An independent review of the medical records of a number of patients who died at Cavan General Hospital has again raised serious concerns about the care provided.
The review of case notes of up to seven patients who died at the hospital in 2003 was carried out by a retired UK surgeon who has criticised the management of a number of the patients and said that in one case if the patient had been treated differently she might have survived.
The Irish Times has learned that Prof MRB Keighley, retired professor of surgery at Queen Elizabeth Hospital, Birmingham, has sent his assessments to the Health Service Executive North East Region (formerly the North Eastern Health Board) in recent weeks. The health board's risk advisers have been examining them.
One source said yesterday that the reviews "have raised significant concerns in relation to patient management".However, the health board said it was not commenting.
Last year the health board asked its medical adviser, Finbarr Lennon, to review these and other cases, and after his report was published in March, it said any family seeking an independent review of the care and treatment offered their relatives before they died would be provided with one. Prof Keighley was asked to conduct them.
Mr Lennon's report dealt with a total of 15 adverse clinical incidents in the surgery unit of Cavan Hospital between September and December 2003. They came to light following the death in February 2004 of nine-year-old Frances Sheridan from Cootehill, three weeks after an appendix operation at the hospital. A postmortem found she died from complications of recent surgery.
Nine of the 15 sets of case notes looked at by Mr Lennon belonged to dead patients.
Mr Lennon stressed that all the cases under examination were high-risk cases "where a significant post-operative morbidity and mortality rate could be anticipated". He found that, because the patients posed difficult and complex clinical management problems, consideration should have been given at an early stage to transferring these patients to another hospital.
Furthermore his report said it was likely one of the principal causes of the high number of adverse outcomes was "the inadequacies in the assessment and selection process for surgical interventions".
He also found an absence of clear surgical leadership. Two of the unit's three permanent consultant surgeons, William Joyce and Pawan Rajpal, had been suspended in August 2003 over what were described as interpersonal difficulties.
Their suspensions were lifted last December by Minister for Health Mary Harney, but they have not returned to work. The HSE has sought to attach 21 conditions to their return, something Mr Joyce is challenging in the High Court. Mr Rajpal will be in the Supreme Court next week where he is challenging the legality of his suspension in 2003.
Meanwhile problems are continuing at the surgery unit in Cavan. Last November the Royal College of Surgeons, following an inspection, reported the unit was "currently so dysfunctional that it is not viable in its present form".
And earlier this week The Irish Times reported that the hospital medical board had written to the Medical Council detailing how many of the problems identified at the hospital following the death of Frances Sheridan were still present. The health board hasn't commented on that report either.
It is likely the Medical Council will now reinspect the hospital.