A Medical Council monitoring group found significant deficiencies in patient care during a visit to Nenagh General Hospital in April 2001, The Irish Times has learned.
According to documents obtained under the Freedom of Information Act, the accident and emergency department at the hospital is a treatment room with basic facilities. "The concept of managing a seriously traumatised patient or an ill patient is daunting," the report states.
Doctors working at the hospital expressed concerns to the Medical Council assessors about the management of paediatric patients in Nenagh. While the majority appear to go to Limerick for treatment, the smaller hospital "tends to get patients who are extremely ill", they said.
The report notes that the single greatest reservation expressed by junior hospital doctors during the assessment was in relation to patients with psychiatric disorders, especially those who came to the hospital following attempted suicide.
"Consultant psychiatric services are only available two days per week and the hospital for acute admission is in another health board area in Clonmel. This has implications for patient transfer and safety for the patient prior to, and during, transfer," the report states.
"Transport of critically ill patients is a serious problem insofar as the sole staff available to the hospital may have to leave in order to accompany such patients," it says.
It follows with a recommendation that the Mid-Western Health Board must establish rapid and safe patient transfer structures within its area.
The Medical Council assessors called for the supervision of the A&E department by an accident and emergency consultant, and the provision of protocols for the management of paediatric and psychiatric emergencies "as a matter of urgency".
In a follow-up assessment in July 2002, the Medical Council report noted that "significant improvements have occurred within the last 18 months in the ward areas", with seven-day provision of electrocardiograph and blood-taking facilities.
The Mid Western Health Board also indicated that a newly appointed consultant anaesthetist would be designated as the consultant responsible for the overall provision of accident and emergency services at the hospital from September 2002. The Assistant CEO of the Mid-Western Health Board has told The Irish Times that the Medical Council's concerns have now been addressed.
Mr John O'Brien said that since November last, all major trauma cases are now brought directly to Limerick Regional Hospital, although some patients from the north Tipperary area may need to be stabilised at Nenagh en route.
A Medical Council source said the council was pleased that the assessment visits had brought about positive changes which have directly benefited patient care in the region.