Making hard work of bowel problems

The HSE West made an expensive mistake when it failed to accommodate, in all senses of the word, one of its own medical secretaries who had a serious bowel illness.

The Equality Tribunal ordered the HSE West to pay €70,000 to the woman who has irritable bowel syndrome (IBS) and also ordered she be provided with an office in University Hospital Limerick.

The tribunal found the unnamed woman should have been provided with facilities necessitated by her condition, given the size and budget of the hospital where she works.

She joined the HSE West in April 2001 and was diagnosed with IBS in 2004. She worked in an office next to a toilet but in July 2007 was transferred to another location where the toilet was more difficult to access.

The Equality Tribunal was told the nature of the woman’s illness meant that she needed to be able to access a toilet quickly “as she suffers from embarrassing symptoms associated with her medical condition”.

She was forced to go on sick leave rather than work in an office with three other staff which would cause her "embarrassment and she believed her dignity at work would be compromised".

Crosshead
Equality officer Marian Duffy says she feels the woman's HR manager did not take her medical problems seriously.

She was eventually offered different posts outside the regional hospital where she worked, but Duffy says none of them amounted to a “reasonable accommodation”, given the nature of her illness.

Duffy says she can not accept that an appropriate office could not be found for the woman given the size of the regional hospital she worked in and its budget.

The woman took the case on the grounds of disability, one of nine allowed by the Equality Tribunal.

The case has put the focus on the area of serious bowel conditions and their effects in the workplace on those who suffer from them.

IBS is surprisingly common, affecting more than 10 per cent of people in various different forms, from mild to severe.

Consultant gastroenterologist Dr Stephen Patchett says IBS is not so much a disease as a "constellation of symptoms" which includes pain, diarrhoea, constipation and heartburn.

He says the typical IBS sufferer can expect to have the symptoms for three days in a row or three months in a row. The symptoms can be variable and two patients can have different experiences of IBS.

“It would be inappropriate for me to speak about this particular case, but, if you look at other jurisdictions where there have been cases such as this, like the US, it would be sensible for employers to take symptoms of IBS seriously,” he says.

“The definition of a disability includes both mental and physical difficulties. Patients with IBS often suffer from anxiety and depression too. It would be sensible for employers to take such a diagnosis seriously in terms of employment law.”

The woman was advised by the Impact trade union in her case against the HSE West. Impact spokesman Bernard Harbor says the case illustrates that employers are obliged to make accommodations for workers in these situations.

“That’s your right as a worker, and the law is also designed to ensure that the economy and employers benefit from people’s abilities, regardless of any specific disabilities or medical conditions they may have,” he says.

A spokesman for the HSE says: "The HSE had just received the report, the decision has been noted and the HSE is considering the report."

Unknown causes
The causes of IBS are unknown, but may be related to environmental factors, including stress and diet. It occurs when the normal way in which food is moved through the gut is disrupted, leading to stomach cramps and pain.

IBS is often confused with inflammatory bowel disease (IBD) which comprises two conditions, Crohn’s disease and ulcerative colitis (UC). It is much less common, affecting about 15,000 people in Ireland, but generally more serious.

IBD is an autoimmune condition similar to rheumatoid arthritis and multiple sclerosis. Both illnesses have many of the same symptoms including stomach cramps, diarrhoea and weight loss, but IBD is distinguished by bloody diarrhoea.

Both conditions are incurable but can be managed. The nature of them make it hard for those who suffer from them to go public about their condition.

Patricia McArdle, who is now the chairwoman of the Irish Society for Crohn’s Disease and Colitis (ISCC), was diagnosed with Crohn’s disease at the age of 22, two days before starting her career in a Big 4 accountancy practice.

“Starting work in a high-pressure organisation is daunting enough but starting it with an illness which causes constant stomach cramps, urgency and extreme fatigue was pretty tough,” she recalls.

“I survived to a point but after a few months, when constant deadlines and frequent nights working to 2am meant my body was not responding to the medication, I received some straight talking from my consultant,” she says.

"I had to give in and change my job to something a little less stressful. I was very lucky to be able to do that and still follow my career goals, many patients out there aren't."

Job prospects
The extent to which serious bowel conditions can affect a person's jobs prospects was outlined in a European-wide survey of patients with IBD which included Ireland.

Some 4,000 IBD sufferers across Europe, including 125 in Ireland, were surveyed by the European Crohn’s and Colitis Organisation (ECCO).

Some 65 per cent of those surveyed spoke of feeling pressure for taking time off work and a similar figure felt their career prospects were hindered by the illness.

A total of 77 per cent had to take five or more days in sick leave in the previous year. Roughly one in four people (24 per cent) says they have experienced discrimination in the workplace and one in five says they have been the victims of complaints or unfair comments about their performance.