WEXFORD IN ‘DEATH ZONE’ SAYS DOCTOR
ENTIRE WEXFORFD GP FACULTY BACK NEED FOR SECOND CATH LAB
AS many as 13 people a year die due to the lack of a cath lab at University Hospital Waterford, a doctor warned councillors at the monthly meeting of Wexford County Council.
Dr Aidan Buckley said the service preferred by the HSE relies on a patient suffering a cardiac arrest getting to a cath lab within 88 minutes. ‘We had Brendan Howlin and Mick Wallace raise questions in the Dáil on ambulance times. Prime Time also eventually did a report. The time you get an ambulance from call to arrival if you are based in Wexford is two hours, 30 minutes. Ambulances travel at 69 km/h per hour on average with a top speed of 100 km/h. People outside of the Dublin area are living in the “death zone”,’ he said.
Dr Buckley said heart attacks don’t respect the working week times at when Waterford Cath Lab is open. ‘International studies show that within the first hour there is a 15.4 per cent risk of mortality. This raises to 30 per cent for the two to three hour mark. We are moving people who should have access to treatment within one hour. A small number of people have died because of this, but every single cardiac patient will have a worse outcome.’
Dr Buckley said there is no other region in Ireland that is excluded from having a cath lab. ‘ The standard in Switzerland is to get into hospital within 20 minutes. This is killing approximately seven to 13 people per year. That is one person every month or second month depending on the statistics you look at.’
Criticising the Herity Report which recommended that all cardiac patients be transferred to Cork on the basis that the ambulance journey time is 88 minutes, as ‘slapdash’, he said: ‘ The Waterford service was developed in lock-step with the Limerick service for the mid west which went 24/7 in 2012 and the south east service was circled back into the Herity process. It’s a really strange political anomaly and we don’t have any answers for that.’
Matt Shanahan said: ‘I am sure there are many of us here who are monitored for cardiac issues. The average transfer time is two and a half hours. Over a three year period from 2015 to 2018 196 patients were transferred out of the south east for acute care. Only three of these patients managed to get to the hospital within 90 minutes. No patient from Wexford did. Prof Herity recommended a helicopter service, which is being used as a defective stop gap at €20,000 per hour. There were three helicopter transfers in July to St James’s or Cork: that’s €60,000. As the helicopter doesn’t fly at night or in fog, it’s availability is very limited,’ he added. ‘It’s absolutely unacceptable what is going on with cardiac medicine.’
Mr Shanahan said the Secretary General of the Department of Health gave an unequivocal guarantee in 2013 that a second cath lab would be provided for Waterford, with cardiology teaching posts and Health Minister Simon Harris announced that it was a priority in 2016.
The problem of emergency cardiac patients being denied access to the hospital continues because of difficult procedures which are prioritised to be carried out. ‘Minister Harris agreed to three day diagnostics a week when the waiting list was two to three years long. The lab didn’t arrive on site until October 2017. In July of that year the minister announced that he was scrapping an independent review of cardiac services in the south east. It’s now being looked at in a national review, set to be released in mid-2019. He said there would be no expenditure on cardiac units but two days before St Vincent’s put in their tender, and it (the tender) closed within 20 days. It has not been fully commissioned as a primary centre.’
He said Dublin has ten public and 11 private interventional cath labs compared to one in the south east which has a population of around half a million people. ‘University Hospital Waterford’s cath lab is the most efficient in the country doing twice the procedures than Dublin hospitals do. In 2017 there were 3,200 cardiac procedures carried out compared to 1770 in St Vincent’s.’
He said there were two prominent deaths in Waterford last year, a female lecturer and Thomas Maher. ‘If that woman had received care in a timely manner she would have survived.’
The fact the lab is closed from Friday afternoon until the following Tuesday on bank holiday weekends is also unacceptable. He said the new lab is staffed by three to four cath lab employees from the UK who are only doing diagnostic work and not interventional life saving work they are trained for.
Mr Shanahan said imaging equipment was removed from the lab and as a result doctors can’t put a stent in. ‘It’s not just happen-stance that this is happening. There is significant resistance within the department.’
He said a new monitoring lab would cost €2,700 per week extra to run. ‘Simon Harris agreed he was going to make a permanent cath lab available but three people in the Department of Health said he couldn’t afford it for the south east. The lab will not be delivered for €3.6m. With it we could Wexford patients to a cath lab in a half an hours time.’
Cllr Joe Sullivan you have painted a very bleak picture. In early 2017 I was brought to Wexford. The doctor instructed the ward sister to check with the cath lab in Waterford but I had to be transferred by ambulance to the Mater. It took 103 minutes from Wexford with no traffic. I set out on that journey not knowing if I was going to make it or not and I was lucky I got there. There were two cath labs side by side. If I was waiting on a public service I was gone. It’s a sad reflection that you have to have private health insurance to get primary heart care in the south east.’
Cllr Ger Carthy said County Wexford is geographically tied between two HSE areas: south, south west and Ireland East. The ambulance paramedic relayed a story of a woman whose life was hanging in the balance as she was transported to a Dublin Hospital. ‘She did survive but it should have been dealt with in Waterford.’
Calling for a council deputation to meet senior HSE officials in the region, along with Minister Simon Harris, Cllr Carthy said: ‘ This can has been kicked around the road long enough. People are being airlifted from the GAA pitches across this county and it’s not acceptable.’
Cllr Johnny Mythen said he can’t understand how pieces of vital equipment could be removed from a cath lab, asking what the cost of a full-time cardiologist would be per year. Cllr David Hynes said he had a heart attack but was one of the luck ones who lived to tell the tale.
Cllr Michael Sheehan said: ‘ There seems to be some person who is blocking this proposal,’ while Cllr Tony Dempsey enquired if the current cath lab is working.
Mr Shanahan said: ‘If you have VHI and if you are an elective patient you will absolutely get access to a cath lab in Dublin or Cork.’
He said cardiac inpatients are left waiting for up to a fortnight to be seen, when they should be treated within 36 hours. ‘ There is an issue where emergency patients will arrive in to a hospital where there is a complex care is ongoing that a patient does not get immediate access. Tacit approval has been given for an interventional consultant, which would be a fourth consultant to be appointed. The consultants have indicated they would implement a rota of 8 a.m. to 8 p.m. seven days a week.’
He said the piece of medical equipment was removed from the lab, adding: ‘No-one wants expanded care in Waterford. I believe this is not coming from the HSE,’ he said, adding that a full-time cardiologist would cost between €250,000 and €300,000. ‘ A doctor has been identified and would be available to come on stream. If we had that second lab open providing priority access it would free up 5,000 hospital beds in the south east needed for acutely sick patients. I do believe the pressure is coming from the very highest level in the secretary general office, not the Department of Health.’
Cllr John Hegarty said the lab was in the Programme for Government, adding that it is an enormous political failure. ‘It has failed our citizens and the professional who are assisting in providing this service like people who are in driving ambulances and flying helicopters and admissions staff. They are being deprived of essential tools that are cheap. This wrong starts at the top.’
Mr Shanahan said the entire GP faculty in County Wexford and consultants have written to Mr Harris, spelling out that the lab is needed. Liam Spratt, who is part of a Wexford campaign to get the lab, said: ‘ All of us deserve the chance to live if we have a serious ailment and I can’t think of anything more serious than a heart attack.’ HORRIFIED, drawn, weakened and shattered. Clinging on to power by her fingertips. Gasping and grasping and very much on borrowed time. Theresa May, Prime Minister of the UK, resembles a trout on the riverbank. Brexititus finally seems to have choked the life out of her. Panting like a puppy. She’s a goner. Or is there one more twist or turn of defiance in the oul dog yet? Like the last kick of a dying ass struggling in her political world of despondency?
Where once she was Queen of all she surveyed, with steady hand at the wheel, now the poor cratur is in a hole, with a shovel. Rattled to the core. Where, as is surely necessary, might she seek inspiration or solace? Do words of such required magnitude even exist? And if they do, who possibly could have uttered them? Step forward one literary giant of the old Empire!
Rudyard Kipling (1865-1936), remains one of modern times’ more recognisable and respected writers, considered by many a genius, a moral compass and an inspirational figure with the might of the pen. In 1907, at the age of 42, he was awarded the Nobel Prize in Literature, making him the first English-language writer to receive the prize and its youngest recipient to date. Works such as ‘The Jungle Book’, ‘The Man Who Would Be King’ and ‘Kim’ remain timeless. Plus, he was an excellent poet.
His poem ‘If’ has most likely been quoted and read to us, inspired and encouraged us, and resounded and existed within us far more than any of us may realise. It is delivered at births, deaths, marriages and mishaps with equal measure. Alongside life’s non-stop cycles of peaks and troughs that shadow each and every one of our lives, it remains relevant.
And if life itself is but a series of highs and lows, bitters and sweets, well, Kipling’s was no exception. Born in India during the time of The Raj, to well-off loving parents, his early life was one of wonder, adventure and splendour. A sharp twist in his road found him transported to England at the age of six for his education, and left under the wing of a cruel, abusive foster mother for the next five years. There followed an upward curve when he was moved to a school in Devon where he thrived. His path toward writing became clear and his first successes followed, only for disaster to strike when he was left penniless by a collapsing bank. He rose again following a move to the USA, but was forced to return to England after a lengthy, costly court battle.
On a return trip to the USA in 1899, his greatest catastrophe of all struck when his seven-year-old daughter Josephine died of pneumonia, leaving him utterly devastated. Although hardly a consolation, his reputation continued to climb culminating in the Nobel Prize in 1907. However, a further cruel twist of fate lay in store. When his son John failed the medical to enlist for World War One, Kipling pulled a few strings on his son’s behalf.
Alas, his son did not return from the Front, dying in the Battle of Loos in 1915. Guilt and despair swamped Kipling. But he coped with his grief and the harsh hands he had been dealt, and let us hope he took some measure of comfort from his own words contained within ‘If’, written for his son, some years earlier, in 1910. Because the words of this poem in its entirety are seismic, and will remain with us for all time. Small wonder they crop up again and again and again. Here is the fourth and final stanza; If you can talk with crowds and keep your virtue, Or walk with Kings—nor lose the common touch, If neither foes nor loving friends can hurt you, If all men count with you, but none too much; If you can fill the unforgiving minute
With sixty seconds’ worth of distance run, Yours is the Earth and everything that’s in it, And—which is more—you’ll be a Man, my son! Joseph Rudyard Kipling died following surgery on January 18, 1936. His ashes were interred at Poets Corner, Westminster Abbey, London.