Most of the recommendations made, following two inspection visits to Monaghan General Hospital, were responded to, according to the North Eastern Health Board. Paul Cullen and Dr Muiris Houston report
The North Eastern Health Board says it has implemented "most" of the recommendations made by the Medical Council following two inspection visits to Monaghan General Hospital.
Any outstanding issues raised by the council were addressed when services were "reconfigured" last September, the board says.
As reported in yesterday's Irish Times, the council had expressed its concern at the operation of the accident and emergency service at the hospital, and at the quality of care offered to children attending this unit, after inspections carried out in July 2001 and May 2002.
However, in a detailed response to questions from this newspaper, a board spokeswoman said there is no accident and emergency department. Instead, there is a treatment room for the management of "minor surgical conditions" and the stabilisation of patients "pending transfer".
The board said it had issued a "full and comprehensive" response to the council on the first assessment. After the second visit, it sent a detailed response to the council. This letter was copied to all the consultants in the hospital.
The council had found there was no consultant to supervise the accident and emergency service. However, the board says that since last February, a temporary consultant surgeon, Mr Roy Cabazon, has supervised the treatment room.
The Irish Times also asked why the North Eastern Health Board protocol for maternity care for mothers presenting to Monaghan hospital, which requires those at less than 32 weeks' gestation to be sent to Drogheda, was not followed in the Baby Livingstone case.
However, the spokeswoman said the board was not in a position to comment until the Minister for Health published the independent review on the case. This report was published last night.
The council said there is a lack of clear policies regarding paediatric patients at the A&E unit. In particular, it was unhappy that there was a perception among the public and family doctors that the hospital offered a paediatric service despite the absence of a consultant paediatrician.
However, the board said there never was a consultant-led paediatric service at Monaghan hospital. A children's unit dealing with "minor conditions" existed until July/August, 2002.
Children attending the treatment room who require paediatric admission are referred to a consultant-led in-patient paediatric unit at Cavan Hospital, it said. Where a patient attends Monaghan requiring immediate stabilisation, this is provided and the child is then transferred by ambulance to Cavan or Drogheda.
Asked about the existence of clinical protocols in Monaghan, the board said these exist for the management of patients in the treatment room. Written protocols exist for head injuries, advanced trauma and life-support injuries, paediatric asthma and diabetes and meningococcal meningitis.
The board's A&E consultant had provided advice about protocol development for the treatment room. Members of the medical and nursing teams have completed courses in emergency cardiac and trauma treatment, and in paediatric resuscitation. After its second assessment, the council had found there was no mechanism to introduce protocols or training within the A&E department.
The board spokeswoman emphasised a number of initiatives which have been put in place in its area. A risk adviser was appointed following a review of services at Monaghan by a leading risk management firm.
In addition, an external facilitator "with an international reputation" is helping the various parties involved to resolve the issue surrounding surgery at Cavan/ Monaghan. The board has also engaged management consultants to develop a "clinicians in management" programme in the acute hospitals sector in the north-east.