Patient forced to wait three days to see doctor

AN ailing patient at Leas Cross waited three days to see a doctor because a staff member claimed difficulty in contacting one, a damning report on the disgraced nursing home reveals.

The report into the mistreatment of elderly residents at the home shows they were let down at all levels — from the nursing home owner to their nursing and care staff to health service management.

The report of Professor Des O’Neill, a consultant geriatrician at Tallaght Hospital, concludes care of the patients at the nursing home was “deficient at many levels” and amounted to “institutional abuse’’.

Prof O’Neill bases his findings on the case notes of 105 patients who died while residents of Leas Cross between 2002 and 2004, as well as other official documents, records and letters pertaining to the nursing home during that time.

One of the key conclusions he draws is that there were too few staff employed, while those who worked there had too little training for the job they were doing. Neither of the two directors of nursing had any qualifications or experience in the specialist area of care of older people and there was no evidence that the owner tried to recruit staff with suitable experience.

This is described by Prof O’Neill as “perhaps the single most grievous area of concern of practice within the nursing home’’. He continues: “It is not unreasonable to infer that many of the other problems arose from this fact.”

Only one medical officer was on duty at any given time and there was little evidence that any attention was given to immunisation, infection control or review of medication. There was also a complete absence of documentation recording any use of physiotherapists and occupational therapists.

There was under-recording of dementia among the patients. Official records showed dementia was identified in just over half the patients but a revised estimate for Prof O’Neill’s report suggests the figure was around 80%.

The register of patients was poorly maintained and for 439 of the 690 patients cared for there during the period under scrutiny, there was nothing to say where they had gone after they left or whether they left the register because they had died.

There is a statutory obligation to report deaths within a nursing home yet just 31 of 60 such deaths were notified.

Of patients who were referred to Leas Cross directly from their own home, Prof O’Neill says: “In no set of notes could I find the person’s medical records from their former GP, and I could find no request for their medical records, nor any evidence of such a policy.”

Prof O’Neill is also critical of the excessive use of restraints on patients. “An alarming number of the residents were being noted as being nursed in Buxton chairs,” he says.

Overall death rates rocketed at Leas Cross from 14% in 1998 to 44% in 2001 before evening out to 38%-39% in subsequent years.

Prof O’Neill concludes: “It would be a very major error to presume that the deficits in care shown in Leas Cross represent an isolated incident. Rather, given the lack of structure, funding, standards, and oversight, they are very likely to be replicated to a greater or lesser extent in institutions throughout the long term care system in the country.”

Judgment: report’s key findings

* Leas Cross had inadequate numbers of staff.

* The staff it had were inadequately trained.

* Health service management failed to heed the concerns of medical professionals.

* Health service management exercised poor judgement in trusting that Leas Cross could address the problems.

* Inadequate funding by the State.

* Inadequate attention by the Government and health service to the sector generally.

* Problems and failings likely to be replicated in other nursing homes.

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