Senior consultant admits removing Ennis A&E cover was ‘a significant mistake’

A SENIOR medical consultant has broken ranks by describing the removal of 24-hour casualty cover from Ennis and Nenagh Hospitals in April 2009 as a “very significant mistake”.

His comment comes as University Hospital Limerick (UHL) struggles to cope with surging Emergency Department admissions after its declaration of a major internal hospital incident.

The controversial removal of round the clock casualty cover from Ennis and Nenagh, which has been consistently criticised by the Mid-West Hospital Campaign has been thrust back into the political agenda following the intervention of a senior medic.

Professor Declan Lyons told RTÉ Radio One on Monday morning that some problems affecting healthcare in Limerick are separate to winter surges.

“Unfortunately, we’re in the unenviable position where we’re almost characterised as a national basket case at this stage,” he said.

He outlined that overcrowding issues date back to 2009 when the medical reconfiguration of hospitals saw a “very significant mistake made at that time when direct access to Ennis, Nenagh and St John’s Hospital for emergency care was withdrawn”, which took place following a review which found those hospitals could not provide critical ITU care safely.

“And so from that point on, huge numbers of patients, which normally would have gone to those hospitals were directed to UHL,” he said.

Only about 5% of all medical and surgical patients occupy critical care beds, according to Prof Lyons, meaning the challenge is then to “direct those patients that you think might need a critical care bed to UHL, but at the same time directing all other appropriate patients to their local hospitals”.

He said no one is suggesting an “all singing, all dancing critical care units” in Ennis, Nenagh and St John’s, but the real issue is how to land the 5% that need major emergency care while the majority of patients can be managed appropriately in their local hospital.

Citing the case of a West Clare man who is living alone, he recalled this patient who collapsed last week was brought past Ennis Hospital in an ambulance to UHL where he spent three days on a trolley only to go back to Ennis Hospital, which he should have been taken to in the first place.

He said the “chronic and persistent overcrowding in the emergency department” had created conditions that were in many instances “inhumane”, and not appropriate for the evaluation of patients, with trolleys often “crammed” beside each other, as staff compete for space around each.

He described it as a “very serious situation in terms of patient comfort, but also in terms of patient safety”, as it “simply isn’t possible to carry out an optimal clinical evaluation on patients given the extent to the overcrowding” in the ED.

“It is a very serious situation concerning patient safety. We have been advising our junior doctors to practise the best type of medicine you can under the circumstances. I am full of admiration for junior doctors, nurses and attendants who are working in the ED in the circumstances they are having to deal with.

“The main issue is the extent to which patients are crammed together side-by-side. When you come to examine a patient you barely have room between one trolley and the next. You are competing with this space with attendants who are trying to feed patients and nurses who are trying to take observations.”

Deirdre Culligan, Kilrush, said this is the first time in almost 14 years that a local medical person has admitted that closing 24-hour accident and emergency services in Ennis was a mistake.

She called for the restoration of casualty cover in Ennis and Nenagh Hospitals.

Professor Lyons’ views are at odds with recent statements from the Clinical Director of the UL Hospitals’ Group, Professor Brian Lenehan, who doesn’t support calls from the Mid-West Hospital Campaign to resume 24-hour casualty cover in Ennis and Nenagh Hospitals.

In a recent interview with the Clare Champion, Professor Brian Lenehan didn’t support any move to have another ED in the Mid-West, despite the fact the group is the only one along the western seaboard that doesn’t have a Model Three Hospital.

“I fundamentally believe as part of the additional bed stock we need a scheduled care hospital. That could be a new development or the development of one of our existing hospitals, but I don’t believe we need to go back to where we had more than one ED in the Mid-West.

“Emergency care, critical care, care for heart attack patients, stroke and multiple trauma all need to be centralised in one hospital. We are strong advocates for the Local Injuries Unit and Medical Assessment Unit model.”

There have been renewed calls for radical action after UHL was allegedly taken off-call for ambulance cover for a period last week, apart from very serious cases, ambulances spent long waiting times trying to access UHL, the number of patients on trolleys in the Mid-West totalled 113, and outpatient clinics were cancelled in UHL.

Newly-elected Taoiseach Leo Varadkar has been urged to take over responsibility for the health service after UHL took the unusual step of declaring a major internal incident due to unprecedented ED attendances.

The UL Hospitals Group has hired extra staff by asking nurses and doctors to present to the hospital for duty, redeploying staff to care for additional patients in the ED, opening extra surge beds in Ennis, Nenagh and St John’s, converting day beds in UHL to inpatient beds, focusing on discharging patients to home and community, converting a ward in Croom Hospital for medical patients and sanctioning only urgent elective surgery.

Deputy Michael McNamara has called on the government to move responsibility for the health service into the Taoiseach’s office like Tony Blair did when he became Prime Minister of the United Kingdom.

Following previous requests to the former Taoiseach Micheál Martin, Deputy McNamara said Deputy Martin refused to show any leadership to address this ongoing issue.

Citing the tragic case of Shannon teenager Aoife Johnston who died in University Hospital Limerick after contracting meningitis, the independent deputy he confirmed he had spoken to Taoiseach
Leo Varadkar about this issue and stressed the promised inquiry needed to happen quickly.

“The length of time that anyone with meningitis spends on a trolley is unacceptable regardless of the impact that ultimately has. I don’t think anyone would suggest a 16 year-old with meningitis should be on a trolley.

“We have to be sure this doesn’t happen again. The government has to resource UHL and make sure there is a management team in place that can manage existing resources because neither are happening, according to the HIQA report on the ED in UHL.”

Deputy Violet Anne-Wynne has written to Health Minister Stephen Donnelly seeking a meeting between Mid-West Oireachtas members and the Department of Health to discuss chronic overcrowding at UHL.