A cancer care systems failure was well flagged, writes Muiris Houston, Medical Correspondent
The crisis of confidence affecting breast cancer services in the Republic can be traced back to two cases earlier this year.
In May, Cork University Hospital apologised to 41-year-old Rebecca O'Malley after she was diagnosed with breast cancer 14 months after she had been given the all-clear.
Last month it emerged that a 51-year-old woman from Co Tipperary, who had been given the all-clear following investigation of a breast lump in Barringtons' Hospital in Limerick in September 2005, was found to have breast cancer.
Taken together, both cases raised concerns about misdiagnoses and questionable treatment practices.
Last month the Department of Health ordered Barringtons to stop offering breast services and the Health Information and Quality Authority (HIQA) is now investigating 10 cases of women with breast cancer who were treated at Barringtons.
Both the Department of Health and the Minister for Health have maintained that no action could have been taken prior to August this year because, until then, only "issues of a general nature" in relation to breast disease services at Barringtons' Hospital had been raised.
However, it is now apparent that seven specific concerns about the process of care for women with breast cancer at the hospital were known to the department as far back as January 2006, some 19 months prior to it taking definite action. Taken together, the authorities should have seen these concerns as flagging a systems failure in the treatment of breast cancer in the mid-west region.
Despite the clear enumeration of seven specific concerns by Paul Barron, the assistant secretary of the Department of Health in a letter dated January 16th, 2006, to the head of the Health Service Executive, Prof Brendan Drumm, what emerges in subsequent correspondence between the two institutions is the batting back and forth of a problem neither side seemed capable of acting on.
In his initial letter, Mr Barron asks the HSE to examine the concerns outlined by the regional director of cancer services in the mid-west, Prof Rajnish Gupta.
He says "no public patients are referred to it [ Barringtons] for services"; in fact the National Treatment Purchase Fund (NTPF) does use Barringtons' Hospital to treat public patients referred from lengthy public hospital waiting lists.
A response dated February 3rd 2006 from Tommie Martin, director of the HSE CEO's office, points out that, as a private hospital, Barringtons does not operate under the aegis of the HSE. He then lobs the problem back to the assistant secretary of the department, asking: "What steps does the department propose to take to address the concerns expressed to the department regarding the quality of care provided at this private hospital?".
On March 2nd 2006, John O'Brien, the network manager of HSE Mid West, wrote to Mr Martin saying: "You make reference to seeking my 'views with respect to patients etc'. Clearly, this is a clinical matter, which I cannot address."
In a letter of April 7th 2006, some four months after the initial correspondence from Mr Barron, a different John O'Brien, director of the national hospitals office with the HSE, wrote to the assistant secretary of the Department of Health pointing out that the HSE has no jurisdiction over Barringtons' Hospital because it is a private institution.
Mr O'Brien then suggests the matter be referred either to HIQA or the Irish Hospitals Accreditation Board.
Eventually, some 19 months later, an examination of breast disease services at Barringtons begins. During this interval, many women with symptoms of breast cancer continue to be assessed and treated at the Limerick facility, notwithstanding serious concerns about its modus operandi having been recorded at the highest level in the Department of Health and the Health Service Executive.
The question that must now be asked is: in the likely event of similar concerns about patient safety being voiced in the future, do we have a system, covering private and public healthcare, that is capable of reacting appropriately and expeditiously?