BACKGROUND:BARRINGTONS' PRIVATE hospital in Limerick, which sees about 8,500 patients a year, hit the headlines last August after it emerged that the Department of Health had taken the unusual step of asking it to stop treating breast cancer patients.
The department did so, even though it has no authority over private hospitals, after being informed that concerns had been raised with the Health Information and Quality Authority (HIQA) about the treatment given to 10 women with breast cancer who attended the 40-bed hospital over a four-year period.
The authority had the 10 cases looked at by Prof Arnie Hill, professor of surgery at Beaumont Hospital, Dublin and Dr Ann O'Doherty, consultant radiologist with BreastCheck. As Minister for Health Mary Harney put it at the time, they expressed "very serious concerns".
She said she had been informed "there was an immediate and ongoing risk to patients at Barringtons' Hospital". As a result, her department asked Barringtons to suspend its breast cancer services, which it agreed to do, and an independent review of the care given to all breast cancer patients who attended the hospital between September 2003 and August 2007 was ordered. This review was published yesterday.
The review team found 331 patients had used the breast cancer service over the review period. It asked them all to consent to having their files reviewed. In the end, 285 consented. Of these, the review team noted two had had their breast cancer diagnosis delayed. The case of one of these - a 51-year-old Tipperary woman whose diagnosis was delayed by 18 months - has already been highlighted in the media. She had attended Barringtons in September 2005 and it sent a breast biopsy it took from her to the laboratory at University College Hospital Galway (UCHG) for analysis. It reported back that everything was normal. When the woman presented to Barringtons again in March 2007, another biopsy was taken and again sent to UCHG. Again it reported back that the biopsy was normal.
However, Barringtons was concerned at the result, given the woman's physical state, and sought a second opinion by sending another biopsy at that time, to a private hospital in Cork. It found the woman did have breast cancer.
It has since emerged that both earlier biopsies sent to the Galway hospital for analysis were wrongly reported. The hospital has apologised and the incident is now the subject of a separate inquiry by HIQA.
Barringtons argues the delay in this case was not its fault but the fault of UCHG.
Meanwhile, the second woman attending Barringtons who received a delayed breast cancer diagnosis - and whose case has not previously been highlighted - had presented for a mammogram at the hospital in 2003 and was given the all-clear. She presented again in 2004 and a mammogram showed she had a tumour. When staff looked back at the earlier mammogram, they discovered that the tumour had been present in 2003.
The hospital said yesterday it accepts it "missed" this cancer in 2003, but manager Denis Cahalane stresses it was picked up in 2004 and not by the independent review. He said the patient concerned was now "doing well".
When the review team looked at the other 283 patient files, they found no cancers had been missed, though two patients are waiting the results of a reassessment. However, the report did find evidence of "inappropriate clinical care in more than half of the women who had consented to have their records reviewed".
This related to things such as not doing imaging before surgery, some lumps perhaps being removed unnecessarily and multidisciplinary care not being in place. These were among concerns aired by Prof Rajnish Gupta, the regional director of cancer services in the mid-west, with the department as far back as January 2006.
The independent review does not say precisely what its findings were in relation to each of the 10 specific cases raised by Prof Gupta with HIQA, other than to point out that one of them is deceased and one had never in fact been treated at Barringtons.