Is funding cut a false saving?

A home device that increases arterial blood flow to the leg can help save patients' limbs – and taxpayers' money – so why is it no longer paid for by some HSEs, asks MICHELLE MCDONAGH

EIGHTY SEVEN-year-old Bridget O’Malley has managed to stay in her own home and avoid having a second leg amputated through the use of a cost-effective, non-invasive home device which increases arterial blood flow to the leg. However, she is the only patient in Mayo still receiving HSE funding for the ArtAssist device and one of very few in the country due to funding cuts.

Mrs O’Malley is fortunate enough to have been started on the pneumatic compression device before funding for it was cut by the HSE in Mayo in 2008. However, her surgeon has told her that if the pump had been available to her earlier, she would not have lost her other leg to amputation.

A sufferer of severe Peripheral Arterial Disease (PAD) for many years, Mrs O’Malley had her leg amputated nine years ago after bypass surgery failed to improve the circulation to her legs. It was a very traumatic experience for her and it has left her in a wheelchair.

When she started getting gangrene of her remaining leg and lost the top of her toe eight years ago, her surgeon, Mr Sharif Sultan, introduced her to the ArtAssist device which had just become available in Ireland.

“I don’t think my mother would be alive today without the pump,” says her daughter, Ena Scahill. “Without it, I could see her going downhill very quickly, losing her second leg and ending up in a nursing home for the rest of her life because we would not be able to care for her at home – which would cost the Government a lot more money. She can do everything for herself, except take a shower.”

Distributed in Ireland by Galway-based company, Deprimo, ArtAssist is the only external pneumatic compression device developed with vascular surgeons for the sole purpose of increasing arterial blood flow. Compression is applied to the foot, ankle and calf using cuffs to increase arterial blood flow, stimulating the beneficial effects of brisk walking.

It helps to heal wounds and, vitally, to prevent amputations and is recommended for patients with PAD, diabetic foot ulcers and rest pain.

Mr Sultan, a vascular surgeon at the Western Vascular Institute at University College Hospital Galway (who has no affiliation to ArtAssist or Deprimo) has been fighting for funding for patients in Ireland to access this limb-saving therapy for a number of years to no avail. Funding was cut in Mayo in 2008 and in Galway earlier this year. The HSE in Sligo, Leitrim, Donegal and Cavan/Monaghan is still funding patients.

“This is a no-brainer. It costs about €1,100 for three months of therapy in the patient’s own home compared to a cost of up to €100,000 to the tax-payer for an amputation, taking into account surgery, a prosthetic limb, aftercare and home modifications,” Mr Sultan says.

“The cost of one amputation could fund 60 ArtAssist patients a year. These people are living on borrowed time with intractable pain, ulceration and gangrene, they might only have three or four years to live and they deserve to have some quality of life and dignity during that time.”

A spokeswoman for the HSE West said the Galway Roscommon community services funded a very small number of clients up to the end of March 2012.

“However, since April 1st, 2012, Galway Roscommon community service has been unable to continue ArtAssist therapy as it does not receive funding for this service nor is it part of the agreed 2012 service plan for HSE West. The ArtAssist therapy was discontinued in County Mayo in 2008, as it was never a core funded service and again wasn’t part of the HSE West Service Plan.”

The HSE spokeswoman said the Primary Care Reimbursement Service (PCRS) had advised that expenditure for ArtAssist was not reimbursable to local health offices by the PCRS.

Three years ago, Mr Sultan met the then Minister for Health, Mary Harney, who approved funding of €200,000 for ArtAssist therapy. However, by the time the monies trickled down to him, all he got was €35,000 which had to be paid back to patients who had already paid for the therapy out of their own pockets.

“I have spoken to every available HSE manager in the country. They all tell me they believe me about the effectiveness of this therapy and they are behind me but the money simply does not exist. I have patients who cannot afford the therapy borrowing from credit unions and families or going to their local churches.”

A research paper by Mr Sultan on the use of the sequential compression biomechanical device in patients with critical limb ischemia over a four-year period from 2004 to 2009 was published in the Journal of Vascular Surgery last year. The study of 171 patients concluded that the device was a cost-effective and clinically efficient solution for the treatment of high-risk patients with non-reconstructible lower limb arterial disease.

His findings have shown the therapy provides ameliorated amputation-free survival, rapid relief of rest pain, and enhanced rates of ulcer healing.

In the recent past, Mr Sultan says, he has been contacted separately by two junior ministers who have heard about the therapy and want to bring its funding up for discussion before Minister James Reilly. He has 77 unfunded patients using the machine in the West of Ireland and up to 200 nationwide – patients come to his clinic in Galway from all over the country as they are the only team with expertise in using ArtAssist, according to Mr Sultan.

“We know the HSE is bankrupt and that it is a dinosaur that needs to be dismantled, but why should my patients suffer when for the cost of an amputation in one patient, we could save 60 others? Somebody needs to step in and find the money to fund this therapy which will save in the long-term expenses of amputation surgery, home conversion and in many cases, long-term nursing home care.”

Patrick Conneely (86) from Connemara, Co Galway, who suffers from critical limb ischaemia, was given a prescription for ArtAssist by his surgeon to prevent surgery or amputation.

As he was unable to access funding through the HSE, he has been paying for the therapy himself which is a significant financial drain on the household.

His daughter, Barbara Allen, says: “He was in severe pain, he couldn’t sleep at night or walk far because of the large ulcer on his heel. His toes are black, there is blood oozing from the tops of them and his legs are all swollen. Since he started the ArtAssist machine about a month ago, his foot is not as sore and he can leave it on the floor for longer.”

Barbara, who cares for her father full-time, explains that he may not be suitable for bypass surgery as he has heart problems. If he had to have his leg amputated, she would no longer be able to care for him at home as she is also the sole carer for her mother, who is bedbound following a stroke two years ago, and her own four-year-old daughter who has cerebral palsy and is wheelchair bound.

For more information on ArtAssist and how to access this therapy in Ireland, go to deprimo.ieor tel 091-762480