of misdiagnosis emerge, it is detected at the earliest possible date.

An Leas-Cheann Comhairle

Deputy Shatter has used his five minutes. I wish to draw attention to the fact that five minutes are allocated to the Deputy and the Minister. The Deputy was notified when four minutes had been used and it is not appropriate to share time with Deputy McGinley and expect the House to provide time. If the House is agreeable on this occasion Deputy McGinley can speak for a minute.

Mr. McGinley

I do not wish to detain the House, but I wish to support the case put so eloquently by my colleague, Deputy Shatter. This is causing great concern to people in Donegal who had to visit Letterkenny General Hospital during the times when this consultant was present in 1997, 1998 and 1999. I think the consultant spent a total of eight weeks at the hospital and I hope the recommendations made by Deputy Shatter are followed, namely, that every advice, help and support possible is made available to those concerned.

This is the second shock in the north-west. Only last year there was a problem with a laboratory which tested blood samples. To get two such shocks within a year is unacceptable and I hope the Minister will act on the recommendations of Deputy Shatter.

Minister for Health and Children (Mr. Martin)

I thank the Deputies for the opportunity to outline to the House the action which has been taken to review the pathology practice of a doctor who provided holiday cover as a locum consultant pathologist in Tralee, Letterkenny and Sligo general hospitals. The key concern in this matter must be to ensure priority is given to the rights and needs of patients. In this instance the overriding priority for my Department and the hospitals concerned was to ensure a process was put in place to review the work of the pathologist in question, to identify any problems arising from that review and to ensure the appropriate action was taken to safeguard the interests of the patients affected.

The Department was contacted in September 1999 by the Southern Health Board with regard to concerns which had arisen in relation to the work of a locum consultant histopathologist who had provided holiday cover in the pathology department of Tralee General Hospital for short periods at various times from 1991 to 1999. Arising from the information which came to light it emerged that this person had also worked in a locum capacity in Sligo and Letterkenny general hospitals at various times since 1997.

As soon as this information came to light, both the Southern Health Board and the North Western Health Board put in train measures to identify all work undertaken by the locum pathologist. Arrangements were also made to have the work in question prioritised and reviewed with the assistance of the faculty of pathology of the Royal College of Physicians of Ireland on the basis of a standard clinical protocol in line with that used in the reviews which were undertaken in the United Kingdom.

In the context of the review it was established that the pathologist in question had provided holiday cover as a locum pathologist in Tralee General Hospital for two to four week periods on 18 occasions since 1991. He had also provided holiday cover in Sligo and Letterkenny general hospitals on six occasions for short periods totalling 14 weeks since July 1997. A total of approximately 3,000 pathology tests undertaken by the locum pathologist during his periods of employment in Tralee between 28 January 1991 and 27 June 1999 were identified. In the North Western Health Board a total of 945 tests reported on by Dr. Elwood were identified. All tests which were classified as more serious on the basis of the clinical protocol for the review have been reviewed and, in addition, due to the considerably smaller number of tests involved, a review of all the less serious tests in Sligo and Letterkenny has been completed. A review of low priority tests is currently under way in Tralee. To date, a total of 625 tests have been reviewed in Tralee, including 268 of the most recent less serious tests.

In relation to the 625 tests reviewed in Tralee, the review identified 27 tests where a disagreement with the original report was identified on review. However, in all but one case the patients were treated appropriately because the doctor treating the patient had correctly diagnosed the patient's condition. There was, therefore, one case where a change in treatment was required.

Of the 945 tests reviewed in the North Western Health Board, 11 cases were identified which needed to be reviewed by the doctor treating the patient. Of these 11 cases none gave rise to significant changes in treatment other than a change of diet or minor change in medication.

I am determined that the lessons of this case will not be lost and I have already put in train a range of measures to identify any further action required to ensure as far as is possible that such situations do not arise in future.

While it is important to remember that the vast majority of doctors do an excellent job, the public needs to have full confidence in those who are responsible for all aspects of their medical treatment and care. I am determined to ensure appropriate measures are in place to ensure the competency of all doctors. I have, therefore, initiated a review of the Medical Practitioners Act. This review will consider proposals that recertification and re-accreditation for doctors should occur on a regular basis throughout their careers as a competency assurance measure.

The issues under review in this case arose from the work of a locum consultant who was engaged to maintain services during holidays. In relation to the specific issue of locum consultants my Department is, therefore, establishing a working group which will consider existing recruitment procedures for locum consultants. I am anxious to deal with the issues raised by Deputy Shatter, particularly in relation to age. However, it is important to have the necessary consultation and to get a number of issues ironed out before we make final decisions. After all, if we made decisions I suspect Deputy Shatter would criticise the lack of consultation. The working group will have the task of making recommendations on necessary improvements, or otherwise, to these procedures. The aim is to ensure the highest standards are in place for locum consultants. We must ensure these procedures are robust and easily monitored for compliance.

A primary focus on the interests of patients is evidenced by the action already taken by the Southern Health Board and the North Western Health Board to review the work of the locum consultant pathologist in question. Arrangements have been put in place by the health boards to respond to any concerns on the part of patients or their families arising from this case. In addition to the action taken by the health boards to review the work of the locum consultant pathologist, the follow-up action which I have outlined will help ensure that situations like this do not occur in the future. People have a right to expect that all who come under the care of our hospitals receive quality care from competent staff. I want to see rapid results on the issues which arise from this case with a view to taking any necessary follow-up action as soon as possible.

I again thank the Deputies for raising this issue.