Errors in the administration of medication to four separate patients within a 24-hour period led to the closure of the Galway Hospice to new admissions on May 9th last, The Irish Times has learnt.
A source close to the Western Health Board's palliative care consultant, Dr Dympna Waldron, has outlined 17 "serious life-threatening errors" in the administration of drugs to hospice patients. These include a number of incidents where an intravenous antidote to morphine had to be administered to patients because of a potential threat to their lives.
The allegations have been documented in a dossier presented by Dr Waldron to her employer, the Western Health Board. It is understood her concerns centre on management issues within the hospice; there is no suggestion that medication was deliberately given in overdosage with the intention of harming patients.
However, in one instance a patient was given 10 times the prescribed dose of a morphine-like substance and required intravenous treatment with the drug naloxone to reverse the toxic effects of the overdose.
In another case, it is alleged that a patient, in transit to a Dublin hospital, received a substantial overdose of another opiate medication and had to be similarly resuscitated on arrival in the capital.
The 12-bed Galway hospice has been open for more than 10 years and is run by an independent board of directors. It receives in the region of €2.3 million in funding annually from the Western Health Board.
Dr Waldron, who has been in her post for three years, is employed by the Western Health Board as its sole consultant in palliative care.
Comhairle na nOispideal has structured her post so that she works the majority of her sessions for the Western Health Board. Although mainly based in University College Hospital Galway (UCHG), Dr Waldron is also responsible for palliative care in acute hospitals in Castlebar, Roscommon and Ballinasloe.
Dr Waldron works with a team of junior doctors including a specialist registrar within an academic unit at UCHG. They also provide a service in the hospice, and it is understood that most of these doctors have expressed a lack of confidence in the management system at the hospice, primarily because of ongoing incidents of drug errors at the unit.
Dr Maccon Keane, consultant oncologist at UCGH, told The Irish Times last night that the issue involving problems at the hospice were ongoing for over six months and have been well documented.
"From my standpoint, I will only admit patients to the hospice through the appropriate palliative care consultant," he said.
"Dr Waldron offers a superb service. At present, patients are admitted to UCGH under the joint care of the palliative care consultant and myself, but this group of patients would receive better management on terms of quality of life if they were in the hospice".
According to palliative medicine sources the problems in the Galway hospice are not unique to it but are symptomatic of a culture clash between well-motivated voluntary bodies and professional healthcare organisations.
"Health board management structures need to be put in place in accordance with good clinical governance," one source said. It is understood that the body representing palliative care professionals in the Republic wrote to the Department of Health recently asking that the relationship between voluntary bodies and health boards be re-examined in the light of ongoing difficulties in some regional units.
The board of the Galway Hospice Foundation has established an independent expert group to review medication procedures at the unit.
The group includes a senior hospital manager, a pharmacist and two nurse managers.