The latest report repeats many of the original concerns about Cavan Hospital's surgery unit, writes Eithne Donnellan, Health Correspondent
The contents of yet another report on troubled Cavan General Hospital and in particular its surgery unit has repeated many of the concerns expressed previously about the unit and which have continued to go unaddressed. The unit first became the subject of public scrutiny in August 2003 when two of its permanent consultant surgeons were suspended by the North Eastern Health Board (NEHB) over so-called interpersonal difficulties.
The suspended surgeons, Mr Liam Joyce and Mr Pawan Rajpal, who are now challenging their suspensions in court, have been replaced by a series of locums which have given rise to concerns among family doctors across the region about the continuity of care for patients.
In the period between September and December 2003 some 15 adverse clinical incidents were reported at the surgery unit.
A review of them by Mr Finbar Lennon, a surgeon who is medical adviser to the NEHB, found an absence of surgical leadership at the unit.
His report was published last March but now a report from the Royal College of Surgeons in Ireland (RCSI), which inspected the unit just weeks before Christmas, has found the situation unchanged. Mr Lennon also recommended that beds be ringfenced for surgery at the hospital. It hasn't happened, and now months later the RCSI report has made the same recommendation.
Senior hospital staff have complained that surgical beds are being overrun by medical patients, limiting the amount of surgery which can be carried out. This makes it difficult for surgeons to maintain their skills and if this situation continues the entire unit will be in jeopardy, the RCSI report stated.
The RCSI describes the current state of the unit as "dysfunctional" and is critical of health board management for not addressing the problem. It pinpoints a lack of communication between hospital management and consultant staff.
An independent report published almost two years ago, the so-called St Paul's Report, also referred to "a dysfunctional relationship between the medical staff and the board of management".
And another health board report, published last June, into the circumstances surrounding the death of nine-year-old Frances Sheridan three weeks after an appendix operation at the hospital, noted there were still difficulties in the surgery unit. It said doctors in the hospital's A&E unit at the time the girl presented with a stomach ache three weeks after having her appendix out had reservations about contacting the surgical team, which they should have done, because they viewed them as uncooperative. An obstructed bowel, a complication of recent surgery, went undiagnosed and the child was sent home. She died 36 hours later.
The latest RCSI report referred to the fact that the surgery unit cannot develop its services and maintain the confidence of patients and GPs if it continues to depend on locums. It recommends three new permanent consultant surgeons be appointed - the unit has only one at present - and that the ongoing matter of the suspension of the two surgeons be resolved as quickly as possible.
Questions must now be asked as to why difficulties in Cavan have been allowed drag on for so long, allowing further patients to be put at risk. As recently as two months ago an elderly man had to be transferred to Dublin for emergency surgery after complications followed an operation on him in Cavan.
There have also been recent reports of patients being transferred to Dublin's Tallaght Hospital and St James's Hospital for treatment after other adverse clinical incidents at the hospital.