HIQA independence in question

TWO families who triggered the independent review of services at the Mid-Western Regional Hospital in Ennis are furious no one has been held accountable…The Health Information and Quality Authority (HIQA) found it was unable to blame anyone because of a lack of clarity around local accountability and the authority to make decisions (Irish Examiner).

Once again a so called independent investigation into death within the HSE has been unable to hold anyone to account. I don’t think anybody really expected anything better. After so many other whitewash reports why would anyone think this one would be any different?

We’ve had the usual waffle from bureaucrats and politicians who have employed the usual cynical strategies to protect their backs.

A particularly nasty but common strategy is to supply the report to the victims just hours before its publication. This means they have no time to read it in detail and as we’re heading into a long weekend it will be old news by next Tuesday.

Mary Harney had promised to supply the report to the families of the victims before publication; she did so, at 11.30 on the morning of publication. It’s difficult to get more ruthlessly cynical than that.

This is in stark contrast to how the State favours the Catholic Church. The Dublin Archdiocese Commission of Investigation into clerical sex abuse is due for publication in May or June but Archbishop Martin and others have already been given a copy of the report so that they can prepare their response to what is said to be an absolutely shocking litany of abuse (Irish Examiner).

A solicitor for one of the families involved in the Ennis hospital misdiagnosis scandal said that the report seemed to have a political agenda connected to the downgrading of hospitals.

This was put to the chief executive officer of HIQA, Dr. Tracey Cooper, on the Six One News (1st report, 4th item) yesterday, she replied:

“As an independent authority we’re established to take work independently from the rest of the system. What’s driven the findings of the investigation is that it isn’t about political agenda’s; it isn’t about territorialism of local hospitals.

It is about the fact that international evidence is very clear that patients that require emergency care, specialist care have to be treated in care by people who see sufficient volumes of patients with those types of conditions to keep their skills up to date.”

This statement could have been taken straight out of Mary Harney’s files so close is it to government (political) policy regarding the downgrading of hospitals.

The merits of this policy have been widely debated throughout the media but why is this so called independent authority that was supposed to be investigating the deaths of two patients by misdiagnosis, parroting Government policy as a justification for its conclusions?

Is HIQA independent? I don’t think so.

Copy to:
HIQA

HIQA joins HSE in the sewer of cynical strategies

The Health Information and Quality Authority (HIQA) was set up only two years ago and already it has descended into the sewer in company with the Health Service Executive (HSE).

Just like the HSE, HIQA has now apparently adopted the cynical strategy of waiting for the most opportune moment to bury unfavourable reports (Irish Independent).

It became clear that HIQA had descended into the sewer of cynical strategies when they published the report into Rebecca O’Malley’s misdiagnosis on the day Bertie Ahern resigned.

Nobody knew in advance that Ahern was resigning but it’s likely that HIQA had the report ready and were waiting for the right moment.

It could have been argued that this was perhaps just a coincidence, like all the other amazing ‘coincidences’ in Irish public life but the latest report publications leave us in no doubt that HIQA has abandoned its commitment to “operate to the highest standards of corporate governance.”

The report into cancer misdiagnosis at University College Hospital Galway was published (buried) on the eve of the Budget when it was certain to go unnoticed by the media.

Another report; that of the misdiagnosis of Ann Moriarty, was published (buried) just after the budget and before the Easter Bank Holiday weekend.

Karl Henry, whose wife died of breast cancer a year ago after doctors failed to diagnose her cancer in Ennis General Hospital, said:

“It is a cheap stunt. Are we being taken for complete and utter fools?”

Unfortunately, we are being taken for complete fools. The person/s in HIQA who are responsible for publishing these reports are probably congratulating themselves on how clever they are as they head off to enjoy the long weekend.

By next week it’s likely that their betrayal of the people they claim to serve will be forgotten as they consider how best to bury the next report.

Copy to:
HIQA

Protecting little empires and big egos

On 23rd January 2008, I wrote that Mary Harney and the HSE were highly unlikely to accept any of the very generous offers made at the time by businesses and the general public to provide facilities for Cystic Fibrosis sufferers.

A spokesperson for the Cystic Fibrosis Association of Ireland confirmed on Liveline (Wednesday) yesterday that these ruthless and uncaring people in the HSE had indeed turned down all offers of help.

At the time CF sufferers were cynically told that the HSE didn’t want to accept portakabins and other help but rather wanted to provide long term permanent facilities.

We now learn that these facilities have been deferred for at least five years. Obviously, all the promises were nothing more than a ruthless delaying tactic until the controversy died down.

The brutal reality is that Mary Harney and the faceless HSE bureaucrats are more interested in protecting their little empires and big egos than saving the lives of very sick people.

Having completely lost confidence in Mary Harney and the HSE the CFAI have decided to take action into their own hands as the following article on the CFAI website makes clear.

Irish War Crimes

Are Human Lives The New Currency?

After years of empty and broken promises, the CFAI have lost total and utter confidence in the Department of Health, the HSE and Minister Harney and have decided to take action into their own hands.

Despite the severity of the issues and the simple request to have a Yes or No answer today by 5pm to the Question: Are the HSE/Department of Health going to honour the commitment given publicly in 2008 to fulfill the promise of having the CF Unit operational in St Vincent’s by 2010?

The only response back was a phone call at approximately 4pm to say that the Minister would not be able to deal with our communication until at least tomorrow afternoon. And at 4.40pm a generic email from Professor Drum’s office to say that they confirmed receipt of the letter.

It is obvious the contempt they are showing for young Irish people living and dying with CF, their families and loved ones. Orla Tinsley, CF Campaigner stated. It is degrading to everyone involved that they could not have the courtesy, urgency or even the efficiency to answer one simple question with one simple syllable.

National Chairperson Sean O’Kennedy, together with the National Council is not surprised by the total lack of respect for the young people with Cystic Fibrosis. We were fairly sure that the response we were going to get would be no response.

So we have already put our plans in place in case there was no reply. Over the next number of days we will be mounting a campaign both nationally and regionally to reverse the shocking and devastating decision that Minister Harney, the Department of Health, the HSE and Professor Drumm have made.

Sean added, the support from everyone, politicians on all sides of the Government, Medical Professionals, the general public and the media has been astounding and all are on board to wage a war against this injustice and Human Rights Issue.

The ultimate price of inefficiency, bureaucracy, politics, mismanagement and apathy is human lives. As Orla finished by asking Are human lives the new currency?

Further information on Cystic Fibrosis and the Cystic Fibrosis Association of Ireland can be found on www.cfireland.ie. A further statement from the National Council of the CFAI will be issued tomorrow morning.

ENDS

"I have absolutely no faith in the HSE or in Mary Harney" Bernadette Cooney, recently deceased. RIP

Early last year there was a major controversy, which began on Liveline, over the very poor facilities available to Cystic Fibrosis sufferers in Ireland.

CF patients are extremely vulnerable to infection and therefore need isolation units and other special care. In some countries, where the facilities/care is provided, patients can live until they are 40 or even 50. In Northern Ireland the average is about 35, in the Republic it’s early to mid 20s.

Because of the controversy and subsequent embarrassment the Government promised to take action on the matter but last Friday the HSE announced that the promised facilities were being deferred and would not now be available until 2011, at the earliest, because of lack of funds (Irish Times).

The scandal came to light after a CF sufferer, Bernadette Cooney, wrote a passionate and desperate letter to Liveline last year, begging the Government to provide even the most basic of facilities to give her and her fellow sufferers some hope, she died three weeks ago aged just 25 (Liveline, Friday).

At the time I wrote about the lack of anger displayed by Irish Independent journalist, Sam Smyth, whose daughter suffers from CF.

“The odd thing about Smyth’s interview was his complete lack of anger. He even praised Harney and Ahern for their ‘efforts’ and spoke as if he really believed the promise made by Prof. Drumm that proper facilities would be provided sometime next year. This promise has been made and broken for the last 14 years.”

It is this lack of anger, common to most Irish citizens, that allows chancers like Ahern and Harney to survive and prosper at the expense and suffering of ordinary citizens.

Thankfully, Smyth has finally realised the reality of how the vulnerable are treated in this country. He (angrily) introduced the subject on his show this morning.

“Let’s get stuck into something that’s really disgusting that this government has done and it’s something I’ve got a personal interest in and that is Cystic Fibrosis.

An absolute disgrace, this administration was shamed last year into providing €34 million that would undoubtedly save lives and clearly they’re gambling on those people who are campaigning now that they will be dead soon and therefore it’s a waste of money.

What we should do is find out the names of those people in the department, in the HSE and the hospitals who engineered this between them to get that cut done.

If you live in Newry you will live for ten to fifteen years longer than you would if you lived in Dundalk. Who are these people, who had the authority to do that?”

A panelist provided the answer.

“We know who is responsible, Mary Harney is responsible but she has tried to offload responsibility for years to the HSE.”

I’ve reproduced the email that Bernadette Cooney wrote to Liveline last year, the letter speaks for itself.

Dear Joe,

First and foremost I want to thank you so much for the coverage you have given CF patients over the last few days. Unfortunately, after years of listening to the same thing over and over again, I have absolutely no faith in the HSE or in Mary Harney and am not holding out any hope that anything will be done.

I am 24 years old and have cystic fibrosis. I am currently an inpatient in St Vincent’s Hospital in Dublin for a severe chest infection. I have been here since the 2 January and there has been no significant improvement in my condition. I have been informed that my disease is progressing and I won’t be able to regain the level of health that I had 6-12 months ago.

Transplant has also been put on the agenda. I can’t put into words how absolutely devastated I am-as a CF patient you make the best of everything and try to ignore the statistics that are staring you in the face, but when it is spelled out for you it is truly awful.

Every day is a massive effort now as I struggle to fight and maintain the exhaustive regime of treatment I must undergo which involves oral, nebulised and intravenous antibiotics, physiotherapy, nutritional supplements (and possibly having a feeding tube inserted) and oxygen.

The constant stream of anger and indignation in the media must start to sound confusing to the everyday person as there is such a massive web of problems for us within the services and facilities we are offered. However I just wanted to add my piece and get it off my chest. Here are a few points that I feel are important.

En-suite rooms are NOT A LUXURY, they are a basic need.

Firstly, as has been pointed out lots of times in the last few days, going into the current mixed and cramped conditions in Vincent’s is extremely dangerous for CF patients. We are at a low with infection and are open to any bugs flying around. These bugs can spiral out of control and could kill us. That is a fact. It is not as if we are looking for some kind of luxury-we are just looking for the basic and necessary treatment for cystic fibrosis which is recognised as international best practice. We NEED isolation units with en-suites and we need them now.

Intensely depressing scenario regarding conditions.

It is hard to describe how truly soul destroying it is to be put in a ward with 5 patients who are elderly and often senile and incontinent. I make a concerted effort each day to be strong and positive and to fight my illness, but just imagine trying to maintain this frame of mind when you are stuck in your bed because of o2xygen dependency while all around people are calling out for people who aren’t there, and are regularly soiling their beds or using a bedpan, making the smell in the ward unbearable.It is so horribly depressing.

May I also point out that the ward is where the meals are served. Would you eat your dinner in a public toilet? Because that is basically what I am expected to do EVERY DAY.

Sometimes all I want is a bit of peace and quiet and maybe to curl up in a comfortable place on my own. Even this simple desire is not possible in here. Each time someone dies in your room you are forcibly confronted with the reality that someday this could be you. What did I do to deserve this? Do I not have the right to be protected from this?

Mary Harney’s private hospital “solution” and staffing levels.

Although all the coverage has been about the lack of facilities, it is important to note that the staffing levels are also dangerously inadequate. If you refer to the report on CF services in Ireland conducted by Dr. Ron Pollock this is stated quite clearly.

However whenever the issue of cystic fibrosis is raised with Mary Harney, she tells of how funding has been allocated for new staff. While some funding has been allocated and there are now two consultants in St Vincent’s, all the consultants in the world won’t be able to get me a bed when I need it if it is not available, and they can’t magic isolation units out of thin air. If the problem is to be tackled extra staff alone will not alleviate our situation.

Also Mary Harney’s idea of freeing up public beds by building private hospitals does not help CF patients at all. While it MAY mean a shorter stay in A&E, which, I might add, is a ridiculously dangerous situation, it does not address the issue of single isolated room with en-suite, which are VITAL.

I want some answers. Why is this allowed to continue? Would Mary Harney like to step into my shoes for a day? I don’t think so.

As I write this, my 6 bed room has finally quietened down, but I’m sure that I can look forward to some noise later on. Here’s hoping for a good nights sleep.

I also want to say that despite all of this mess, the CF team and the staff of St Vincent’s hospital are nothing short of amazing, and I feel so lucky to have them looking after me. I couldn’t ask for any better, each and every one of them is just fantastic.

Yours Sincerely,
Bernadette

Medical consultants and strip clubs

Liveline (Friday) had some interesting calls last week regarding the fees charged by medical consultants. Here’s an example.

Margaret noticed some lumps on her arm. Her GP had no idea what they were but charged €55 before referring her to a consultant. The consultant had no idea what the lumps were but charged her €230 before referring her to a surgeon who would be charging €150 just to have a chat. So, €435 and Margaret is none the wiser about the lumps on her arm.

It reminds me of the old strip club scam (I, er, read about this someplace).

The customer arrives at the club and is charged, say, €20 before being led into a small bar where he is encouraged to buy some very expensive drinks. Where’s the action he pipes up? Oh, that’s in the club proper, it’s just an extra €50.

He’s then led into an even bigger bar where the expensive drinks become very, very expensive. By this time the customer is drunk and becoming impatient and very angry. The bouncers arrive, give him a good thrashing, rob his wallet and throw him out the back door.

Yes, I think that’s a pretty accurate description of how certain parts of the Irish health system operates.

Minister Andrews and Cloyone child abuse – I don't want to know

Here’s how Minister for Children, Barry Andrews explained his part in the Cloyne child abuse scandal

Interviewer: “When did you first read this report?”

Minister: “When I received the report from the church board I simply handed it on to the HSE because that is exactly what the post Ferns scenario requires us to do, to ensure that the HSE as the child protection authority in the State investigates any concerns about child protection, that’s what I did.”

“So you didn’t read it, you passed it on.”

“That’s correct.”

“But this is part of the questioning of protocols and responses because I suppose it is a learning curve for everyone in trying to cope with the scandals but do you think that was the best way for things to be?”

“That’s the we have learned is the best way, it’s not for the Minister for Children to investigate matters, it’s not for any government minister to investigate any issue.”

“Is that not neutral to the point of detachment?”

“No, it’s not. The HSE is a state authority and it has the function of ensuring that child protection practice in the State is very good. It’s my role to ensure that the HSE are doing that job so if I get a report about child protection concerns from any authority, sporting organisation or anybody, I wouldn’t investigate, I would pass it on to the HSE who have the staff and who have the statuary function under the Child Care Act to investigate these matters.”

“Does not reading mean that you don’t know anything about it, you barely read the title on the cover and you say – I don’t want to know?”

(At this point the Minister decides not to answer the question but instead reverts to political waffle)

“What’s absolutely lost in all of this is that we had an audit already in place on the part of the HSE in relation to Cloyne, so it was an unusual set of circumstances… blah blah blah.”

It’s crystal clear from this interview that Minister Andrews does not see child protection as an important matter. He’s apparently very happy to hand over total responsibility to the HSE, a discredited, unaccountable and completely self-serving organisation, an organisation that regularly puts the lives of Irish citizens at risk.

Barry Andrews is a young politician with the likelihood of a long and prosperous career as a member of the most corrupt and irresponsible political party in Ireland. Irish citizens and in particular Irish children are likely to pay the price.

Copy to:
Barry Andrews

Child abuse holocaust continues

The holocaust of child abuse continues in the Catholic Church. A publication by the National Board for Safeguarding Children strongly censured Bishop of Cloyne, John McGee, for “potentially exposing vulnerable children to further harm.”

Even the usually mild mannered and conservative Marian Fincuane (Saturday) was angry.

“I was listening to the Bishop on the six o’clock news where he said ‘we’re in learning mode’ – learning mode??
And I just think we should remind ourselves that Ivor Paine was first sent for treatment in 1981, the Brendan Smyth event happened in 1994, we had the revelation about the £30,000 which was paid to Andrew Madden and then we had Archbishop Connell coming out in May 1995.
Then we had Ferns, then, fortunately we had Archbishop Martin who said we’re going to get our act together here, we’re going to cooperate in every possible way with the State, we are going to be open and transparent.
But down in Cloyne they’re still in ‘learning mode’ and this is about the protection of children who can have their lives destroyed by these kinds of events happening. So, I think now that below in Cloyne it would be very useful if you got into a slightly faster learning mode.”

Matthew Ring, a priest who nine years ago courageously left the Diocese of Cloyne in disgust at how sex allegations were being dealt with by McGee, was even more to the point.

“If John McGee as bishop of Cloyne was resident in England he would be questioned by the police and all his documents would be removed from his house and there would be a thorough investigation into what went on. I think in terms of Ireland the bishops feel they’re above the law and above accountability and that’s the fundamental problem in Ireland. Until such time as a bishop is held before the courts of the land in Ireland there will be no transparency and no accountability.”

We at Public Inquiry would add to the list of those who are above the law in Ireland – Politicians, bureaucrats, bankers, solicitors, policemen – the list goes on.

The Catholic Church always puts its own interests before the vulnerable it claims to protect. This is unlikely to change given that it is now led by a man who fatefully served Hitler’s Nazi party until the very last days of the war.

The HSE, another agency that often operates outside the law, refused to give a date for the release of another report it possess concerning child abuse. No doubt it is waiting for the most opportune moment to slip it out quietly while the media is otherwise engaged.

The (Fianna Fail) Hippocratic Oath

Here’s how Donegal Fianna Fail TD Dr. Jim McDaid explained why he could not support the Government’s decision to postpone a cervical cancer vaccination programme for young women.

“We will pass a death sentence on a certain percentage of the 12-year-old girls whose parents cannot afford the cost of it.”Is there anyone in this House who would not give the vaccine to their daughters today?”

“Fifty years from now, it will not be important what my bank account was, what type or car I drove or what size of house I lived in.”It does matter to me that during my stay in this House I may have been, just may have been, important in the life of a child.

“Accordingly, I cannot vote for the Government’s motion this evening,”

“I fully realise the implications of this but I trust that my colleagues understand that, while I will abstain, I will not vote per se against them.

I cannot vote against an oath I took 34 years ago.”

The oath Dr. McDaid speaks of is, of course, the Hippocratic Oath. The following are two promises made in the oath.

“To practice and prescribe to the best of my ability for the good of my patients, and to try to avoid harming them.” and “Never to do deliberate harm to anyone for anyone else’s interest.

Dr. McDaid seems to be taking a distinctly Fianna Fail attitude to the oath.

He knew that no matter how he voted the Government would prevail. So if he was genuinely determined ‘never to do deliberate harm to anyone for anyone else’s interest’ he should have voted against the motion instead of hedging his bets by abstaining.

As it is he has put himself in the worst of positions. His colleagues will not be impressed by his plea that he is ‘not voting per se against the motion and others will judge that as doctor who took the Hippocratic Oath he felt it was enough to merely abstain on a matter that was important to the life of a child.

He won’t, however, have to worry about the judgement of a ‘certain percentage of 12 year old girls’.

NTPF rip off

Letter in yesterday’s Irish Times.

Madam,

The National Treatment Purchase Fund (NTPF) has a budget of of €100 million in taxpayers’ money for 2008.

According to the NTPF’s latest report, some 20,000 “in-patients” were treated in 2007 at a cost of €92 million. The report does not provide precise details of the procedures performed or of their individual cost, but at least two-thirds of the procedures listed, such as endoscopy, tonsillectomy and dental extraction, would normally be carried out as day-case procedures, which are relatively inexpensive.

Some 10,000 out-patient consultations and some 2,000 MRI scans were also provided. Excluding the out-patients, the cost per in-patient treated was therefore €4,600. Four private hospitals shared €49 million of the fund.

The Mid-Western Regional Hospital complex in Limerick, which includes three hospitals – the Regional Hospital, the Regional Maternity Hospital and Croom Orthopaedic Hospital – has a budget of €195 million. In 2007, it treated 33,000 genuine in-patients, about 75 per cent of which were emergency cases, of all levels of complexity, and 19,000 day-case “in-patients”; 29,000 new out-patients were seen along with 109,000 review out-patients. Again excluding this massive out-patient activity, the cost per-inpatient treated was €3,750.

There is something radically wrong here. On the basis of these numbers and the case mix, the NTPF figures suggest a waste of, at the very minimum, €20 million.

Those who are committed to eroding our public hospital system in favour of creeping privatisation might take note.

Yours, etc,

Dr GERRY BURKE, Riverside Clinic, Steamboat Quay, Limerick.

The figures quoted in this letter are astonishing and outrageous. The NTPF was originally set up to treat seriously ill patients languishing on long waiting lists. The idea was to treat these patients outside the jurisdiction in order to relieve pressure on a creaking and inefficient health service.

But as always in Ireland the scheme has been corrupted. Here’s how it now works.

A consultant in a public hospital treating a public patient will be paid X amount for his work. If that patient is put on the NTPF list the consultant’s fee is considerably increased.

So, we can have a situation where a consultant, working in a public hospital paid for by the taxpayer, treats a patient in the morning and decides to put him on the NTPF list. The same consultant returns in the afternoon and because the patient is now on the NTPF list and therefore judged to be a private patient the consultant’s fee is multiplied.

As the above letter reveals many of the treatments are not of a serious nature and therefore should not qualify for NTPF. I suspect that the €20 million wastage mentioned is a fraction of the total cost to the long suffering taxpayer.

See here for more on this scandal.