Failure To Diagnose

Headaches are a common symptom of many conditions and almost everyone will experience headaches at some point in their lives. Normally the average headache is nothing to worry about, despite the discomfort you might be experiencing. However, if you get a severe/sudden headache unlike any you have had before, you should always seek medical advice. Sometimes, a headache can be a warning of something serious that needs to be investigated so don’t delay in seeking help.

As I have a long history of chronic sinus infection, I’m well-used to getting headaches. I don’t panic when a headache occurs as I’m familiar with the signs and symptoms of acute sinusitis and have the necessary prescription medications to relieve the pain. However, if I develop a severe headache that I’m not familiar with/it continues to worsen, I will always seek medical advice. If the headache is considered a cause for concern, my GP/specialist will refer me for an urgent CT/MRI scan in order to rule out any serious cause. As I hold private health insurance, I rarely have to wait longer than 24 hours to undergo a scan. If, however, I had no health insurance and was a patient in the public health service, the story could be very different…

THE HSE has apologised before the High Court to the family of a young woman over deficiencies and failures which led to her death from a massive brain haemorrhage. The apology was part of a settlement of court proceedings.

“Louise Butler (21), Cappa Lodge, Sixmilebridge, Co Clare, died at Limerick Regional Hospital on November 16th, 2006, from a large subarachnoid haemorrhage, the court heard. She had worked as a security guard at Shannon airport.

Her family claimed the HSE had failed to properly diagnose she was suffering from the condition when she presented at the hospital just weeks earlier suffering with a serious headache.

Had she been properly diagnosed and referred for treatment after being admitted on October 6th, she would probably have survived, they alleged.

As part of the settlement yesterday of the family’s action for mental distress, the HSE apologised for the anguish and distress caused to the Butlers due to Louise’s tragic death.

The HSE also acknowledged there were failures and deficiencies which led to Ms Butler’s death and accepted her family did everything it could in the circumstances.

The settlement also includes a payment of €40,000 to Ms Butler’s family and was approved yesterday by Mr Justice Michael Peart. The action was brought by her brother James, Cappa Lodge, Sixmilebridge on behalf of the family.

They claimed they suffered mental distress and injury arising from their older sister’s death due to the HSE’s alleged negligence and breach of duty of care. The HSE had denied the claims.

The family claimed Ms Butler’s attended the hospital between October 6th-12th. It was claimed she was ill with a very substantial headache, which she had described as like “a hammer blow” to the back of her head, and photophobia.

She was discharged on October 12th without a CT scan being carried out. She was due to have a CT scan subsequently as an outpatient.

Despite the best endeavours of Ms Butler’s mother and the family GP it was claimed the scan was not arranged until November 13th. It was claimed Ms Butler never got the results of that scan as she collapsed the following day. The scan revealed she suffered a massive bleed in the brain and she died two days later.

It was alleged the HSE had delayed a CT scan which would have alerted medical staff to the existence of her condition. The family claimed their experts would argue, in October 2006, Ms Butler was suffering from a “sentinel” or “herald” bleed, which was a precursor to a large bleed.”

Information Source: The Irish Times 13/07/10

Green to Go!

At long last, I’ve got an answer. Funding for the surgery has finally been prior approved by my health insurer. I’ve got the green light!

I’m off to pack my bag. Thanks everyone for your support.

When you need us, we’re there

The VHI pride themselves on being there when you need them. I’m due to undergo revision surgery in the UK next Friday. The arrangements have been made, flights and hotel are booked but if the pen pushers in the VHI don’t get their act together, it will all be cancelled. Facing surgery is never an easy task but when you have to fight to get insurance cover for it,  it can be soul destroying. Surely it’s not right that a health insurance company can hold you to ransom like this?

People associate VHI Healthcare with excellent hospital cover. I’ve been insured with them since childhood and with my medical history, it’s fair to say that I’ve given them a good run for their money. With medical costs soaring, holding private health cover should offer peace of mind. However, should you find yourself in a position where you require treatment that is not available in Ireland, be warned! There is no guarantee of insurance cover.

No matter what level of insurance you hold, you will be made to grovel for treatment abroad by a process called ‘prior approval’ and if you fail to tick all the right boxes, cover will be refused. What really bugs me about this process is that it interferes with patient autonomy and the doctor-patient relationship. The VHI make the decisions.

The VHI state in their terms and conditions that “VHI Healthcare does not provide cover if a member travels abroad specifically to get treatment. However, in exceptional circumstances and subject to prior approval and satisfaction in full of specific criteria, we will pay up to the plan amounts outlined in the Table of Benefits.”

I was first sent ‘abroad’ for surgery in 2007 as treatment options in Ireland, had run out. The VHI subjected me to the process of prior approval and despite meeting all the specific criteria, my application for funding was turned down. This caused untold stress at a time when I was facing major surgery. The funding was subsequently granted on appeal and the operation went ahead as planned, in Nottingham.

I was referred back to the UK last year to undergo further radical surgery. Again, the VHI insisted on prior approval and again my referring consultant was asked to complete an in-depth questionnaire and supply academic evidence to support the proposed surgery. On this occasion, funding was sanctioned on the first attempt but the VHI kept me on tender hooks right up to the week of surgery.

Two weeks ago, I travelled back to Nottingham for a consultation with the surgeon who last operated on my head. I was referred back to him with a post-operative complication which has failed to respond to treatment in Ireland. The surgeon advised that some revision surgery is required. On contacting the VHI on my return, I was informed that prior approval must be sought for any surgery outside Ireland.

I have spent the last 2 weeks trying to get the revision surgery ‘approved’ in time. If it has to be cancelled, I will have to wait another month for surgery. On phoning the VHI last Friday, I was informed that I would be notified by post of their decision. When I reiterated that the matter is urgent, I was asked to phone again on Tuesday. That’s two days before I’m due to travel to the UK and there is no guarantee that my application will be approved.

“When you need us, we’re there”

Well, I need the VHI now so where the hell are they?

‘Cos you deserve better

Have you noticed the sudden upsurge in radio and TV ads for private healthcare? Frankly, they sicken me.  “Because you deserve better” quotes one ad for a state-of-the-art private hospital. Because who exactly deserves better? Answer: Those who can afford private health insurance. But what about those who can’t, I ask? Don’t they deserve better too?

I hold private health insurance and I make no apology for it. I’ve a complex medical condition which requires regular medical supervision. Unfortunately, I cannot rely on our public health service to provide the care needed. Our health system has been so stripped of services that ‘public’ patients face long delays in accessing out-patient appointments and treatment. Privately insured patients can access care faster by paying for it. Such is the inequity of a 2-tier health service. Emergency care is different, it’s provided on the basis of need only. The delay in the public system, is putting people’s lives at risk. Remember Susie Long? I’m not prepared to risk my health because of our government’s failure to provide an equitable health service for all. I therefore see my health insurance as a priority, not a luxury. I choose to do without other non-necessities in life so as to afford the health insurance. I’m lucky to have that choice. Many don’t.

In these difficult times of recession, many people are struggling to maintain a roof over their heads/to afford enough food to feed the family. The advertisements for private healthcare appear very inappropriate in the circumstances. Of course, the real reason why these companies are advertising, has nothing to do with your welfare or mine. They are desperately trying to survive too.

Our Minister for Health has gone terribly quiet!

Dear Mary

To: Ms Mary Harney, Minister for Health & Children

I’m writing to let you know my views on the public health service. Having spent three days last week residing in the busy A&E department of a large teaching hospital, I feel qualified to comment. The experience has left me wanting answers to many questions. Please listen to what I have to say.

Last Friday my doctor sent me to A&E for emergency care as I’d developed a serious complication following surgery some weeks earlier. On arrival in A&E, I was rapidly processed by a triage nurse and seen by the registrar on-call. An immediate decision was taken to admit me to the hospital. I finally reached a ward on Monday afternoon! During the 3 days and nights spent in A&E, I was extremely well-cared for but the conditions were hell. The staff were so busy, patients had long waits for help. It was like being in a war zone, people lying on trolleys everywhere with further casualties arriving by the hour. It was also extremely noisy with little or no privacy. These conditions do not aid recovery.

My first question to you, Mary,  is this… why must sick and injured people be exposed to these awful conditions in order to be admitted to hospital? Where are the 1,000 extra beds you promised when you took over as Minister for Health 5 years ago? I sure could have done with one of those beds last Friday.

It was a great relief when I was finally transferred to a 4-bed semi-private ward where I remain. I’m receiving excellent medical and nursing care here. Thankfully, this hallmark of Irish healthcare remains intact despite the inadequate funding of our public health service. I’ve no doubt that this is due to the dedication of the staff who work in frontline services. The unit I’m in, has been recently refurbished and is beautifully fresh and clean. I’ve no complaints really except I’d obviously prefer to be in my own howm. The catering is good, plenty of good nutritional food and frequent offers of hot/cold drinks. I’m very aware that this aids a speedy recovery and subsequent discharge from hospital.  I’ve not always hit this lucky.

Over the years,  I’ve spent many weeks as a patient in this same hospital, on the public wards.  It has always been a grim experience in terms of patient comfort, lack of facilities etc. I don’t think much has changed although I have heard that hygeine levels have improved on the big wards. My medical history is extensive so I choose to hold private health insurance to ensure that I can get care when needed. My case is complex and so I cannot be admitted to one of the smaller private hospitals for treatment although I’m fully insured to do so. These smaller hospitals cannot provide the care I require.

I want you to know, Mary, that it’s distressing to observe your clear policy of starving the public hospitals of funding while you promote the development of co-located private hospitals. The staff who work at the frontline in our public hospitals, are fantastic but they are being stretched to the limit to provide the care needed in our under-resourced public hospital system.  I plead with you to stop bleeding our health service to death while you continue to promote an inequitable health service. Give us a break, Mary.

The semi-private unit I’m in, is excellent. I do not need for anything better as all my needs are being met here. I’ve hit lucky on this occasion as this is the most comfortable unit in the hospital. However, the WHOLE hospital should run like this unit. Instead, the majority of the rest of the hospital is no longer fit for purpose. It’s time to put our health resources to proper use. Surely everyone deserves fair and equitable healthcare?

I look forward to hearing from you.

Steph @ The Biopsy Report

Check ‘N Go

I’ve booked so many flights over the last few days, I really don’t know whether I’m coming or going. I seem to have multiple trips to Nottingham booked and also a return ticket to London for Wimbledon but I’ve a little hurdle to get over between now and the tennis.  I’ve got a date (not THAT sort of date, Grannymar) and I’ve got funding too.

It’s been some week.  Since hearing of the date for my surgery in Nottingham, I’ve been struggling to get funding organised for the operation. When you require treatment outside Ireland, my health insurance company stipulates that you must gain prior approval for funding. There is a long list of criteria to be met and even though I hold comprehensive insurance, funding is automatically refused if surgery proceeds without prior approval. As very short notice was given for my surgery, an urgent application was submitted for approval and we waited with baited breath all week. Thankfully, the green light was given on Friday so now my surgery can proceed.

I travel to Nottingham early tomorrow for admission to a specialist unit at the hospital where I will be prepared for image-guided surgery on my head the following day.  A recent CT scan has revealed further osteomyelitic changes in the bone above and behind my right eye. This diseased bone is in close proximity to the frontal lobe of my brain hence complex surgery is required. Years of severe sinus infections with abscess formation have left the area well-scarred.  All being well, the endoscopic surgery should be completed in 2-3 hours and I hope  to be able to return to Ireland by early next week.  That’s when the fun really starts.

Surgery for chronic osteomyelitis involves detailed follow-up. Long-term antibiotic treatment is required and I will also have a drain exiting near my eye for several weeks post-op. This drain will be used to irrigate the operated area daily with targeted drugs.  I will be taught how to carry out this procedure myself while in hospital so that treatment can be continued at home. I will then return to Nottingham again for review and to have the drain removed.

When I first heard of the date for surgery, my heart fell as I have two tickets for a day at Wimbledon. I entered my name into the public ballot last autumn and hit lucky by getting two tickets for Court No 1.  This was like a dream come true so I didn’t hesitate in purchasing them along with flights to London.  News of my surgery initially dashed these plans but I haven’t quite given up hope yet.

My review in Nottingham happens to be on the day before I was due to travel to London to attend Wimbledon. I will fly to Nottingham for the check-up and overnight there before returning to Dublin.  However, I have a second plan up my sleeve which if it works out, will be a real coup. If I feel well enough after my check-up, I plan to travel on to London by train to overnight with my twin brother who will accompany me to Wimbledon the following day. I’ll then spend a second night in London before returning home on the flight I originally booked many months ago.  This probably all sounds a bit daft right now but it’s where I have my sights set. If I do make it to Wimbledon, it’ll be the best tonic ever.

My long suffering hubby will be with me in Nottingham and so I hope to have occasional access to his laptop while in hospital. I will do my best to update you on my progress and promise not to scare you with any gorey details. I would really welcome comments and while I may not always get to answer them, I would still love to hear from you.  On that note, it’s time for me to Check ‘N Go and get organised for tomorrow. I’ll be back soon!

A Real Supergran

I feel very out of touch with the blog world.  It’s been a roller coaster week here.  It’s got to the stage where when the phone rings, my heart falls.  No news, really is good news.

It all started on the day of the Heineken cup rugby final when my father was rushed to hospital by ambulance with chest pains. After an anxious wait in A&E, news came through that his pain was non-cardiac in origin and so once my dad’s condition had stabilised, he was discharged back to the nursing home.

The following day, my mum-in-law’s health suddenly deteriorated and we were told that her end was nigh. Thus begun a round-the-clock family vigil at her bedside which lasted for five days.  She died peacefully on Friday surrounded by her nearest and dearest. Her funeral will take place next weekend when family and friends will gather from around the world to celebrate a dear life. She was a wonderful mum and a real supergran and will be deeply missed.

In the midst of all this, my son Robin woke last Friday morning with a very swollen foot. He was due to leave at lunchtime on a walking holiday with friends so we had to act fast. His problem was solved by a visit to a VHI SwiftCare Clinic which had him assessed and processed in less than one hour and on his way to Kerry. The following morning Robin phoned to say that the swelling had moved up his leg and a phonecall to SwiftCare confirmed that he should return home.  I collected him off the train several hours later and ferried him back to the clinic for re-assessment. Again, Robin was seen very quickly and thankfully, this time the news was better. He was instructed to rest-up and allow the antibiotics to take effect. SwiftCare is a privatised clinic funded by a health insurance company, to deal with minor injuries and illnesses. I could not fault the care that Robin received there. It would have been a very different story had we attended the A&E department at our local hospital. By lunchtime today, Robin was back on the train to Kerry to re-join his friends.

Thankfully, today has been a rest day.  There’s been no news as yet on a date for my surgery.  Right now the silence from Nottingham, is a welcome reprieve.

Equity of Care?

Misdiagnosis and inappropriate treatment are common concerns for individuals suffering from a serious medical condition. In Ireland more than 1.5 million people can access a second opinion service at no additional cost to themselves. Best Doctors helps people facing serious illness to get the most appropriate care. It’s unique database has harnessed the knowledge of over 50,000 doctors identified by their peers as the best in their specialities. Access is available through three insurance companies in Ireland – VHI Healthcare, Hibernian Life & Pensions and Combined Insurance (IRL) – who pay an annual fee for the service.

The service operates as follows. An insured person who is diagnosed with a serious illness, has the option of having their case reviewed by Best Doctors. On the patient’s request, the health insurance company arranges for Best Doctors to contact the patient. A Nurse Advocate is then assigned, who contacts the patient or their doctor for a copy of all the patient’s medical records. Using their database, Best Doctors identify the most appropriate specialist from around the world to assist in reviewing the patient’s case. The selected specialist(s) comprehensively reviews the test results, diagnosis and prognosis and a report is sent to the patient and their doctor. Doctor patient confidentiality is maintained at all times throughout the process. Patients wishing to have Best Doctors review their medical file continue to have medical care with their own consultant who now has the back-up of other world renowned specialists.

This all sounds very reassuring until you realise that almost 50% of the Irish population hold no insurance cover added to which, not all health insurance companies pay into the scheme. Surely every patient facing serious illness, should have access to the best and most appropriate care available? Do all patients not deserve access to the skill, experience and insight of these highly trained doctors? Nope, sorry! Unless you’re a member of an insurance company which is participating in the scheme, access is denied. It seems care is given based on a person’s ability to pay for health insurance instead of their medical need. There is a fundamental struggle going on over the soul and shape of Irish healthcare.

Battling On

I turned on the news this evening to hear that 909 patients around the country are waiting to have a colonoscopy and some of those people have been waiting for more than two years. In December, our Minister for Health told the HSE to comply with a target of access to a colonoscopy within four weeks of being referred by a doctor. I had a private consultation with a gastroenterologist this afternoon and have been booked for an urgent colonoscopy next Monday morning. This sadly, is the difference between public and private health care.

Unfortunately, the antibiotic I’ve been on for the past 8 days (Vancomycin), has failed to bring a nasty colitis under control. After almost six weeks of worsening symptoms, I’m in real need of help. While this means having to go through a dreaded colonoscopy again, right now that seems like a doddle compared to my present circumstances. The diagnosis is most likely to be an antibiotic-associated colitis caused by the ongoing treatment for the chronic infection in my head. However, biopsies are required to confirm this and also to rule-out other possible causes, such as Crohn’s Disease.

While queueing to see the doctor today,  I received a call from another doctor’s office. The surgeon in the UK has requested a CT scan of my skull before I travel to Nottingham for a review consultation. My surgeon in Ireland has organised the scan for tomorrow and I will travel to the UK in a couple of week’s time to receive the verdict. It’s certainly been all go today.

The reason I’m able to access prompt medical care for my health problems, is simply because I hold private health insurance. The policy is a huge burden on our family budget each year but I cannot afford to be without it. The delay in accessing investigations in our public health service, is costing lives. It seems that little has changed since the untimely death of Susie Long who succeeded in highlighting the inequities in the system. The Irish Cancer Society has described the waiting times as unacceptable. I’d describe the situation as scandalous and it’s time the HSE was held accountable.

RTE News Bulletin

My Two Cents

The HSE is facing more than a €1 billion shortfall in it’s finances this year. Are we surprised? I don’t think so. The HSE is a faceless organisation wasting millions of taxpayer’s money every year to fund it’s quagmire of management levels and all at the expense of frontline healthcare. In a bid to address the budget deficit, the HSE is devising a major cost cutting plan to downsize our health service and you can be sure that it won’t be the HSE to suffer the consequences. While waiting to see a specialist yesterday in an over-crowded out-patient clinic at a large public hospital, I came up with some alternative ideas for the HSE to consider. Instead of solely concentrating on cost-cutting measures in our hospitals, I would suggest that the HSE would be well-advised to look at opportunities to complement our health service.

For starters, let’s look at the area of catering in our hospitals. The catering budget  must be astronomical and yet the wastage of food is phenomenal. Over the years, I’ve had many stays in hospital and I’ve often joked that this provides a saving on the family budget as my board and lodgings when in hospital, are fully covered by my health insurance. I pay dearly for health insurance and am fully entitled to this return. All medical card holders when admitted to hospital, are entitled to free care in our public health service. Those patients who are not entitled to a medical card and who do not hold private health insurance, pay a small daily levy for in-patient care. The point I’m trying to make here is that everyone regardless of income, has to budget for their daily nutritional expenses so why should the State or an insurance company be expected to pick up the tab for our food requirements when we’re in hospital? I guarantee you that if patients were  charged for their meals, the wastage of food in hospitals would be radically reduced.  Granted a lot of hospital food is inedible but again if patients were subsidising the cost, the standards would automatically improve.

Another aspect of hospital care which should be addressed, is the way out-patient clinics are managed in our public hospitals. There is no charge for appointments or investigations once a patient is in the public system and like all free services, it is open to abuse. By comparison, those who hold health insurance, must pay-as-they-go to be investigated within the private system, the difference being of course that they enjoy the benefit of shorter waiting times. While private health insurance is fairly comprehensive for in-patient expenses, out-patient expenses are generally poorly reimbursed. I would like to propose that all patients should be expected to pay something towards the cost of their appointments. I believe that a small charge for an out-patient appointment in a public hospital, is not unreasonable. It would not only help to offset budget deficits but would also reduce the number of appointments as public patients would take ownership of their healthcare just like privately insured patients are forced to do. This in turn would free-up non-consultant hospital doctors (NCHD) and reduce overtime expenses for the HSE.

I know I’ll be unpopular for these suggestions but I don’t care as I see it as the right way forward. At a time when the government is asking everyone to shoulder the economic difficulties, we can start by taking responsibility for our own health service. Every single person in this country should have equal, speedy, and efficient access to safe healthcare. At the moment, we have a 2-tier, apartheid health system where those that can afford health insurance, have the fastest access to health care.  Let’s use patient power to save our public health service and stop the degradation planned by the HSE.

And before anyone asks why as a privately insured patient, I was seen yesterday in a public out-patient clinic, let me explain. I had no choice in the matter as I required endoscopic investigation and this service is no longer available in private consulting rooms as a result of the boom in MRSA litigation. MRSA has little to recommend it but in this regard, it has worked in my favour. I got to enjoy an appointment with my own choice of consultant, in perfectly adequate facilities and at the expense of the State.  Point taken?