Hospital surgery dysfunctional, says new report

SURGICAL services at Cavan General Hospital are continuing to nosedive despite repeated recommendations for ways to improve the situation, the latest in a series of damning reports warns.

The new report, from the Royal College of Surgeons in Ireland (RCSI), describes the surgical unit at the troubled hospital as "dysfunctional" and says poor communication, lack of resources and failure to implement previous recommendations are sending the facility into a decline.

The report follows an inspection by an RCSI delegation last November. RCSI president, Professor Niall O'Higgins, said yesterday the inspection team had found the surgical service was "declining quite a bit".

"Very little elective surgery is taking place there, morale is declining, activity is falling and expertise is at danger of being lost," he said. He added there was a "big need" for those in charge of the hospital to commit to "infrastructure, leadership, consultant manpower, ring-fenced surgical beds and extra operating theatre activity".

The RCSI also recommend that an additional post be created for a senior figure with medical and management expertise. "There is a need to have someone to guide the department, to restore its morale and price, to end its feeling of powerlessness and reverse the trend of deskilling," Prof O'Higgins said.

Cavan General has been in difficulty since two of its three permanent consultant surgeons were suspended over a year ago. At the same time the hospital was forced to deal with an increased workload after neighbouring Monaghan General Hospital was taken off call for emergency surgery as part of a scaling down of services there.

Independent TD for Cavan/Monaghan, Paudge Connolly, said this latest report demanded an immediate response from the health authorities. "These problems have been very well identified for a very long period of time and the time has come to ask serious questions," he said.

Prof O'Higgins said the hospital deserved support given the size of its catchment area and the high quality of many of its staff.

That view was backed by a senior doctor at the hospital who rejected the description of the surgical unit as "dysfunctional" but agreed the ongoing reliance on locum doctors was a serious problem.

Dr Alan Finan, secretary of the Medical Board at the hospital, said: "No medical department or surgical department can function appropriately with 75% locum staff."

The North Eastern Health Board said last night it had already identified as priorities many of the issues highlighted by the RCSI.

Time line:

March 2003: "St Paul's Report" for North Eastern Health Board criticises staff relations and management at Cavan General.

June 2003: Royal College of Surgeons in Ireland (RCSI) ceases to recognise surgical unit as a training facility for junior doctors. Says problems at consultant surgeon level creating "an environment that is not conducive to training".

August 2003: Consultant surgeons, William Joyce and Pawan Rajpal, suspended over "interpersonal difficulties". First in series of locums taken on to cover for them. Protracted court wrangle begins.

September 2003: Health Board risk adviser says surgery should be limited and/or transferred elsewhere until suspensions resolved. This does not happen.

February 2004: Frances Sheridan, nine, dies from post-operative complications three weeks after having her appendix removed. She was diagnosed with a tummy bug.

March 2004: Risk adviser reports reveals 15 "adverse incidents" in surgical patients from September-December 2003. Report highlights inadequacies and lack of leadership in surgical unit. Repeats advice that some surgery should be transferred elsewhere and calls for ring-fencing of surgical beds.

June 2004: Health Board report on Frances Sheridan's death finds "failure to adequately assess and manage" the child's condition.

September 2004: Medical Council says hospital must be given funds to recruit key personnel.

September 2004: Health Minister Micheál Martin announces hospital can have three permanent surgeons to replace two suspended doctors. Recruitment is still under way.

October 2004: Elderly man is rushed to Beaumont Hospital in Dublin for emergency surgery following complications from an operation in Cavan.

January 2005: RCSI report describes surgical unit as "dysfunctional". Finds surgical beds taken over by non-surgical patients and poor communication between management and staff. Says suspensions must be resolved as soon as possible.