Sir, – I refer to the cover story of The Irish Times Magazine, (August 6th), and particularly the comments ascribed to Bill Hughes regarding the treatment provided to the late Vincent Hanley at St James’s Hospital in 1987. As the consultant in charge of his care, I feel I should comment.
Mr Hanley, when he returned from New York, was admitted to a private hospital in Dublin. That hospital realised that it did not have the capacity to treat him and asked me to accept him as a patient. This was prior to Prof Fiona Mulcahy’s appointment and there was no structured service for Aids care anywhere in Ireland. As a medical oncologist I had knowledge of opportunistic infections which occur in cancer patients independent of Aids and Kaposi’s sarcoma, mentioned by Mr Hughes, is a malignancy which can occur in Aids and in other contexts. Care was given on a specialist ward catering for patients with malignancy and blood disorders. Mr Hughes describes the conditions as antiquated but they were what was available in Ireland at the time and housed the National Bone Marrow Transplant Unit and the National Haemophilia Treatment Centre. Single- room accommodation was provided and any isolation procedures were entirely appropriate given the needs of all patients receiving care on the unit. I can recall a senior diplomat from a foreign state being treated for leukaemia around that time in the same environment and being entirely happy with his care.
I cannot comment on the Foxford rug. Whatever about the physical facilities, I can vouch for the expertise of the staff and, while Mr Hughes and others may have given support to their friend, nursing care was confidently and compassionately provided by an excellent team of nurses. The medics and others did their best too against the background level of knowledge which existed at the time. Patient confidentiality was a major consideration in the circumstances. It is, therefore, a disappointment to see issues of a personal nature aired again publicly, even at this remove.
My memory of events surrounding Mr Hanley’s death are particularly vivid since I was with him on the Saturday morning when he died and was called to the telephone to be told by my wife that her father had died suddenly.
Almost immediately I had to meet my patient’s parents who were poorly informed about his condition and unprepared for his death. I had to discuss many difficult issues with them. Personally, this meant that it was a considerable time before I could be with my wife and share her grief.
Media interest was acute and elements of the press hovered for information (none forthcoming) and particularly desired sight of a death certificate which would contain details of the illness. Since there is no legal obligation to issue a certificate of the cause of death for up to a year after the event, with his parents’ consent I decided to wait. It is a tribute to all involved in his care that no details emerged in the succeeding months.
I personally took the certificate to the Registrar of Births, Marriages and Deaths during the week of December 21st, 1987 so that his death could be registered. I hoped that the press would be in a state of torpor at that time of year. To my disappointment, the information was in the papers early in the New Year. Evidently practices, similar to those recently seen with News International were in place even then.
Part of the joy of being a doctor is to learn constantly and to do what is humanly possible as a professional at any given time. We seem to be experts in this country at measuring the past in terms of today. We were all trying to do our best back then and I am happy to give another view of the story. – Yours, etc,