|
|
|
|
|
 Email+  Share+
Concern remains over ‘dangerous’ waiting lists
15 November 2009
In June 2003, two-year old Róisín Ruddle was sent home from Our Lady’s Hospital for Sick Children in Crumlin, Dublin, without having her scheduled heart operation. It was cancelled because of a shortage of intensive care nurses to care for her after surgery.
Róisín died the next day. The case shocked the country and elicited the usual response from government: an inquiry. Six years on and distraught parents are again aiming to highlight the delays that have resurfaced.
Two-year-old Joy Lawlor, who is awaiting open heart surgery, was due to get an operation last spring. It was postponed until September and it then emerged that she needed another major operation now. Her mother, Gemma, said she didn’t expect her daughter to receive the life-saving operation before 2010.
‘‘It is an appalling situation for a first-world country," said Lawlor. There are around 120 children on the cardiac surgery waiting list in Crumlin and Joy’s parents have launched a campaign to highlight the plight of their daughter and others. Doctors at the hospital are exasperated. Although the Health Service Executive (HSE) agreed to build a 17-bed intensive care unit, it will be 18 months before it is ready.
‘‘Even that is probably an optimistic timeframe," said Dr Paul Oslizlok, a consultant cardiologist at the hospital. ‘‘In the interim we have been left with a waiting list that is simply dangerous."
Crumlin Hospital has lodged a formal proposal with the HSE seeking more staff; Oslizlok said if more staff were not made available, then doctors would be forced to send patients overseas for treatment." We may have no choice but to use external referrals," said Oslizlok, who is also president of the Irish Hospital Consultants Association (IHCA).
The €112 is one option. This is an EU regulation that entitles people to get a treatment abroad if it is not available within the time normally necessary for obtaining it in Ireland (see panel). The sending country is forced to foot the bill. Not surprisingly, the €112 has not been widely advertised and there is little awareness among the general public about it. It can also be somewhat complicated, said Oslizlok.
‘‘There is ambiguity over whether prior approval from the HSE is a prerequisite. That is a barrier. It is also very bureaucratic," he said. Cardiothoracic surgeon Professor Mark Redmond said that the €112 did not lend itself particularly well to cardiac surgery. ‘‘It is hugely complex. It is not like getting your hip done. It requires a life-long investment in care," he said.
Both Redmond and Oslizlok said doctors were loathe to send their patients overseas. Doctors ‘‘hate to have to say we can’t provide for you any more. It goes against the grain.
There is a sense of having let the patient down," Oslizlok said. ‘‘Under the circumstances, we have possibly been over-reluctant."
Parents of sick children are also reluctant to break that doctor-patient bond, said Gemma Lawlor. ‘‘The doctors in Crumlin are world class. This is something the government should fix here," she said.
Lawlor said many families are so distraught and preoccupied with what is going on every day that the thought of having to consider travelling overseas would be too much for them.
The logistics and, in some cases, language barriers would be immensely difficult, she added.
Sending children overseas for treatment is not a new phenomenon. Nine years ago as many as 100 children were sent overseas for cardiac surgery, according to Oslizlok.
The Department of Health has previously sanctioned specific arrangements with hospitals overseas, such as Great Ormond Street Hospital in London, with Irish children being sent there for cardiac surgery.
Redmond organised to send children needing heart surgery to Johns Hopkins Memorial Hospital, in Baltimore in the US. Redmond had worked at the hospital before returning to Ireland. He travelled to the United States along with a specialist nurse and performed the operations himself.
H e said he did this over a five-year period and performed more than 100 operations.
The bill was footed by the state. The ability of the state to pay for expensive overseas operations was debatable. Redmond said he was open to doing it again, but that he had not felt it ‘‘was necessary just yet’’.
Oslizlok described having to send patients overseas as ‘‘demoralising. It is also a huge waste of financial resources. Those operations were costing between €30,000 and €50,000.
It would have been better to have pumped that money into building up our own resources in Crumlin," he said.
‘‘The idea was that it was an emergency stopgap and that we would build up the resource.
But it never happened. It is disappointing that during all of the boom years we never got our act together. ‘‘We didn’t need to send patients abroad, apart from rare cases when the surgery was not available here.
Now, the birth rate has increased.
Techniques have also improved so we can do more [to help]," said Oslizlok. The higher birth rate has resulted in an increase in the number of children requiring cardiac surgery. ‘‘In 2000, we did 182 operations. Last year we did 525.We have the same staff numbers," said Redmond.
Aside from the human cost, Oslizlok said the real frustration with the lengthy wait for cardiac surgery was that the increased demand was ‘‘entirely predictable’’.
‘‘About 65,000 babies are born in the country. One in every hundred will have a heart problem. It is the same everywhere. We should have been able to plan for this," he said.
While Crumlin had reduced its waiting list in recent years, the shortage of intensive care beds and a moratorium on recruitment means the situation has rapidly deteriorating.
‘‘About 40 per cent of our surgery is done late at night so that means people are on huge overtime and it is not a good way to run a service. It is also very costly as after working through the night, people then take the next day off.
The hospital also tries to prioritise heart surgeries so other services get bumped," said Oslizlok.
The delays faced by children with scoliosis was also highlighted in recent months with a new initiative to address that waiting list having since been agreed.
Last week, Oslizlok telephoned doctors in other countries to assess their waiting lists for cardiac surgery. He said they were short, or nonexistent, in France and Germany. They are shorter in England than they are here.
Huge waiting lists already exist for other specialties at the hospital - particularly ENT (ear, nose and throat surgery), and orthopaedic surgery, where inadequate staff numbers and theatre space shortages pose huge obstacles. Four full-time equivalent orthopaedic surgeons looked after 26,000 paediatric outpatient attendances in 2008.They performed 3,800 procedures - an average of 475 cases per consultant, representing a massive workload.
A collaborative initiative to address the waiting list for children awaiting spinal surgery has been agreed, but a solution has yet to be found for others, such as those with dislocated hips. In some cases, delays can lead to further deformities. Orthopaedic consultants at the hospital said he had had many more €112 forms across his desk in recent months.
If agreement is not reached soon, the HSE may well find itself stumping up for some very expensive overseas trips. Aside from the questionable economics, it would be an unpalatable option all round.
|
|
|
