EXPLOSIVE EMAILS REVEAL DOCTORS’ FEARS IN A&E
Explosive letters obtained under Freedom of Information Act show medics fear overcrowding will cause unnecessary death
LETTERS sent by stressed medical staff reveal the full extent of the nationwide crisis in emergency departments.
Emails and letters sent to the Health Information and Quality Authority, released under the Freedom of Information Act, show the intolerable conditions under which patients are treated every day.
This comes as an internal HSE report reveals the slow pace of making changes that were recommended by a damning study on A&Es written three years ago.
Earlier this year, more than 600 patients lay on trolleys on a single day – a record number that spurred the creation of yet another emergency department taskforce.
But as the reports pile up, medics and nurses feel forced to go beyond their hospital managers and alert HIQA to growing problems.
In Co. Donegal, an email sent by a senior nurse at Letterkenny General Hospital referred to rising patient numbers and said: ‘We are at level BLACK. There are no physical spaces in which to treat patients in the ED [emergency department] at this time.’
Medical staff use a colour-coding system to classify overcrowding in a simple manner. The informal system gives points based on patient numbers and other data. It starts at green for ‘normal’ and rises to black for ‘disaster’.
A doctor at the busy hospital wrote: ‘This morning there were 12 admitted patients awaiting beds in the six-trolley ED, with another six patients in the four-bed unit including [patients] in the store room. We assessed a patient on an ambulance trolley at a desk.’
On another occasion, he wrote: ‘I am hugely concerned for patient safety at this time.’
A second consultant in Letterkenny warned of overcrowding: ‘This is a frequent occurrence’.
The problems continued this week with 30 patients on trolleys waiting for a bed on Wednesday.
Consultants at Tallaght Hospital have written to warn that should a serious motorway pile-up occur there would be no room in the A&E for injured people.
One wrote that on a single day 11 patients waited more than 15 hours to be admitted. Another email said one patient had been ‘boarded’ for over 48 hours: ‘[this person] was most disturbed by the constant light and excessive noise. This is a form of torture in many regimes,’ the angry doctor wrote.
HIQA’s response to these emails is to remind staff to raise concerns with hospital management.
Dr James Gray in Tallaght Hospital was not content with this, and wrote: ‘ There was a time when reporting clerical abuse to senior clergy was deemed appropriate. It resulted in a cover-up.
‘It is wholly inappropriate and irresponsible for HIQA to respond in the same way to senior clinician whistle-blowers asking them to continue to complain to senior management.’
A doctor working in Beaumont Hospital wrote to HIQA, saying the chaotic conditions were: ‘equivalent to a healthcare Guantanamo.’
The Irish Nurses and Midwives Organisation has also highlighted concerns with HIQA. A letter about Beaumont Hospital warned: ‘Acutely ill and elderly frail patients are spending up to three to four days in the emergency department waiting for a bed.’
INMO representative Mary Fogarty highlighted concerns about Limerick Hospital in August, calling on the hospital to review ‘specific clinical incidents’. This refers to breaches of patient safety.
She said this week: ‘The risk is still there. There are 44 people on trolleys today.’
The INMO also wrote about Our Lady of Lourdes Hospital in Drogheda. The letter said: ‘It is a constant reality that patients are cared for on three particular corridors. It is often the case that in excess of 18 patients are cared for in this area, often only one nurse.’
On Friday 36 patients were on trolleys.
Members of the public also contacted HIQA about emergency departments. One person complained of the ‘chronic situation’ in hospitals. Another wrote: ‘There is a huge risk to these people in the A&E from cross-contamination.’
The Irish Association of Emergency Medicine has also written to HIQA protesting about the conditions on behalf of all hospitals.
Speaking to the Irish Mail on Sunday this week, IAEM representative Mr Gerry Lane said: ‘It is heartbreaking. There is an escalation policy for dealing with overcrowding in many hospitals. Many of them would be at black much of the time.’
He warned: ‘It is impossible to deliver equitable care in these conditions.’
Mr Lane, a consultant at Letterkenny, said: ‘There is no Irish hospital with an ED which is consistently at a normal level of bed occupancy. This is a symptom of a sick, sick healthcare system.’
A Tallaght Hospital spokesman said new policies have seen trolley numbers drop by 45% compared to 2013. Nurse recruitment is planned to cope with rising attendances and an extra doctor has been hired.
A spokesman for Beaumont Hospital said it regrets the difficult conditions. Beds occupied by patients waiting to be discharged to nursing homes or respite beds can equal three wards at times.
A new 24-bed unit is to open in Drogheda in June, and recruitment is ongoing. Limerick Hospital will open a new ED next year. Letterkenny General Hospital had not responded last night.
This is all happening three years after a HIQA report on Tallaght Hospital in 2012 made 76 recommendations for the emergency services nationally.
But documents released by the HSE under the Freedom of Information Act show change is slow – where it is happening at all.
The report said patients should be seen within six hours. However the latest target from the HSE and the Department of Health is nine hours – an admission that six hours is not achievable.
One of the more worrying files shows the response by HIQA to a request to investigate the A&E in Our Lady of Lourdes, Drogheda.
Writing to Sinn Féin TD Gerry Adams, the HIQA boss wrote that as the HSE has not carried out recommendations from earlier inspections, another assessment would be of little use.
He added: ‘ If recommendations were to be implemented, we believe risks within the country’s ED would be significantly reduced.’
‘This is a form of torture
in many regimes’ ‘It’s a symptom of a sick, sick healthcare system’