Full epidural service still not available in Kilkenny

Patient services continue to suffer despite the last-minute agreement last month between the Minister for Health and the Medical…

Patient services continue to suffer despite the last-minute agreement last month between the Minister for Health and the Medical Council to expedite the recruitment of non-EU junior hospital doctors.

Women who go into labour at St Luke's general hospital in Kilkenny no longer have an epidural service between midnight and 8 a.m. The hospital has been unable to fill two of its four anaesthetic registrar posts since July 1st. It has also had its consultant anaesthetist staff reduced from six to five. As a result, obstetric patients face the prospect of inadequate pain relief during the night.

In addition, the proper risk management of both mother and child during labour requires the availability of a 24-hour regional epidural service.

The South Eastern Health Board (SEHB) continues to provide a full elective orthopaedic service at Kilcreane in Kilkenny, which is staffed by the same anaesthetists.

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When asked why this service has not been reduced and the resources reallocated to provide a 24-hour epidural service, a spokesperson for the SEHB said "we asked for this to take place; however, the national negotiated consultants' contract does not provide for a consultant to be first on call.

"The board cannot renegotiate a national contract on a local basis. Therefore, with only two registrar anaesthetists available to St Luke's and in the interest of patient safety, the board, in consultation with the hospital management and anaesthetic team, has taken the only decision available and reduced temporarily the epidural service to 16 hours per day."

Guidelines from the Association of Anaesthetists of Great Britain and Ireland state that an epidural service must be provided on a residential, rather than an "on call", basis.

The Irish Times has seen correspondence between a consultant obstetrician at St Luke's and the SEHB in which the minimum acceptable standards of care are detailed.

"A minimum requirement, as laid down by the Royal College of Obstetrics and Gynaecologists, is for an epidural pain relief service and both regional and general anaesthesia for operative delivery," the letter states.

In response, the SEHB has said "the anaesthetic team is providing a full emergency service and will provide epidurals for those women who require one for specified medical reasons".

Medical reasons for epidurals include dangerously elevated blood pressure in the mother (toxaemia), twins and breech presentation. However, the availability of a 24-hour epidural service can also affect psychological health. If a women endures a traumatic birth, it is possible that she may have psychological problems as a result.

The royal college, along with the Irish Institute of Obstetricians and Gynaecologists, sets standards of care to be followed by all obstetric units in the Republic. The standards state that "anaesthetic cover must be available throughout 24 hours".

mhouston@irish-times.ie