Mutiny in the Ranks

The Irish Nurses Organisation (INO) is escalating it’s campaign against the proposed spending cuts in the health service. It has launched a new website Stop Health Cutbacks to monitor the level of cutbacks proposed by the Health Service Executive (HSE). Hospital staff and members of the public are invited to post comments online on what their experience of cutbacks has been and to air their views on how the services could be improved. All material will be validated before publishing and patient confidentiality will be protected at all times. Liam Doran, General Secretary (INO), has stressed that the overriding aim of this initiative is to demonstrate in detail where the system is failing patients.

The non-consultant hospitals doctors (NCHD) are also up in arms with the latest decision by the HSE, to cut their overtime and allowances.

Six junior doctors have begun a High Court challenge, along with the Irish Medical Organisation (IMO), against the HSE. The IMO and the doctors claim that the HSE’s proposals are a breach of contract. They further claim that the proposed changes are impractical and will damage the functioning of the various departments in the hospitals where they work.

Next month’s emergency budget will radically affect healthcare in this country and it will be patients who bare the brunt of the further cutbacks. It is essential that everyone plays their part to ensure the highest possible standards of patient care in the difficult times ahead. Make your views known before it is too late.

A Terrible Blunder

Last April a young boy was admitted to Crumlin Children’s Hospital in Dublin, to undergo surgery to have his defective right kidney removed. It later emerged that his healthy left kidney had been removed in error. Today a report has been released following an independent investigation into the tragedy and it’s revealed a shocking catalogue of contributing factors which led to the mistake.  It was described as “an accident waiting to happen”.

When news first broke of this medical blunder, it seemed incredulous that such a terrible mistake could occur at the country’s leading children’s hospital. It has now transpired that the consultant general surgeon who recommended the surgery, mistakenly listed the wrong kidney on the surgical request form.  When the child was admitted to the hospital, a junior doctor filled out a consent form for the parents to sign without referring to the clinical notes on the child and again the wrong kidney was listed for removal. The child’s operation was carried out by a senior surgical registrar who had not examined the child on the ward before he was brought to theatre. This surgeon proceeded to remove a perfectly healthy left kidney leaving the unfortunate child with one poorly functioning right kidney.

The investigation carried out by experts at London’s renowned Great Ormond Street Hospital, outlined ten contributing factors to the botched surgery. These included delays in filing hard copy x-ray reports in the medical records, patients being regularly admitted outside of working hours and the heavy workload of doctors at the hospital. The report found that there was no policy in place at the hospital to mark the site of the procedure and that the surgeon didn’t have access to scans for reference at the time of the surgery. It also found that there was no fail-safe system to ensure a patient having surgery had their case discussed by a range of experts. It said the operation was carried out by a paediatric surgeon who hadn’t met the patient beforehand and when the blunder became obvious, it was too late to do anything about it. The report made eight recommendations to ensure the mistake is not repeated, including:

* The hospital should formally monitor the hours junior doctors work. Overwork was stated as a contributory factor in the error over the consent form. It’s a well-known fact that junior doctors are expected to work horrendously long hours resulting in serious sleep deprivation and it’s inevitable that mistakes will occur if their workload is not properly regulated or supervised.

* Surgeons should introduce team briefings at the outset of each theatre list to discuss patients. The surgeons at Crumlin Hospital have an enormous workload and are working under huge pressure to reduce long waiting lists.

* Radiology and x-ray systems should be reviewed. No up-to-date scan was available on the child for reference during the surgery.

* Consent processes should be revised. A hospital spokesperson admitted that the family had repeatedly raised concerns and questioned if the correct kidney was being removed, up to and including the time of handover to theatre.

This tragic case will undoubtedly raise concerns for the parents of any child who is presently awaiting surgery. The report has clearly outlined the need for extra safety measures to be implemented for children undergoing surgery. It has also raised the issue of doctors working under too much pressure in a hospital system that is stretched to the limits. Thankfully, the hospital appears to have handled the situation correctly as it’s taken full responsibility for the tragic error and has offered an apology. The child’s parents are happy for the child to continue to receive treatment at the hospital and have requested anonymity. One can only hope that the child will be a suitable recipient for a kidney transplant in the future and that lessons will have been learnt to prevent a tragedy like this ever occurring again.

Some Day…

Do you have health insurance or is this something you’ve put off until another day? If you’re young, fit and healthy, the chances are you’ve never really given your health much thought. Why would you worry when you haven’t had to face huge medical bills? With the rapid privatisation of our health service, health care in Ireland is becoming more like the 2-tier system in the States. Those with insurance will get top dollar care while those without, will suffer.

About five years ago, my GP sent me urgently to the A&E department of our local public hospital as I had developed acute abdominal pain. I was processed by the triage nurse and allocated a trolley in a cubicle so that the doctors could assess my condition. Once my blood tests had come back from the lab, the decision was made to admit me overnight in case I needed to go to theatre. I was put on a drip (nil by mouth) and lined up on a trolley in the centre of the department along with scores of others, in a queue for a bed. I hit lucky on that particular occasion and was transferred to a ward in the middle of the night. By the following day, my abdominal pain was severe (my intestine was blocked by an abscess) and it was decided that a CT scan should be performed to ascertain if surgery should be performed. I was started on intravenous antibiotics while I awaited the scan but kept fasting in case surgery was required. This was bearable until a harassed looking junior doctor appeared at my bedside to announce that the CT scanner had broken down and was awaiting repair. By the following morning (day 3), the scanner was still out of action and my situation was beginning to look very bleak. Around lunchtime, the same doctor rushed in and asked me to confirm that I had private health insurance. I did, thankfully, so the decision was made to transfer me to the private hospital, to avail of their scanner. The scan confirmed a diagnosis of acute diverticulitis with obstruction of the bowel but it was seen to be resolving so I could finally be taken off the emergency list. Had I not had health insurance, I hate to think that I may have ended up having investigative surgery as no scanner was available to make the diagnosis. Please don’t get me wrong here, I received excellent medical care during my 10-day stay in this public hospital and was very grateful for it. However, the system was clearly in overload and patients were suffering as a result. My insurance was worth every penny to get the care I needed when I needed it most.

Health insurance is a complicated business. It’s designed this way so that the insurers are protected against excessive charges by private doctors and also to restrict patient benefits. There are three main insurance groups in Ireland and they each purposely have slightly different health plans so that it’s almost impossible to compare like with like. I have spent vast amounts of time over the years, trying to work out which plan offers the best deal for my family. It was years before I realised that each member of the family can hold a different policy to meet their individual needs but don’t expect your insurance company to tell you stuff like this, ‘cos they won’t. I review our policies every year to see how we can reduce costs yet still retain adequate cover for both emergencies and day to day care. There are all sorts of clauses to catch you out, so be careful what you change. And remember, it’s too late to look for insurance when you’ve already become ill because penalties will abound. You have to put in the work yourself if you want to see improved benefits. I long ago gave up hoping that an apple a day would keep the doctor away.

Medical Error

Disturbing news has emerged today from an inquest into the death of an elderly man at the City Hospital, Belfast in 2005. A junior doctor at the hospital gave him an overdose of insulin (he administered 100 times the correct dose) causing the man’s kidneys to fail and he died a short time later from a heart attack. The patient had undergone surgery for an aneurysm (blood clot) in the knee and while he had a number of life threatening conditions, the inquest found that his death was most likely attributable to the medical error. The junior doctor, in a letter to the coroner, stated that he had not received any instruction in the handling of insulin. There was no mention of an apology to the family of the deceased.

This incident does little to inspire patients’ confidence in the medical profession. It begs the question as to why a junior doctor who was clearly ‘out of his depth’ in prescribing medication, should have failed to seek advice from a more experienced colleague – a senior nurse or doctor. The medical profession should have come out today with their hands up to explain the circumstances of this case, and to apologise. We were simply told that the junior doctor in question no longer works within the UK hospital network. That is not good enough! Patients need reassurance if they are to put their trust in the medical profession. Is it any wonder that the practice of medicine is now hugely threatened by litigious claims from patients/relatives who are dissatisfied with the treatment received? An apology is so often all that is required.

This has reminded me of an incident I experienced as a patient many years ago. I was undergoing intensive antibiotic treatment at the time with two different antibiotics. One antibiotic was administered in diluted form via an intravenous drip. The second antibiotic (the name of which I can no longer recall) had to be administered undiluted, by injection. This drug was very hard on veins and in order to prevent it collapsing the veins, it had to be injected very, very slowly into a cannula in my arm. Each treatment with this particular antibiotic involved two syringes – one large one which contained a harmless solution to ‘flush’ the vein out both before and after the treatment, and one smaller syringe which contained the antibiotic. The night nurse duly arrived with her injection tray and proceeded to flush out my cannula/vein with the first syringe. Within seconds I experienced severe pain travelling up my arm and I was completely consumed by it’s intensity. Very quickly though I realised that the nurse must have mixed up the syringes and once I’d recovered my senses, a quick glance at her injection tray confirmed my suspicions. By this stage the nurse had become very flustered and it was clear that she too realised her mistake. When the pain finally started to ease I told the nurse of my suspicions and to my horror she completely denied the error. The evidence was there to see but she was having none of it. She continued to insist that what she’d injected was the ‘flush’ solution. The fact that she looked like the ‘She Devil’ (remember that TV programme?) did little to improve my confidence in her and I refused to let her to continue to administer my treatment. It was so obvious that she had made a mistake but she was never going to admit that fact. She left my bedside to telephone the house doctor to request the insertion of a new cannula as the vein had collapsed from the abuse received. I never saw her again.

I considered making a formal complaint about her but I never did so because I was concerned that it would impact on my overall treatment in the hospital. As a patient, you feel somewhat vulnerable when in hospital and tend to put up/shut up rather than cause a scene. That nurse was very lucky that she didn’t cause more harm through her carelessness. She could have killed me had the drug been a more toxic one or had I been a frail, elderly patient who may not have been able to withstand the shock to the system. I regret that I never complained officially about her and I can only hope that she learnt something from her mistake. After today’s news though, I’m not so sure.

Do you have a view on this? Please let me know what you think by leaving a comment on this post, or if you prefer, you can email me at biopsyreport@gmail.com

Junior Docs risk Burn-Out

The final (repeat) episode of ‘Junior Doctors’ lived up to expectation last night. Catherine, Paddy, Paul, and Sinead ‘survived’ their year as interns which they completed at the end of June last year. All were in agreement that they’d been on a huge learning curve but at a huge cost. Talk about mental and physical torture – it’s really inhuman what’s expected of our Junior Docs! And I’m not the only one to think this. Burn-out is a real issue. The problem is that the good ones get burned out as well as the ‘not-so-good’ and potentially fine doctors are lost to another profession. You couldn’t help but notice that the patients too are pawns in this crazy training scheme. As Sinead confirmed, it’s unfair on the patient to have one of these exhausted Docs attempt to insert a cannula when they’re ‘drunk’ with tiredness. I’ve been there, and while I have great sympathy with the junior doctors, I can tell you it’s not much fun being on the receiving end of this sort of treatment.

The series ended last year with an update on each of the four interns. It’s seems that each of these bright young things had their dreams come true. Catherine wants to be a surgeon (a Consultant, no less) and had commenced her training (a very long haul) as an Surgical SHO in St. James’s Hospital Dublin. Paddy who also had his heart set on surgery but had some doubts creep in, did the sensible thing and took a complete break from medicine while he completed 10 weeks in flight school to get a pilot’s licence before commencing work in Emergency Medicine in Sydney. Paul left Dublin for Waterford to begin his training in Orthopaedic Surgery, while Sinead got her wish to return to country life to train as a General Practitioner.

This series was an excellent ‘warts and all’ insight into the life of an intern. Intending medical students need to know the real story before they embark on this arduous career path. Let’s hope that Mint Productions keep up the good work and bring us another update on the progress of these four Doctors-in-the-making. I’d place bets that we’ll see Paddy as a HEMS (Helicopter Emergency Medical Service) doctor before too long!

Junior Doctors

Another excellent four-part series by Mint Productions is being repeated on RTE 1 television (Mondays 11.45pm). Part 1 was screened last night and this ‘real-life’ medical drama should not to be missed by anyone thinking of studying medicine. Mint Productions also produced Surgeons, another brilliant series featuring the lives and daily work of Irish surgeons.

‘Junior Doctors’ is a fly-on-the-wall documentary series which follows the plight of four interns – Paddy Barrett, Catherine de Blacam, Sinead Beirne and Paul Carroll – over the course of their first year as junior doctors at St. Vincent’s University Hospital, Dublin. As ‘interns’ they are on the lowest rung of the medical ladder. It is an incredibly hectic and demanding job where these junior doctors are expected to work 80+ hour weeks at the coalface, in life and death situations.

This is definitely not a job for the faint-hearted. The programme gives a very good insight into the life of interns as they come to terms with the incredible hardships, compromises and rewards of their chosen profession. It was interesting to witness last night how a simple, mundane task such as remembering the code to unlock a door, could become a real issue for over-worked and exhausted junior doctors.