The revelation that a consultant surgeon is under investigation over the care provided to a substantial number of patients raises serious questions about the identification and investigation of such incidents in the health service.
These questions are the same ones raised in other, previous cases of alleged poor performance by HSE staff yet, broadly speaking, they remain unanswered.
The fact the surgeon has been placed on administrative leave could be interpreted as a sign that the mechanisms in place for spotting problems are working properly. Issues of poor performance and adverse outcomes arise in all health systems, given their size and complexity, so it is vital that any deviations from the norm in terms of performance or outcomes are identified and acted upon quickly.
In this case the incidents under review span a period of 12 months and involve up to 18 patients. Both the time period and the number of patients allegedly affected seem high, especially given the doctor involved had previously been suspended. Quicker action might have reduced the number of patients affected.
The incident once again raises questions about standards and levels of oversight in smaller hospitals outside Dublin. Some of these have low levels of patient throughput in areas such as surgery, which means consultants get less opportunity to maintain their skill levels. They also suffer from a heavy dependence on locum doctors and nurses, and difficulties recruiting well-qualified staff.
Effective links with level-4 tertiary hospitals, mostly in Dublin, can help ensure high standards and proper levels of clinical audit are maintained. However, the slow rollout of the hospital group structure has meant that in many parts of the country, these links do no exist.
Left in limbo
The consultant in this case joins a long line of other senior HSE staff who have been placed on administrative leave where problems have arisen. This process seems to be the preferred response of the HSE when performance issues arise, but it leaves the doctors involved effectively in limbo for years, while the taxpayer is left to foot the bill for their salaries and the health service has to find locums to do the work.
HSE disciplinary processes have been shown time and again to be slow-moving and inefficient in upholding patient safety on the one hand and the rights of affected staff on the other. The threat of litigation hangs heavily over the area. The business of ensuring accountability has effectively been passed to the Medical Council, where the stakes are higher but processes move equally slowly.
There, doctors before fitness-to-practise hearings endure the often cruel light of public attention, regardless of whether they are found guilty or not. On the flip side, recent court judgments have pushed the bar for proving allegations of poor performance or professional misconduct on the part of doctors even higher, leading to a reluctance to bring cases.
There is a clear need for the health service to measure performance more comprehensively so issues can be flagged as soon as possible, and threats to patient safety minimised. Most doctors will agree that their decisions benefit from a “second pair of eyes”, and the system, especially with hospital groups, needs to provide these opportunities.