When hospitals fail patients
READING THE Health Information and Quality Authority report into the emergency department at Tallaght hospital triggers a depressing sense of déjà-vu. A sense of despair that despite many years of awareness of the elements that render our public health system dysfunctional, lack of accountability persists and patients pay the ultimate price. In this case it’s the family of Thomas Walsh who died in a corridor waiting for a bed at Tallaght in March 2011 who must absorb the litany of errors that contributed to his premature death.
While the scale of failings at Tallaght may be of a different magnitude, the Hiqa report makes it clear these failings occur throughout the acute hospital system. Perhaps the most shocking is its finding of a “cultural belief” that the routine practice of accommodating patients on trolleys in corridors was acceptable.
As part of its investigation into Tallaght hospital, the authority looked at waiting times in emergency departments in 33 other acute adult hospitals around the State on August 24th last year. National and international best practice recommends that 95 per cent of patients who arrive at an emergency department and who need to be admitted should be in a bed within six hours and all should be admitted within nine hours.
The snapshot study found 24 of 25 emergency departments failed to meet the target “despite the recommendations and initiatives undertaken as a result of the HSE emergency department task force report in 2007”. Unbelievably some nine hospitals were unable to supply the regulator with any electronic data. The decision by the State’s chief medical officer Dr Tony Holohan to refer the Hiqa report to the Medical Council and An Bord Altranais is a clear indication he believes certain individuals may have professional standards issues that require further investigation by their respective regulatory bodies. And it is an unmistakeable signal to doctors and nurses in the wider health service that, even in the presence of resource issues, clinical responsibility for patients cannot be abrogated.
Away from the coalface of clinical care, it is also depressing to discover that even as it was mired in financial difficulty, the board of Tallaght hospital saw fit to enter a consultancy contract with PricewaterhouseCoopers costing up to €1.8 million, without any evidence of quotations being sought. The board’s distance from reality is further confirmed by its decision to pay some senior staff top-up fees using separate accounting procedures without any records to show if the appropriateness of such arrangements was even considered. The report shows how governance problems extend to the highest levels of the Health Service Executive and Department of Health. That such a fundamental lack of governance persists more than 10 years since they were identified in various health strategy documents is disheartening. But giving up is not an option. In Hiqa and the department’s Special Delivery Unit, we have professionals who are committed to changing the negative culture surrounding health and systemic shortcomings. They and the Minister for Health James Reilly must be supported by Government in ensuring an adequate acute hospital service rather than facilitating cultural acceptance of obvious healthcare failures.