4,193 women at risk in ob/gyn delay as consultants warn over funding and waiting list crisis

The chief executive of one the country’s largest maternity hospitals is facing an unprecedented revolt among doctors because of chronic underinvestment in its gynaecology service where 4,193 women are awaiting outpatient appointments.

Tony McNamara, chief executive of Cork University Hospital, has received a written warning from doctors, seen by the Irish Examiner, that they “cannot and will not take responsibility” for women suffering adverse outcomes “arising from a well-documented chronic lack of investment in the gynaecology service”.

The group of about 20 consultants, almost the entire obstetrician/gynaecologist and neonatal cohort, also challenged a claim in a letter by Mr McNamara to the chair of the Institute of Obstetricians and Gynaecologists, Peter Boylan, that the governance model for obstetrics, gynaecology, and neonatal services at the Cork University Hospital Group “works extremely well”.

Mr McNamara told Dr Boylan the group was “an exemplar as to how obstetric services might integrate with general services”.

However, consultants say they never endorsed this view. They subsequently wrote to Mr McNamara saying governance at CUMH “cannot be regarded as ‘exemplar’”.

Instead, they said: “On innumerable occasions, both verbally and in writing, we have expressed our concerns about the restriction and curtailment of the maternity services and the failure to ring-fence the budget allocated to CUMH.”

Tony McNamara, chief executive of Cork University Hospital

The upshot of underinvestment is far longer waiting times for women for outpatient appointments and surgeries than anywhere else in Ireland, with a “real risk of delayed diagnosisis” and potentially “devastating consequences for women and their families”.

The consultant group say they have financial data to show surpluses were generated vis-à-vis resources allocated to the maternity hospital from 2008 to 2012.

According to the group, this amounts to €25.6m which they say was “not available to our service”.

In the meantime, the waiting lists for outpatient gynaecology appointments have climbed to 4,193 as of the end of October, of whom almost 800 have been waiting more than 18 months.

The figure is by far the highest in the country for gynaecology — at Dublin’s Rotunda, the closest comparable hospital, the figure is less than half that at 2,032. Inpatient/day case figures for CUMH are at 557. More than one in three women (38%) have been waiting at least one year to have their surgery performed.

The consultant group has warned Mr McNamara in a letter of the “risk to patients’ health and life expectancy as a result of delayed diagnosis of gynaecological malignancy and other serious gynaecological illnesses”.

The group provides gynaecological care to a catchment population of 500,000 across six sites in Cork city and county, and warns that capacity to meet demand is “entirely inadequate and immediate action is required”.

Chair of the Institute of Obstetricians and Gynaecologists, Peter Boylan

They point out that only one of two fully commissioned gynaecology theatres is operational — the second has never opened, even though the hospital itself opened almost a decade ago.

In addition, consultants claim that no new consultant gynaecological posts have been created in Cork in the past decade, despite 26 such posts having been advertised nationawide in a one year period during 2014-2015.

The result of such an overwhelmed service is that a quarter of patients on the general gynaecology waiting list exceed the health minister’s 13-month target for review, which the consultants warn “should result in the accrual of fines in excess of €1m annually” for CUMH.

The Irish Examiner submitted a series of questions to hospital management. However, no response was received. The hospital also refused documents requested under Freedom of Information legislation, including original requests and appeals.

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