A Terrible Blunder

October 23, 2008

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.


Vive la France

October 17, 2008

Okay, so here’s how the Irish health service could/should operate if it was properly resourced and managed. The following article was published in the Irish Times and documents the experience of an Irish person who required emergency care in a hospital in France.  I’ll leave you to draw your own conclusions.

Vive la Différence

“No waiting room, no trolleys, no queues, no admission fee and free parking. It was very strange indeed”, writes Michael Foley

“It is 1.30 in the morning, the first night of the annual Feria, when Beziers, in the south of France, goes en fete for a week of partying. Getting to A&E through streets thronging with revellers is a feat in itself, but arriving at the hospital is an even more unusual experience.

I rushed to hospital, with what later turned out to be a blocked artery.

Where is the waiting room? And where are all the corridor trolleys gone? Well, there is no waiting room and no queue, no line of people drunk or groaning with pain, and facing a 12-hour wait, just a woman at a desk and a sliding door that lets you straight into your own single-occupancy examination room. Parking is free and there is no €60 admission fee either.

Very strange indeed. It is so strange that we waste valuable time assuming we are at the wrong place. Why no waiting area? Goodness me, said a French nurse, urgence, the French name for the A&E, means someone requires urgent treatment; you could hardly expect someone in need of immediate treatment to wait, now could you?

It has to be said that when I last attended a Dublin hospital, eight months previously, I did not have to wait either. As I pointed to my heart and handed over the €60 casualty charge, a wheelchair almost buckled my knees as it wheeled me into triage, but behind me were others who would be waiting and waiting and waiting – unlucky enough not to have chest pain.

Back in Beziers, and two-and-a-half hours later, I had blood taken, a brain scan, a chest X-ray, and all the test results returned, and was tucked up in bed. At no stage did I see anyone on a trolley in a corridor.

Trolleys were used to ferry people. Patients slept in beds. My room, in a public ward, was for two patients, with a toilet and shower en suite. The equipment was new and worked. The bed was high-tech and moved in almost every direction.

What followed were days of tests, done without delay, and all ordered by specialists, who personally delivered results, usually within the hour. I was given scans, X-rays, MRIs and investigations I thought I might have been given eight months previously in Dublin. “Should I have had this test before?”

The doctor was non-committal.

The first specialist was a neurologist. The Centre Hospitalier de Beziers has three (as opposed to a dozen for the whole of Ireland). The doctor was a quiet, respectful woman who was available throughout the day, and who delivered the test results she herself ordered.

There was no entourage, no one to fawn and laugh at her jokes. She even had office hours when family could call in for information or advice – no need for intervention, divine or otherwise here.

We kept checking as to her status with the nurses, because her availability was akin to that of a registrar or a junior doctor in an Irish hospital, but yes, she was everything one could possibly want in one’s neurologist – professional, available and attentive. Extraordinarily, if a test was required, it was done immediately, and she delivered and discussed the results in person.

The second specialist, a vascular surgeon, again was one of three. When surgery was decided, I was moved to another floor and opted for a private room. Cost €40 a night.

Surgery was successful and after a period of recovery, I was out. When discharged, I was given a slip that was officially stamped, this is France after all, and that was it; I paid not one cent.

Under the EU health insurance regulations, I received the same treatment as a French person – 80 per cent of the cost borne by the state – and like a French person, my insurance (in my case, the VHI) paid the rest, including the cost of the private room.

One of the most remarkable features of the hospital was the level of hygiene. And not a nun in sight. The corridors were completely clear. The cleaning trolleys, with their colour coded buckets for every individual surface, plied up and down the corridors.

Masks and sprays were used as appropriate, from one patient to another. Head-to-toe disinfection twice before surgery . . .

In the Dublin hospital I attended recently, there was one shower for some 50 patients. This was in a room with a bath fitted out for disabled use. There were cracked tiles around the shower. The bath/shower room was also used as a store. If you were able to walk, you washed and shaved at a row of washhand basins, like a 1960s boarding school.

The VHI was amazing, constantly phoning me and my wife to see if I was alright. Did I want a second opinion? Was I was satisfied with the doctor? Was everything explained adequately? It also had a French-speaking doctor contact the hospital doctors who came back to explain what was going to happen.

Isn’t it extraordinary that the VHI pays no such attention to the interests or concerns of their members in Irish hospitals?

Would I have returned home for treatment if it had been feasible? Not if the advice I was given was to be taken seriously. Proof of the serious lack of confidence there is in the health service in Ireland was evident in the number of calls I had, from friends, colleagues and family, telling me how lucky I was to be sick in France and not Ireland: “Stay where you are. It’s the best place to be.”

If I returned, they thought, I might not get a bed, and if I did, I would be at risk from MRSA. “MRSA is a given,” said one friend, whose mother recently contracted it.

For the next two weeks, a local nurse visited to clean the scar and eventually remove the staples holding the surgical opening together. Cost for a home visit, €5.50 a day. But it is not just money that is the main difference between the two systems as experienced by patients. I was treated as a critically ill patient, the same as if I were French, by nurses, doctors, specialists and home visits,

I even have a GP in France now, who gave me a free consultation, just to get to know me. I only hope we don’t get to know each other too well.”

With thanks to the Irish Times for their online publication.


Anything’s Possible

May 28, 2008

On reading Grannymar’s post One Armed Bandit last week, I was reminded of a time in my own life when I fought a one-armed battle. I have an inherited connective tissue disorder known as Ehlers-Danlos syndrome (EDS) which leaves me with a tendency to stumble and fall a lot. Being right-handed, my right shoulder has taken many blows over the years but it’s still going strong.

When I was in college many moons ago, I slipped and fell dislocating my right shoulder in the process. Luckily it went back into it’s socket spontaneously but the damage had been done. The anterior ligaments of the joint were torn and my arm needed immobilisation in a sling for many weeks to facilitate repair. From that day onwards, my right shoulder was unstable and certain movements were extremely painful. The joint would easily sub-locate and on numerous occasions this happened when swimming, leaving me stranded in pain with one arm stuck up in the air!

When my first child was a toddler, I stumbled one day while carrying him and again badly tore the shoulder ligaments. As my arms were full, I could not reach out to save my fall and landed on my right elbow sending the full force of the blow through my shoulder joint. I was seen by an orthopaedic surgeon who recommended an operation to stabilise the joint. I underwent open surgery (it’s done by micro-surgery these days) to have the ligaments of the shoulder joint re-structured to form a support network and they were also shortened to limit movement in the joint. A large metal screw was used to hold the re-attached ligaments in their new position. When I awoke from the anaesthetic, my whole right arm was tightly strapped across my chest and it was a struggle even to breathe. I was to spend the next six weeks in this tight strapping with only one arm usable. It was a difficult time as I had a small toddler to look after but we soon devised ways and means to get around most problems. I became a dab left-hander at doing most tasks though it took a while to get used to getting dressed one-handed and trips to the toilet took rather longer than usual. You try pulling up and down your clothes with one hand and you’ll realise what I’m talking about!

Once the ligaments had healed, all the strapping was removed and I started on a long programme of physiotherapy to recover movement in the joint. This was a very painful process and as time went on, the pain got worse instead of better so I was sent back to the surgeon for review. He was puzzled by the pain and recommended further rest for the arm, in a sling. A few weeks later I noticed a protruding lump at the top of my right arm which was very painful to touch. The metal screw used to fixate the ligaments had wriggled it’s way loose and x-rays showed that at least one inch of it was protruding from the bone. Back I went into hospital for more surgery to remove the piece of offending metal which I still have to this day, as a souvenir. Yet more weeks ensued with my arm in a sling before I was allowed to start physiotherapy again. You have no idea what pleasure it was to finally eat a meal using a knife to cut my food.

One of the aims of the surgery was to restrict movement of my arm in certain directions, to reduce the likelihood of further dislocation. No matter how hard I try, I cannot rotate my arm outwards and have learnt instead to rotate my body to reach objects on my right-hand side. I used to love playing tennis but my restricted shoulder movements made this impossible. Not to be defeated, I went back to tennis lessons starting at beginner level and learnt to play the game left-handed. Anything is possible when you’re determined to succeed. This all came to abrupt end however with another stumble which resulted in torn ankle ligaments but that’s another story. These days my right shoulder joint makes lots of strange creaking noises but it remains pain-free. I only wish the rest of my joints were as good.


Pancake Thursday

January 31, 2008

Last year I reached that magical age when I could officially join the ‘club’. BreastCheck is part of the National Cancer Screening Service in Ireland and invites women aged 50-64 for a free breast x-ray every two years. Breast cancer occurs most commonly in this age bracket and with early detection being the key to successful treatment, regular screening is recommended.

My birthday came and went and when six months later I still hadn’t heard from Breastcheck, I decided to take the matter into my own hands. On researching BreastCheck online I was able to check if my name was registered using a self-search facility. My name wasn’t known. I next phoned BreastCheck to enquire what action should be taken and to my surprise, the helpline was answered by a decidedly grumpy male voice. To be fair, my call was made during the time of the outcry about breast cancer misdiagnosis when women all across the country were up in arms and I would imagine that all breastcare services were probably bombarded with enquiries. I still felt it wasn’t right to have a man dealing with enquiries in what is essentially though not entirely, a woman’s area of health. I persisted however and he took my details assuring me that I’d hear from BreastCheck early in the New Year.

Yeah right, I thought! But actually I did get an appointment in the post and today I attended a mobile unit of BreastCheck to undergo my first mammogram. The unit staff were courteous and welcoming. I arrived early for my appointment and as there was no one else waiting, I was seen straight away. While sleet and rain battered against the window outside, I stripped to the waist and a nurse carefully helped me into position to be x-rayed from two separate angles. Each breast was compressed like a pancake in a vice-like structure causing significant discomfort but it only lasted a few moments while the x-rays were taken. My biggest problem was having to contort my body with an arm raised over my head to get the angle required. I have one shoulder which has been surgically restricted to stop recurrent dislocation and this did not make things any easier. However, it wasn’t long before the procedure was finished and I was invited to look at the images on screen. I was informed that one breast is larger than the other though apparently this is quite common and is nothing to be concerned about.

Having dressed and returned to the reception area, I decided to use the opportunity to ask more about the system used to automatically register women. I was confused as to why I seemed to have slipped the net. I was told that BreastCheck compiles their list from information supplied by the Department of Social and Family Affairs, General Medical Services and private health insurance providers. I then learnt that the process can take up to two years before someone will be called for screening. I was appalled to hear of this as I have several friends who developed breast cancer at my age and with this disease, it’s well-known that time is of the essence. My prompt appointment had come about simply because I’d pre-empted the system by making an enquiry. I would urge all women in this age bracket to ensure that they are in the system and that they attend for mammograms when called. We owe it to ourselves to take whatever steps are necessary to stay safe. Please make time for your breast health.

I have no particular reason to fear breast cancer but because I’m aware that a mammogram can show up some tumours two years before a lump can be felt, I’d rather be safe than sorry. I was pleased to hear that today’s results will be posted out to me personally and to my GP, within three weeks. With that reassurance, I took myself and my lop-sided breasts home to wait.