How safe are you in hospital?

After a year in which the hospital system came under fire, our Health Correspondent Eithne Donnellan asks whether patients should feel safe going into hospital

Last month, the Minister for Health, Mary Harney, admitted she herself would be worried about going into some of our hospitals, following the publication of the first national audit of hygiene in hospitals.

It revealed a shocking 91 per cent of hospitals across the State are failing to meet acceptable standards of cleanliness and hygiene. Only five of the 54 acute hospitals which were audited met required standards.

If hospitals are not clean, patients may be in danger of picking up bugs from each other - bugs such as the antibiotic-resistant MRSA - and end up leaving hospital with an illness different from the one they were admitted with.

MRSA can prove fatal if it gets into the bloodstream, particularly in patients with suppressed immune systems. Over one 10- day period recently, the MRSA and Families support group said seven people with MRSA died in seven different hospitals. It claimed MRSA was definitely a factor in their deaths.

Dr Teresa Graham, a spokeswoman for the group, said "people are delaying, or putting off, going into hospital because they are afraid of MRSA. I know from speaking to people, it's quite common, and I would feel that way myself. I need to get my varicose veins done, but am postponing it. They are painful, but I'm going to wait until they are really, really bad," she said.

Dr Graham, from Tramore, Co Waterford, witnessed her husband, Dermot, who had cancer, die in pain after he contracted MRSA.

Patients have also had their concerns about going into hospital heightened by a raft of adverse clinical events. Details of several such incidents emerged in the past year, including the case of Theresa Darcy Lampf, a Co Louth woman who had her baby taken from her by Caesarean section five weeks before its due date at Our Lady of Lourdes Hospital in Drogheda. The baby subsequently died.

An inquest earlier this month heard the wrong due date had been inserted in the woman's file and, despite her drawing the hospital's attention to this, it was never changed.

There was also the case of a 31-year-old national school teacher from Limerick who died as a result of complications while undergoing a routine operation on her back at Our Lady's Hospital in Navan. Caitríona Kennelly, who taught in Julianstown, Co Meath, began to bleed profusely. Efforts to save her failed.

And earlier this month it emerged that Tallaght Hospital in Dublin failed to tell a mother of three, for more than a year, that tests had revealed cancerous cells in her bowel. An apology was read out in the High Court when the woman, Deirdre Conlon (58) from Lucan, settled an action against the hospital for around €200,000. She is now gravely ill with secondary lung and liver cancer.

The High Court also heard last month how a surgical instrument was left inside a woman after a sterilisation operation. The woman, Theresa Tobin (41) from Clonakilty, Co Cork, passed the instrument, a vaginal dilator, a few days later. It also subsequently emerged, when the woman became pregnant with her sixth child, that her sterilisation hadn't worked.

But possibly the most controversial case in which hospital care came under scrutiny was the death of Pat Joe Walsh (75) from Killanny, Carrickmacross, who bled to death at Monaghan General Hospital in October. He needed emergency surgery, but surgeons in Monaghan are not allowed carry out emergency operations. They tried to transfer Mr Walsh to three other hospitals in Cavan, Drogheda and to Beaumont, in Dublin, but were told no intensive care bed was available.

It emerged subsequently, however, that intensive care beds were free in each of the three hospitals. An inquiry into the circumstances surrounding Mr Walsh's death is ongoing.

Ms Harney said in the days following Mr Walsh's death that: "This should not have happened. . . the circumstances surrounding this tragedy require thorough investigation."

The Health Service Executive chief executive, Prof Brendan Drumm, also said he believed Mr Walsh should not have died. He said the system had failed.

He has pledged, since taking up office in August, to put patients and patient safety first and said it was this, rather than local political or other considerations, which would determine how hospital services were organised in the future.

Despite these shocking cases, it is of course important to bear in mind that thousands of patients are successfully treated by Irish hospitals every year.

A recent survey of patients' views carried out by the Irish Society for Quality & Safety in Healthcare (ISQSH) also found 93 per cent of patients were satisfied with their hospital care and 91 per cent said they would return to the same hospital again.

However, given the threat of MRSA, the possibility of spending days on trolleys in A&E, or the prospect of ending up as the patient on whom an accident was waiting to happen, should patients be afraid to go into hospital?

Perhaps, if figures for rates of medical negligence are anything to go by. Ms Harney told a conference on patient safety in July that patients had a one in 300 chance of dying in hospital from medical negligence, compared with a one in three million chance of dying in a plane crash. In many instances, mistakes made in hospitals result from simple things like not listening to patients and their families, Ms Harney said.

Dr Asam Ishtiaq, a surgeon at Galway's University College Hospital and president of the Irish Medical Organisation, believes hospitals are safe and provide good care "despite being overcrowded most of the time due to lack of acute bed capacity and resultant difficulties with patients being in A&E for hours and days on trolleys".

He said "off-the-cuff" remarks by Ms Harney to the effect that she herself would be worried about going into some hospitals were "unhelpful and cause undue anxiety and stress among patients and severe demoralisation of the staff".

If the Minister was worried, then she should do more to update the outdated and overcrowded facilities, he said.

"The clinical care provided by doctors and allied health professionals is of a very high standard and meets all the internationally accepted care protocols," he said.

Marie Kehoe, president of ISQSH, said hospitals were as safe as they always had been, it's just that patients were now demanding higher standards - which, she said, they should demand - and patients or their families talked more openly when things go wrong.

She points out that, although the ISQSH's recent survey found in some cases that doctors did not confirm patients' identities before giving them medication or before operating on them (some 89 per cent of patients said doctors confirmed their identity before giving medication; 96.8 per cent of patients said doctors did so before operations), the same survey also showed 93 per cent of patients were satisfied with their care.

However, Liam Doran, general secretary of the Irish Nurses Organisation, said that for as long as hospitals remained as overcrowded, and for as long as there was no clarity of decision-making at management level, then, in his view, hospitals would not be as safe as they could be.

"We do not have the physical infrastructure in many of our hospitals to deal with MRSA. We do not have isolation rooms. To change that we need sustained investment and I do not get a sense this Government is committed to that sustained investment," he said.

Dr Ishtiaq also refers to infrastructural problems. "The service is safe but we have pressures due to overcrowding and lack of adequate diagnostic facilities in many hospitals. There is a serious shortage of ICU [intensive care unit] beds nationwide and the tragic case in Monaghan was one example. We, at times, work on a shoestring in terms of availability of ICU beds. Major emergency surgery has to be carried out without the guarantee of ICU beds," he said.

"Patients at times have to be moved outof ICU or high dependency beds too early to make way for more urgent cases and it is not the way to provide acute care, but our pleas for increases in such resources fall on deaf ears," Dr Ishtiaq added.