Mallow hospital patients put at risk, says report

Critically ill hospital patients were put at risk by inadequate out-of-hours staffing levels, a report has found.

The Health Information and Quality Authority (Hiqa) said Mallow General Hospital in Co Cork did not have round-the-clock on-site expertise and facilities to safely manage patients with complex clinical needs.

Jon Billings, Hiqa's director of healthcare quality and safety, said services in Mallow were based on historic practices, with insufficient action at a local, regional or hospital group level to identify and anticipate risks to acutely ill patients.

He said: "The investigation found that the seniority of medical staff available on site outside core hours in Mallow General Hospital was not adequate for a hospital open to emergencies 24 hours a day.

"This has subsequently been addressed by the Health Service Executive (HSE).

"In short, the safety and quality of the service provided to patients was dependent on the willingness of local clinical staff at MGH, rather than a resilient and reliable system of care."

The authority highlighted a number of immediate patient safety concerns which came to its attention during the course of the investigation and requested the HSE take immediate steps.

The HSE has since introduced a mandatory policy for Cork University Hospital to accept critically ill patients from Mallow General Hospital.

The inquiry was launched last August after a tip-off that patients with major or complex conditions were being treated in the emergency department.

MGH did not have an intensive care unit, with critically ill patients cared for in a four-bed coronary/high dependency unit.

Hiqa was also informed that acutely ill patients were undergoing major surgery in a hospital with few similar procedures and without round-the-clock critical aftercare.

This went against recommendations published by the watchdog some 14 months earlier after a review of a similar-sized hospital in Ennis, Co Clare. It found such services could pose a serious risk to the health and welfare of acutely ill patients receiving emergency, major surgery and critical care.

Mr Billings said the response of the HSE to key recommendations from the Ennis Report had been slow and inconsistent.

"Mallow General Hospital should have an important future serving its community. But this must be as part of a wider hospital network which ensures patients requiring specialist and complex care receive it in a centre with the arrangements in place to do so safely and reliably, while allowing the majority of patients to continue to be diagnosed and treated locally," he added.

"The fact that the authority found it necessary to invoke its powers to investigate services at Mallow General Hospital indicates a fundamental and very concerning deficit in our health system, namely the ability to learn."

Health Minister Dr James Reilly said the report was an important contribution to driving further improvement in the quality and safety of acute hospital services, but reiterated his support for expanding the services that could be provided in smaller hospitals.

"Local hospitals can and should be a vibrant element of local health services, providing treatment and care at the appropriate level of complexity to the patients in their area," he added.

Local Labour TD Sean Sherlock said the report showed an under-investment and shortage of resources at the hospital for more than a decade, but that it vindicated doctors and staff.

"These workers have had a cloud hanging over them since this investigation began in August 2010," he said.

"The report clearly shows that their position as healthcare professionals is beyond reproach."