The North Eastern Health Board has failed to adequately address two key causes for concern pinpointed to it by the Medical Council when it inspected Cavan General Hospital three years ago.Hospital report
The report of the Council's inspection, which has been seen by The Irish Times, found medical staff were excluded from any meaningful role in the management of the hospital.
It also found an absence of "a conventional structure" within the hospital's accident and emergency department. The problem in A&E is particularly significant considering the unit failed to detect that nine-year-old Frances Sheridan had an obstructed bowel when she presented to it with abdominal pain, three weeks after an appendix operation at the hospital, earlier this year. She was seen by two junior doctors who believed she had a tummy bug. They sent her home - she died 36 hours later.
A health board report into her death published last month blamed a lack of protocol and guidelines in the A&E unit for what happened.
However the Medical Council, when it reported on its inspection of the unit in 2001, warned that without continuity of staff and responsibility in the unit, it was difficult to see "how the Department can evolve policies or practices which are in the best interests of the management of emergencies".
It took the health board until September 2003 to appoint an A&E consultant, a move recommended by the Council report. Even then the doctor appointed was, according to the health board's own report into the death of Frances Sheridan, given no secretarial support and was "expected to carry out his own clerical duties".
Clerical assistance would have allowed the consultant more time to educate and supervise junior members of staff, it said.
The consultant recently left to take up another job and is now replaced by a short-term locum.
The Medical Council discussed the Frances Sheridan report at a meeting last Thursday and afterwards expressed concern at its contents. It said it wanted to visit Cavan Hospital before the end of this month to see for itself if the recommendations of its 2001 report were implemented.
It is likely to find, when it does visit, that there is still a problem with continuity of staffing in A&E. The Council also found in 2001 that the A&E Department had limited space given its increasingly busy workload. The situation today remains unchanged.
Furthermore, the Council is likely to hear similar concerns from medical staff about their lack of input into the running of the hospital during its visit later this month.
The Council's last report said senior medical staff expressed concern at "the poor relationship that exists between consultant staff and hospital/health board management".
It added: "Throughout the visit, consultant staff repeatedly returned to concerns about the absence of clinical input to policy making within the hospital and to the relatively poor relationships that appear to exist with management of the health board.
"The hospital is managed by a management team, which does not include medical members. The Medical Board consists of all consultant staff with a major commitment to Cavan Hospital but has a purely advisory role. Staff expressed concerns about the absence of input from them to decision making on funding, staffing, clinical policies and relationship with other hospitals".
The Council concluded this was "inappropriate".
A health board spokesman said last evening the "vast majority" of the issues raised in the Medical Council report had been addressed. But sources close to Cavan Hospital claim that while members of the medical board do attend management team meetings, doctors still have no meaningful role in management.
A separate report on Cavan Hospital in 2003, the so-called St Paul's report, also pinpointed "a dysfunctional relationship between the medical staff and the board of management".
Patient care at the hospital has come under intense scrutiny since the suspension of two of its consultant surgeons over "interpersonal difficulties" last August and since the death of Frances Sheridan in February.