PEOPLE ARE at risk of dying unnecessarily because of the absence of a proper medical service for both victims of crime and individuals taken into custody, the annual meeting of the Irish Medical Organisation (IMO) will be told today.
Prof Denis Cusack, head of legal medicine at University College Dublin and coroner for Co Kildare, will tell the conference the neglect of this area by successive ministers for justice is "a disgrace".
"This is a health service issue as much as a justice issue, but the responsibility lies with the Minister for Justice," Prof Cusack told The Irish Timeslast night.
He added that he had written to both Brian Lenihan and his predecessor, Michael McDowell, but had not had a meaningful response from either.
He said research had shown that more than 50 per cent of people detained by police had active medical problems, with three-quarters of these taking prescribed medication. But, at present, there was no system for prescribing the necessary medication for the first 12 to 18 hours of a person's detention.
A 2006 study of detainees in London found that 56 per cent of people in custody had acute medical problems, while 74 per cent of these were taking prescribed medication. It revealed that mental health problems predominated but other medical issues among detainees included asthma, epilepsy and lung clots.
Prof Cusack said that, as a result, a dangerous situation existed whereby the lives of people with heart disease, asthma, epilepsy and diabetes were being put at risk. "In addition, the Garda Síochána are placed in a very difficult position, with no medical back-up."
He called for the 1987 custody regulations to be updated so that doctors can be called early in a person's detention to prescribe regular medication, review medical conditions and assess their fitness to be interviewed by gardaí.
The Republic's leading expert in medico-legal matters said there was a need for 10 to 15 full-time forensic medical examiners in the State, with a further 20 to 25 part-time specialists in the area. These doctors would be fully trained to deal with alleged assaults of people in custody, as well as forensic mental health issues, and would be expert in dealing quickly and sensitively with rape victims. The present forensic medical service structures were "ad hoc and patchy".
Describing the absence of a forensic medical service as a breach of article 40.3 of the Constitution and articles 3 and 6 of the European Convention on Human Rights, Prof Cusack said: "It is a failure when a detained person dies in custody for want of proper medical attention and protection and when gardaí do not have the medical support to provide for victims of crime and detainees."
Meanwhile, Prof Andrew Murphy from the department of general practice at the National University of Ireland, Galway told the conference that little was known about attendances and outcomes at private hospitals because they did not produce figures.
He warned that as these hospitals flourish, there was a danger more patients would self-refer to them for tests which they did not need and these tests could do them more harm than good.
"In particular, for screening interventions I would say where the patient is asymptomatic, there are very significant concerns about whether inappropriate tests done at the wrong time can cause harm," he said.
He stressed the importance of GPs referring patients to hospitals for tests and said integration between primary and secondary care, which would include that provided by smaller hospitals, was very important and had reduced rates of premature death here from cardiovascular disease.
But Dr Neil Brennan, a consultant physician at the Mercy University Hospital in Cork, told delegates the HSE was disregarding the importance of care provided at smaller local hospitals and staff morale in them was deteriorating.
As far as the HSE was concerned, "finance matters more than quality of care" in these facilities, he said. However, he said it cost less to treat patients in these hospitals than in larger hospitals.