A new report on troubled Cavan General Hospital has shown that many of the problems identified at the hospital following the death of a nine-year-old girl last year are still present. Eithne Donnellan, Health Correspondent, reports.
The report by the hospital's medical board points to a lack of clerical support throughout the hospital, which means patients' medical records may not always be available when they are needed.
When Frances Sheridan, from Cootehill, presented at the hospital's A&E unit with abdominal pain at the end of January last year, three weeks after having her appendix out, her medical records could not be found.
She was seen by two junior doctors who believed there was nothing seriously wrong with her and sent her home.
An obstructed bowel had gone undiagnosed and she died 36 hours later.
The medical board report, dated February 28th, 2005, was prepared for the Medical Council. Its purpose was to update the council on issues at the hospital since the council inspected it in the wake of the publication last June of a report into the circumstances of the girl's death. That report said medical records should be easily accessible on request.
The hospital medical board's report said lack of consultant trust in management continues and the medical board, made up of the consultant staff, is constantly reminded that it has no statutory or executive function.
It adds that there is ongoing lack of communication between management and the medical board over key issues on which communication should be possible.
"The communication between management and medical board remains dysfunctional," it says.
Furthermore, it says the report into the death of Frances Sheridan recommended that one paediatric trained/experienced nurse should be rostered on each shift because 30 per cent of attendances at the hospital's A&E department were children. However, this still hadn't happened.
"We consider this to be a serious and significant deficit," the medical board said.
The board's report, which has been seen by The Irish Times, also notes that staff are demoralised because of the lack of beds and resources.
Patients remain on trolleys in A&E while there are empty beds at Monaghan hospital. A plan for additional beds in Cavan, it says, has not been ratified by the Department of Health and at the current rate of progress a planned extension to the A&E unit, which is too small, will be several years away.
Furthermore, it states that a Royal College of Surgeons recommendation that three A&E consultants be appointed has not been met, and no clear structures have been put in place to develop any clear role of clinician in management despite numerous recommendations.
It also expresses concern that continuing bed shortages and an embargo on major surgery at the hospital means there is insufficient volume and complexity of work to maintain training standards and experience.
The medical board's report is the second in recent months to criticise the hospital. A separate report from the Royal College of Surgeons, following its inspection of the hospital in November, found the surgery unit to be in a "dysfunctional" state. It also referred to a lack of communication between management and consultant staff at the hospital and stressed that unless the situation was addressed, the entire unit may have to close.
Last night the Health Service Executive (North Eastern) Area said it required time to respond to the issues raised in the medical board's report.