The future of the A&E unit at the troubled Cavan General Hospital is in doubt unless it is able to recruit at least three accident and emergency consultants, the hospital's management team has been warned.
The warning has come from the Royal College of Surgeons in Ireland (RCSI), which inspected the hospital recently.
While the RCSI paid particular attention to the hospital's surgery unit, which it branded "dysfunctional" and "not viable in its present form", it also visited the A&E unit and made the following recommendation: "In order for Cavan Hospital to remain open to emergency care, it requires three A&E consultants, with appropriate back-up in medical and nursing staff, in addition to facilities and equipment within the department."
While the college made more than 20 other recommendations, it said in its report to the North-Eastern Health Board (NEHB) that all its recommendations were considered important. "The order in which they are listed does not necessarily denote priority", the RCSI stated.
The hospital will find it difficult to meet the RCSI's recommendation on A&E consultant appointments as its efforts over the past several months to recruit just one permanent A&E consultant have been unsuccessful. The hospital currently has one locum A&E consultant.
"A recent Local Appointments Commission board failed to make a full-time replacement. Major trauma patients are sent directly to Drogheda, which is 58 miles from Cavan," the unpublished RCSI report stated.
The A&E unit at the hospital, as well as the surgery unit, have been the focus of much attention since the death last February of nine-year-old Frances Sheridan. She returned to the hospital and presented at its A&E unit three weeks after an appendix operation and was seen by two junior doctors, who sent her home, believing nothing serious was wrong. She collapsed and died 36 hours later from complications.
Anaesthetists at the hospital, in addition to surgeons, are concerned that they may become de-skilled unless they have more work. The absence of dedicated surgical beds means that they are often underworked.
The RCSI said that the hospital should have 50 beds ring-fenced for surgery and that its fourth theatre should be opened.
"Should this situation continue, even for a further few months, it will not be possible to sustain a surgical service which is compatible with contemporary standards of care," the RCSI stated.
"The need for a decision to be taken at the highest level is acute. The continuation of the current arrangement is damaging to all the employees of the hospital and will soon become dangerous."
It said that the surgery department needed three new consultants but would "not attract quality applicants" unless a fixed number of beds were ring-fenced for surgery.
The report went on: "Issues and concerns were raised with the visitors about poor dialogue between the medical staff and the North-Eastern Health Board. In addition to lack of liaison within the hospital between medical and administrative staff, it was perceived that failure to implement changes was attributed to difficulties at NEHB level.
"There never had been, nor is there at present, any meaningful or appropriate mechanism for resolution of conflict in place in the hospital".
This should be put in place immediately, the RCSI stated.
The health board said that it was broadly in agreement with the RCSI report and that many of the issues which had been identified were among its priorities.