To Health And High Water

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From top: St James’s Hospital, Beaumont and Holles Street; Neil Curran

 

“We’re in St. James’s A&E and the doctors have asked for the family to come in”.

As I read the text message from my father that Friday morning in September, it was as if the world had stopped for a second. When we are young our parents are bigger than Jesus and more powerful than the dinosaurs. But as we grow into adulthood, we face the harsh reality that most of us will outlive our parents and there is nothing we can do about it. I was about to face that reality head on.

In September of last year, my Mam was rushed to St. James’s hospital after she collapsed out of the blue. She had suffered from a brain aneurysm.

A brain aneurysm is a weakness in an artery that risks rupturing and when it does, it releases blood on the brain often resulting in a stroke and/or death. Unfortunately brain aneurysms show no advance symptoms. In my mother’s case, the bleed is referred to as subarachnoid haemorrhage (SAH).

As I walked into St. James’s busy A&E, I found my mother on a bed in a corner of an empty ward. Doctors had already placed defibrillator pads on her in anticipation of what might happen. My father, brother and I stood around the bed watching her heart rate fluctuate between 30 and 60 bpm, causing varying physical reactions from my mother as she drifted in and out of consciousness.

A young doctor brought us into a room privately. The look on this face did not inspire hope. My mother needed emergency surgery and the only hospital that could perform it was the neurosurgery department in Beaumont Hospital (the other is in Cork). However, there was no available beds in Beaumont so they couldn’t transfer her there until a bed freed up. The look on his face said it all.

The Doctor did not appear surprised and his familiarity with the words suggested it was not the first time he had to tell someone a bed wasn’t available. There was absolutely nothing that St James’s hospital could do for her other than keep her comfortable. There was already blood on the brain from the first bleed.

As a result, she was at a high risk of stroke but an even greater risk existed. The aneurysm would bleed again and when it did, it would likely be fatal. Speedy treatment was essential. Statistics show that 15% of victims of a ruptured aneurysm don’t survive even before they get to hospital, and 50% of patients never leave hospital for various reasons following admittance.

Later that day, by way of a phone call from a friend of the family who “knew “ someone in Beaumont Hospital, we learned that a bed was available and could tell us the name of the ward. We started to see hope, or so we thought.

Our own humility restrained us from blurting to the doctor that we knew a bed was available through our friend. In fact, it was quite embarrassing to consider that a bed may have freed up because “we knew someone”.

We asked the doctor to recheck the bed availability. It took a few more hours for both hospitals to communicate effectively between themselves that a bed in Beaumont was actually available. Long hours watching a volatile heart monitor while awaiting official confirmation of the bed was incredibly frustrating and distressing, knowing that we weren’t already in Beaumont.

My mother was transferred to Beaumont that evening and the surgery was completed successfully the next day. They managed to close the aneurysm and just in time too. She would remain an inpatient in Beaumont until such a time the medical staff were satisfied that they could transfer her back to St. James’s Hospital for further recovery.

The staff and level of care in Beaumont while she was there was excellent. We were very fortunate that my mother’s surgery was a success. Other patients in the Intensive Care units and High Dependency wards, some of which were much younger than my mother, were not so lucky.

The road to full recovery is a long one; it will take time for her short term loss memory to return if at all. There was a window where the risk of stroke and other issues would remain high. But with the aneurysm sealed, there is very low risk of further bleeds.

Unfortunately, our story doesn’t end there. When my mother was transferred to St. James’s Hospital some weeks later we thought we were on the home stretch. However A number of issues arose within days of her arrival.

Essential medicine to be administered by the hospital every 4 hours was not administered for at least 12 hours. The explanation given afterward was that they did not have the medicine available on the ward, the hospital pharmacy closes at 6pm and did not open until the next morning. They did not try to alternately source the medicine from Beaumont Hospital.

On a separate occasion, my mother was given the prescribed medication of another patient in error instead of her own. When we quizzed the nurse about it, she tried to reassure us that the medicine given would not affect her negatively however they were evasive in telling us what medicine had been administered!

We debated discharging her from the hospital and caring for her at home. We did not feel she was in good place in St. James’s following these incidents after the lifesaving care provided in Beaumont. However, a senior nurse intervened and gave assurances that there would not be further problems with my mother. She remained in the hospital and no further issues with her care was apparent.

Shortly after her discharge from St. James’s, she became in inpatient in St. Patrick’s University Hospital for mental rehabilitation for the brain trauma she experienced. St. Pat’s is a mental health hospital that deals with a variety of mental health issues for patients of all ages.

I was not familiar with the hospital prior to this and I imagine with the stigma of mental health in society, we don’t hear enough about the services they offer and the good work they do. The treatment and care in St. Pat’s have been world class. Of all the hospitals we have been in through 2017, St. Pat’s stands out. We have been very pleased with my Mam’s treatment and recovery and how well the hospital is run.

Throughout her care there, questions started to emerge about her treatment in the previous hospitals. While never explicitly stated by the doctors, there was concern alluded about some of the drugs she had been prescribed, the dosage, the duration they were taken for and the cold turkey approach when the course finished. It seemed that part of my mother’s treatment in St. Pat’s has been incorporating recovery from the withdrawal of some of these drugs.

But again our story doesn’t end there. My mother’s doctor in St. Pat’s wanted to reduce the dosage of one of her medications but needed to speak with the medical team in Beaumont first.

Despite his efforts, he could not get a response from Beaumont for a period of weeks. Eventually Beaumont responded to St. Pats in a voice message. What transpired was beyond comprehensive. Beaumont Hospital had no record of my mother being a patient there, despite having a life-saving brain procedure there. Her patient file was missing.

In addition, my mother’s first outpatient appointment was now scheduled over 2 months later than her first appointment should have been according to her discharge papers from Beaumont. Given the lack of communication from Beaumont, it also raises the question as to whether her dosage on this particular medication should have been reduced prior to this point.

As a family, we have been very fortunate prior to this that visits to hospitals have been limited to minor incidents. We all read the stories in the press about horrendous experiences in the hospital system but it’s hard to comprehend it until it happens to you. After all, aren’t these incidents one-off mistakes? It seems reasonable that the HSE would learn from mistakes made, or court settlements reached and make necessary improvements?

Between this and some other incidents, including my spouse’s experience in Holles St. National Maternity Hospital during the same period, it’s been a real eye opener to how broken the health service is.

With the exception of St. Pat’s, we have experienced a series of fundamental issues across three hospitals in Dublin over a short period of time. Generally speaking, most of the staff are doing their best. But it’s very clear that the infrastructure is broken but that seems to be just one component. The system, for the want of the better word, is not fit for purpose. That being said most of the issues we encountered were the result of human error by members of staff.

In 2017, a story hit the papers about the tragic death of Evan Morrissey (28) in 2014 who died from aneurysm related SAH due to a variety of shortcomings of care in South Tipperary General Hospital. The hospital admitted liability, apologised and a settlement was reached.

Also in 2017, a story emerged of a 60 year woman, Bernadette Surlis, was left completely blind and paralysed down the right side of her body due to a delay in correctly diagnosing and treating a brain aneurysm when she first presented herself to Sligo General Hospital in 2013. She was investigated for glaucoma and discharged.

She presented herself at the Sligo General Hospital again the next day, was eventually seen to by doctors but the aneurysm ruptured that evening at 7:30pm. She was transferred to Beaumont later that night at 1am by which time it was too late. She received a settlement of €5m in the High Court after suing the HSE alleging negligence in treatment and care at Sligo General Hospital.

Time is a critical factor when diagnosing and treating an aneurysm and it does not bear thinking about if my mother would have been in a similar scenario, had the family friend not intervened in securing a bed in Beaumont.

With the number of issues, court cases and settlements we see in the media, it really begs the question; is the health service getting better and if so, how do we measure it? I can’t help but feel that perhaps a view is being taken from the top that it’s cheaper to budget for court settlements than attempt to truly invest and fix the system.

As one doctor told us in Beaumont Hospital, there are roughly only 100 beds in neurology available for a population of 5 million people in Ireland. There are no private hospitals, it all goes through the public system.

Does the lack of beds mean that currently, there is a selective process for choosing who gets a bed/treatment for an aneurysm based on location, severity of the bleed, age or other reasons, rather than there being sufficient beds and services available to meet normal/average demand levels?

Just like currently, where there is the perennial crisis of insufficient beds and services for what is the normal high season for flus. In both cases, a proper level of bed availability to deal with the real demand should be provided.

Just where does the buck stop with responsibility and accountability?

Neil Curran is a improviser, trainer and appears on and produces Broadsheet on the Telly.

Pics: Wikipedia.Rollingnews

39 thoughts on “To Health And High Water

  1. Christopher

    My brother had a very major operation in Beaumont a couple of years back and he was given an extremely high dose of pain killers (this was confirmed to us after the fact that it was much higher normal for reasons unknown to them or us) after that was (just as in this case) brought to ZERO just 48 hours after the operation. He was in screaming agony and the doctors were like “Oh you might need your morphine back”. Surely there are clear guidelines for dosing and duration of pain killers that arent so arbitrary. I really dont know why the system is so hard to fix- it baffles me how companies all work efficiently but the health system cannot.

    1. Sam

      “it baffles me how companies all work efficiently but the health system cannot.”

      Companies are funded to meet the needs of clients who can choose to buy elsewhere or not buy at all. Healthcare isn’t a commodity and patients don’t have the same options as someone buying a DVD player.
      If the company loses customers, the directors take a hit from the shareholders. Actions and consequences.

      People get mobilised about Apple slowing down iPhones to (cough) save battery life (cough) or internet providers proposing to operate a two tier internet system, but not so much about healthcare.

      We can have MRI machines sitting idle, waiting for the next private patient to come up, while someone else is told to wait weeks or months on the public list. But the minister for health will still have his job the next morning, and even if he loses it at the next election, like James O’Reilly did, he can be made a Senator, and the Taoiseach is usually a safe seat.

      We came reelecting the same three parties. If we never show them that there are serious consequences (i.e. a complete wipeout of their political capital) why would they change? They can all endure a few years in opposition.

      That’s what it boils down to. There are vested interests in health and politics and the major stakeholders don’t make enough of a fuss, so we get the system we’re willing to moan about but ultimately put up with, because we don’t want to be seen as radical, or having notions.

    2. Percival

      “it baffles me how companies all work efficiently but the health system cannot.”

      No it doesn’t baffle you. You know damn well the two are not comparable.

      You’re shilling for privatisation of the health service.

      1. Christopher

        Not at all! That is the last thing I want- I want the public servants who run the HSE to what is needed to fix the health service- for some reason they don’t seem to care.

    1. Increasing_Displacement

      Bad record keeping?
      IT issues?
      Communication issues?
      Nurses incompetence?
      Bloated inefficient HSE?

      None of these inspire confidence when dealing with life and death matters.

      1. GiggidyGoo

        The FFGLAB lot are too busy matching our personal information for dubious projects instead of addressing what should be simple – hospital / medical records being shared within the health service.
        Hospitals seemingly aren’t obliged to use the same software, or even hardware, throughout the system. Get a scan done in, say, Waterford, and the software results cannot he read by a scan program in, say, Galway. Hospitals with their own preferred suppliers. Bread buttering.

          1. Steve

            Ah the shinner comes out.
            Nice racism . It suits ye

            I think It’s great that the new Irish are coming here to help with our health service

          2. Brother Barnabas

            eh, the “shinners” would probably be the most non-racist group in Irish politics. say whatever else you like about them, can’t say that.

  2. Kolmo

    Frightening story.
    How can a country so small have such dysfunction – it borders on barbaric negligence, our health system is complex and forever evolving but how are we so far behind the rest of western Europe, and eastern Europe by the looks of things..
    A few weeks ago BS had a story about a giant fungus growing in an actual Ambulance, it’s laughable were it not so serious…

    1. Sam

      In some ways its easier for this small country to have such dysfunction. Fewer people pulling the strings, and more opportunities to turn up in local papers announcing jobs and roads, but not answering questions about how fupped the hospital is or why private companies are doing so well off the backs of the dysfunctional public system.
      I remember reading a story some years back where it was proposed to physically remove beds from a hospital (in the midlands I think) and a big crowd mobilised and stopped the removal.
      Where the population is not willing to get off their knees, they are wasting their time cribbing about being mistreated. Who exactly are they expecting to intervene? Superman? Magic Skydaddy? Joe Duffy?

    2. Percival

      It’s very simple. There has been a consistent policy across Fine Gael and Fianna Fail for decades now to turn healthcare into an industry for profit. The HSE was set up to lay the groundwork for that. The HSE was also designed to be the fall guy for all problems in the health service as if it was somehow not part of the Government or Civil Service remit.

      Just do a bit of research on what politicians and former politicians have invested in private healthcare clinics and are sitting on boards of directors of private healthcare companies.

      It’s all there, laid out to see if you go looking.

      People are dying in this country because a few greedy little morally bankrupt criminals are fixing the system to line their pockets.

  3. Jake38

    Like the rest of the health service, Beaumont needs more beds, scanners, etc, etc. Instead we have HSE bureaucrats doing god knows what.

      1. ahjayzis

        Money will not solve this. We already pay more than than almost all our peer countries for a system far, far worse.

  4. phil

    Neil, I wish to pass on my sympathies , your story is all too familiar.

    You mentioned it , and it was something I discovered myself. In Ireland we are all talking heads, and have strong opinions on various things we know nothing about. That is of course until you, or of your relatives finds themselves in desperate need of help. Then your illusions disappear one by one.

    I myself a couple of years ago, developed a rapid chronic illness. I believed I was well prepared , I had 5star health insurance, my first negative experience was The Blackrock Clinic. There was nothing wrong with the facilities, the empty ER, wards , Scanning rooms and surgery rooms were first class, and there certainly was no delay to errors that made a mess of me. One clear issue was I was an inconsiderate patient for getting seriously ill late on a Friday afternoon.

    Checking into a hospital on a Friday I later discovered can be a death sentence , any hospital, public or private. I assume the Government will once again try to negotiate at some point in the future with unions
    to attempt to implement 7 day , lets just see who apposes it, I guarantee you it wont be the patients.

    Ive have had similar experiences in Beaumount, Vincents, and eventually came to a few conclusions:,
    Private health care is not what most healthy people think it is ,
    The public health care system is not as bad as healthy people think, and patients who have tried both, will tell you the public system is better. Most patients with private health insurance In a private hospital, once diagnosed and are being treated, who no longer expect to spend time in a hospital bed are advised to continue to see their consultant in the public system, less financial strain on a patient is apparently better for their health.

    When you see a consultant in a Private hospital, you are seeing an individual. When you see the same consultant in a public hospital , you are seeing a member of a team, giving you access to nurses, and more eyes on your case.

    I am convinced that Private consultants, who are struggling to diagnose a patient who has a strange but non life threatening illness, order less expensive tests, in public hospitals, they test you for everything useful, even long shots.

    When people talk about problems with hospitals, they often blame the HSE, or infrastructure, but always follow those statements with the front line staff were great, that hasnt been my experience and all too often Ive heard patients describe poor/dangerous practice , be quite upset, only to turn around some time later and say they were wonderful. This is human nature , its easy to blame faceless HSE(and Im sure they deserve it) a little harder when its a person you met.

    The only advice I can offer is, get informed about your own illness, and personally document and follow up on every stage of your treatment, for example, this toxic drug you are taking for 6 months now, if you drop 2stone in weight , ask you consultant should the dosage be changed. Oh and seek a second opinion , just for the hell of it. Dont get sick.

    Why would a wealthy guy Gerry Adams, or other famous people who seek treatment in America? Surely they can afford the best medicine Ireland has to offer? I guess they can , and thats why they go ….

    1. Cian

      phil. I’d totally agree with what you say, especially:
      The public health care system is not as bad as healthy people think, and patients who have tried both, will tell you the public system is better.

  5. Harry Molloy

    The most upsetting part of approaching middle age is seeing your parents age, it’s so sad :-(
    I’ve had amazing experiences with hospitals and some awful. Some departments seem to work a lot better that others.
    A&E in itself seems to work well, and care is usually OK once admitted, it’s the nowhere land between being admitted that is a massive problem. And the maintenance of high standards in terms of care once in the system.
    It’s awful, and too important to play politics and elections with. it needs to be depoliticized and needs drastic action

  6. some old queen

    Re: Private Hospitals. A friend had back surgery in The Mater Private. She had been in a single room and then was moved into a semi private ward. Upon being lifted into a bed, the back of which was sitting at 45 degrees, it collapsed. Not just the support but the entire bed. It later transpired that an engineer had been working on it earlier in the day. She had to be heavily sedated. I know this because I was there visiting and spent two hours holding her hand.

    Because of, she had to have a further operation and spend another two weeks recovering. The insurance wouldn’t cover the extra but she assumed that under the circumstances they would forgo. Not a bloody chance. They threatened legal action and she was forced to counter sue before they backed down.

    Neck like a jockey’s boll ox.

  7. LuvinLunch

    I worked in the HSE. They didn’t even have shared drives. I had to drive from office to office to access files that couldn’t be emailed.

    I was a grade 6, whenever I emailed a grade 8 a question, I would get a verbal answer through my grade 7.

    The HSE is aaaawful

    1. some old queen

      At base level, losing patient files is not possible nowadays… unless they are exclusively in hard copy. Scary.

      1. GiggidyGoo

        He / she didn’t mention losing files though. If someone has to drive to another hospital to get them, in some cases they may as well be lost. And looking at the clipboard people, it does seem like hard copy is the preferred way they carry on business.

    2. Topsy

      Grade 6 you say. Handy money for a handy grade with absolutely
      no responsibility or accountability. Just turn up.

    3. Percival

      That grade thing is across the Civil Service. It’s a nonsense.

      Did you know that only Grade 8s get wireless keyboards?

      That sort of delineation is so typical of the Irish Civi Service. It’s designed to distract the minions from seeing what really goes on.

  8. ahjayzis

    Just where does the buck stop with responsibility and accountability?

    It stops with The System, exclusively. Which means it stops nowhere, ever.

    1. Cian

      Where should the buck it stop?

      Serious question.

      Where should it stop? Who judges it to have failed? What is the ‘punishment’? Who will police it?

      Sometimes there isn’t a single person to blame. A single person that has responsibility. There is a system, and sometimes the system breaks. If that happens frequently then the system is faulty and the system needs to be changed.

      Lets take the first example from above (feel free to substitute any other failing if you prefer). The fact that a bed was available in one hospital but not visible in another. I don’t work in hospitals but I imagine that the process is something like:

      Start: patent is in a bed and is to be moved.
      1. someone triggers the move (doctor discharge patient/patient dies/patient is to be moved internally/patient self-discharges/etc/etc)
      2. someone needs to organise the move (get a porter? phone next-of-kin to collect them and wait until they are actually gone; organise an ambulance/etc/etc) and wait until they are actually gone
      3. bed is finally empty!
      4. someone needs to organise changing the bed (remove sheets, sanitise, re-dress bed)
      5. someone needs to update a list saying the bed Is empty and ready for next person
      End: bed is available for a new patient

      How many different people are involved? How many hand-offs? How much waiting for one task to finish before another starts? how many places may the staff be pulled off on another more urgent task (and never return)? How many different scenarios are there to empty a bed? (and if you computerise this process to make it more tractable then you are adding loads of “update the system to say you have finished step X” into the process. These are very complex systems and have huge variance.

  9. TOMMY

    In June just gone my father had a stroke. He was on a ward in Beaumont over night when his health deteriorated. It took them nearly 6 hours to make the decision to move him to intensive care. When they made the call (truth be known waiting on a bed) they went to move him and there was a power failure. The back up generator didn’t kick in. The power was out for about an hour all the time my father was struggling to breath and stay conscious. When the power finally came back on he was brought down in the lift. This is when there was a second power failure… he was stuck in the lift between floors for 20 minutes. We had to force the doors open and lift him down onto another bed. I took nearly 2 hours for him to get the care he needed and even then the power was still out. He passed away the following Sunday after been in an induced coma ..The hospital management are a disgrace and refuse to tell us why there back up power didn’t work.. all they tell us is they have implemented changes to make sure it doesn’t happen again… not that I believe them or anything

  10. bonzo

    This pretty much accords with my tortuous experiences in the health services here over the past decade – I now will not go into hospital other than in immediately life-threatening circumstances – and even then I am very reluctant – rather stay at home and suffer and hope. What a country

  11. Anthony Parsons

    Hi Neil
    I have just read your article and would like to wish your mother good speed in her recovery and sympathise with you in your unfortunate experience in your mothers care whilst in hospital. I cannot argue with the points that you have made with the failings within the HSE infact I myself have had and continue to have to avail of the services of the HSE. I find tbe fact that hospitals do not have a common data system on paitents records, bed availability etc utterly dissapointing. I attend two hospitals for treatmemt Tallaght and St James, neither one has a complete record of my medical history which means i spend time telling either one my medical history every visit. I have had the same tests in both hospitals within weeks of each other because they cannot access the results from another hospital. I wonder how much money is wasted by the HSE doing repeat tests across the country. I have had mri scans, ultrasound scans x-rays etc etc I obtsined a private mri scan as the waiting list was excessive 2 year wait just to be told that they cannot accept the scan result as it was not carried out by Tallaght hospital and their software cannot read the disc. The system is not fit for purpose. With the advances made in cloud technology surely by now a common database should be possible for patient records and real time data logs of bed availability should be the norm across the system. Its not impossible to achieve a simple discharge of a patient using a scan of their id bracelet to update a server for this to show that a bed is available.

    And to finish i have to say the staff I have delt with and continue to deal with have been exceptional and the care I recieved is excellent, just a little too much in my case.

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