HSE failed to act on Portlaoise safety risks – Hiqa

The Government “determined” Portlaoise hospital should have 24-hour surgery and critical care but did not ensure it was safely resourced to provide this level of service, according to a controversial draft report by the State’s health regulator.

The report, compiled by the Health Information and Quality Authority (Hiqa) and seen by The Irish Times, says the Midland Regional Hospital in Portlaoise was removed from a list of 10 smaller hospitals where services were being reconfigured because of safety risks. This generally involved the replacement of 24-hour services with daytime units.

The HSE drew up the list of 10 hospitals due for downgrading to “model-2” status but the report says Portlaoise was removed from the process after Government policy was spelled out at a meeting of the Oireachtas health committee in July 2011.

Former minister for health James Reilly told the committee it was not Government policy to change Portlaoise to a model-2 hospital because it had maternity and paediatric units. Minister for Foreign Affairs and Portlaoise-based TD Charlie Flanagan had complained at the meeting about the "dismantling" of services at the hospital.

Baby deaths

Five babies have died in controversial circumstances after being delivered at the hospital in recent years, and questions have also been raised about the quality of emergency care and surgery in Portlaoise.

The report says the HSE at all levels was aware of patient safety risks at Portlaoise – as was the hospital itself – but failed to act decisively to reduce these risks.

The draft report is highly critical of official inertia, inaction and indecision in relation to the problems in the hospital, as well as the failure of the HSE to learn from mistakes made in other parts of the health service, as identified in previous reports.

It says there was "no clear vision of the services that Portlaoise Hospital could and would safely provide into the future".

At a national level, HSE managers were predominantly focused on budgets, failed to maintain oversight of the hospital and were unaware of what was happening there until news of baby deaths broke last year, according to Hiqa.

‘Major deficits’

The draft report, compiled last year, says Portlaoise continued to operate a “poorly governed” emergency department, an “under-resourced” radiology service and a surgical service where there were too few patients to ensure surgeons maintained competence. It also found “major deficits” in the way the hospital was run, including the handling of patient complaints and a lack of consultants.

The Irish Times reported last month that HSE director general Tony O'Brien threatened to take legal proceedings against Hiqa to prevent publication of the draft report. Mr O'Brien said the document lacked balance and accuracy and implied the "reckless endangerment" of patients.

In a letter sent to HSE staff last week, Mr O’Brien acknowledged there were “significant failings” at Portlaoise but said many of these had been addressed. “It is important to state that the services delivered at Midland Regional Hospital Portlaoise today are safe and this is an important message for clients and patients.”

The HSE has since sent the regulator its detailed response to the draft report, and further correspondence has issued between the two organisations. A final report is expected to be published later this month.

Taoiseach Enda Kenny and Minister for Health Leo Varadkar have urged the HSE and Hiqa to sort out their differences without resorting to law.