Cut to cardiac services in Waterford hospital based on ‘invalid’ report

Health Minister Simon Harris is basing his decision to cut cardiac services at University Hospital Waterford (UHW) on a flawed and invalid report.

Picture credit: Consultant cardiologists working in the South-East, from left: Dr Rob Landers, clinical director, South/South West Hospital Group; Dr Patrick Owens, consultant cardiologist and clinical lead for cardiology, University Hospital Waterford; Dr Aidan Buckley, consultant cardiologist, Wexford General Hospital; Dr John O’Dea, consultant cardiologist, University Hospital Waterford; and Dr Mark Doyle, consultant in emergency medicine and medical adviser to the Prehospital Emergency Care Council.

Picture: Maxwellphotography.ie

 

That is according to a group of medical consultants in the South-East, in response to the Herity report.

A review into the hospital by Niall Herity found that the region did not need a second cath lab (used for heart examinations) and that it should cease its emergency cardiac service.

The review found that there was not enough demand on the cardiac services to justify a second lab. However, the consultants argue that because the current lab is only open 9-5, Monday to Friday, the real demand (including out of hours) was therefore not reflected in the report.

Dr Patrick Owens, consultant cardiologist at UHW, said Mr Harris “now finds himself hiding behind its pages, committed to its flawed recommendations which we can tell you will adversely affect the wellbeing of our patients in the South-East.

“This is where we are now, in a critical clinical situation.”

Dr Owens said the issue affected far more people than those who lived in Waterford, as patients in Carlow, Kilkenny, south Tipperary, and Wexford used the service.

“This is a story over several years, a struggle for basic cardiac care in the South-East, a story that affects the lives of several hundred thousand people. It has affected how we do care on a day-to-day basis for patients in the South-East.

“The review was to right all that, it was to independently evaluate the clinical risk that threatens the South-East cardiac patients, due to constrained resources. It didn’t do that. It now transpires that it wasn’t asked to do that. It was asked to do something very different.”

University Hospital Waterford
University Hospital Waterford

Dr Owens said the report’s methodology to ascertain the population’s need was incorrect.

“In a nutshell, it attempted to calculate what the need in the South-East was for cardiac cath lab services and to recommend resourcing accordingly. It tried to calculate what’s called a cath lab catchment and it got it wrong,” he said.

He used an analogy to demonstrate how the true need was inaccurately discovered in the report.

“Say the cath lab service is Croke Park on the day of the All-Ireland final and you want to know how many people want to be there on the big day. This method tries to discover this by counting the number of people in the stadium on the day. But the stadium is not infinite, it has a defined capacity; the number can never exceed 82,000, but clearly many more people want to be there.

“This method under estimates the catchment of our cath lab as a result of the same fallacy. It mistakes constrained resource and low activity.

“Since all the recommendations arising from the report ultimately derived from this figure, the report recommendations are therefore invalid.”

Timeline of events at UHW

  • A cath lab (where heart examination and procedures are carried out) opens in University Hospital Waterford (UHW) in 2008.
  • In April 2013, the lack of a second cath lab in UHW was noted by the HSE as being “a critical clinical risk on its risk register,” said consultant cardiologist at UHW, Dr Patrick Owens.
  • In March 2015, a brief document for a second cath lab for the hospital was submitted to the HSE ‘s national capital steering group.
  • In March 2016, the South/South-West Hospital Group approved the second lab “as a priority”, said Dr Owens, and this was signed off by the CEO. This was sent to the assistant director of estates (the HSE’s infrastructure and property office) and “it was and is queued for funding”, according to UHW’s consultant cardiologist.
  • In May 2016, Niall Herity MD, a director of clinical cardiology in Belfast was asked by the minister for health to undertake an independent clinical review of the provision of a second cardiac cath lab at UHW.
  • The Herity report was published last Thursday and did not recommend a second cath lab.


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