Injury Compensation News

A huge increase in the number of patients left overnight on Emergency Department trolleys could escalate hospital negligence claims made against the Health Service Executive (HSE).

According to the Irish Nurses and Midwives Organisation’s “trolley watch”, 6,624 patients were left overnight on trolleys in August due to a lack of beds, with 401 patients bed-less on August 31st alone. The figures indicate a 35 per cent rise on those from last year and are attributed, according to the Irish Nurses and Midwives Organisation General Secretary, Liam Doran, on the rising rate of bed closures due to the pruning of funds by the government and HSE.

“A Serious Negative Impact upon Patient Care”

Selecting Limerick as an example of how the situation has got out of control, Mr Doran noted that despite assurances in 2009 from the HSE that any reconfiguration of services “would not require any additional beds”, 50 acute beds were closed at Ennis General and Nenagh Hospitals, followed by 25 further bed closures at St. John´s Hospital in Limerick and – in the middle of the August crisis – the HSE closed 25 acute beds at Limerick Regional Hospital. This has had, according to Mr Doran, “a serious negative impact upon patient care”.

“An Unsafe Situation”

The Irish Nurses and Midwives Organisation’s claims that HSE cuts were resulting in “an unsafe situation” were echoed by Mr Fergal Hickey, President of the Irish Association for Emergency Medicine. Mr Hickey, quoting research conducted in Australia which was supported in the British Medical Journal, stated that Emergency Department overcrowding could be responsible for as many as 350 unnecessary deaths in Irish hospitals each year. He added that, for the first time ever, children admitted through the Emergency Department procedure were also facing delays in treatment due to the overcrowding situation.

“The Solution is Complex”

In response to the claims, Minister for Health James Reilly – who promised after his appointment in March that there would never again be 569 on trolleys in hospitals as there were earlier in the year -stated that “the solution is complex and will require an enhanced capacity by hospitals to deal with the inter-related issues involved”. Nonetheless, staff working in the country´s Emergency Departments are deeply concerned about the forthcoming months.

The Situation May Get Worse Before it Gets Better

The Irish Nurses and Midwives Organisation is concerned that the increase in bed shortages and subsequent high numbers of patients being left on hospital trolleys is occurring at the height of the summer – traditionally a “quiet” time of year – and has called on statutory bodies such as the Health Information and Quality Body (HIQA), An Bord Altranais and the Medical Council, to inspect all affected hospitals.

However, it is already known that HIQA has been unable to carry out independent hygiene inspections of hospitals throughout 2011 due to a lack of resources. This raises the fears for MRSA and other hospital infections being acquired by patients waiting in hospital corridors for a bed to become available. Furthermore, according to the HSE’s own performance system, five out of the six main Dublin hospitals are ranked as “unsatisfactory” in terms of the performance of their emergency departments.

Hygiene in medical centres across Ireland will come under fresh scrutiny with the announcement that a new strain of methicillin resistant Staphylococcus aureus (MRSA) has been discovered in two Dublin hospitals. MRSA is bacteria which enter the bloodstream through cuts, surgical wounds and invasive devices such as catheters or implanted feeding tubes, causing infection to hospital patients with weak immune systems. Difficulties exist treating these infections, as MRSA are resistant to penicillin based antibiotics and, although some MRSA infections manifest as boils or abscesses, MRSA may cause pneumonia, endocarditis (inflammation of the heart chambers) and septicaemia (blood poisoning).
A report published in 2010 entitled “MRSA in Ireland” revealed that patients who contract MRSA infections in Irish hospitals are seven times more likely to die in hospital than those that do not have secondary infections.
The report further disclosed that secondary MRSA infections meant that patients spent on average an extra 11 days in hospital, costing the Health Service Executive (HSE) more than 23 million Euros each year.
By law, doctors have to report any MRSA infection to the HSE, and statistics produced by the Health Protection Surveillance Centre have shown that as many as 2,500 patients per year contract MRSA blood stream infections in Irish hospitals.
Alarmingly, doctors are not obliged to disclose if an MRSA infection is a contributory factor in a patient´s death and, based on international fatality levels throughout Europe, it is possible that as many as 250 deaths in Ireland per year are directly attributable to a hospital acquired MRSA infection.
Now that a new strain of MRSA has been discovered – that was so different that existing test kits could not recognise it as being an MRSA-type bacterium – new treatments will have to be found to counter the illnesses and deaths caused by the bacteria.
It is claimed in the medical journals “Antimicrobial Agents and Chemotherapy” and the “Lancet Infectious Diseases” that the organism can share its genetic make-up and its antibiotic resistance with other bacteria. This raises the fears of a new generation of superbugs that hospitals will have no answer to. Only through improved standards of hygiene and public awareness will hospitals and other medical centres be able to prevent a new epidemic of MRSA, and the claims for compensation which will inevitably follow.

The mother of a two year old girl, who died after contracting meningitis, has been awarded more than 170,000 Euros after the hospital in which the little girl died admitted errors in the way they handled her condition. Natalie Courtney (28) of Drimnagh, County Dublin, had taken her daughter, Aisling, to Our Lady’s Hospital, Crumlin, Dublin on February 19 2006, after Aisling had started suffering from hallucinations and a sore neck. The doctor who examined Aisling diagnosed her as having a 24-hour viral gastric bug and being dehydrated. Natalie requested that Aisling be kept in overnight for observation and stayed with her daughter throughout.
After the initial examination, a rash developed on Aisling’s back and, early in the morning of February 19, Aisling was placed on a drip. She subsequently developed purple spots on her skin, and Natalie was informed that Aisling was being treated for meningitis.
Aisling’s condition deteriorated and she was moved into the hospital’s intensive care unit. But, at 10.25am, Aisling died of a heart attack. The shock was overwhelming for Natalie who, Mr Justice Iarfhlaith O’Neil heard at the High Court, became socially withdrawn and developed feelings of guilt due to her own failure to intervene in Aisling’s treatment and demand more appropriate action. After seeking legal advice, Natalie sued the hospital for nervous shock arising from Aisling’s death, claiming that she had suffered depressive injuries as a result of the manner in which she had witnessed her child’s death.
Our Lady’s hospital conceded liability late last year – extending and aggravating Natalie’s feelings – and Mr Justice Iarfhlaith O’Neil accounted for this lack of admission when awarding Natalie 150,000 Euros plus an amount to cover the costs associated with legal representation at the inquest into Aisling’s death.

A member of a High Court working group, commissioned to investigate provision for the victims of catastrophic injury and chaired by Mr Justice John Quirke, has announced that the working group is considering the introduction of pre-action protocols to reduce the financial burden to the State of clinical negligence compensation claims.
Mr Michael Boylan was speaking in Dublin at a conference on catastrophic birth and child injuries organised by the charity “Action Against Medical Accidents”. He said that a legal “duty of candour” should be introduced to require medical practitioners to advise a patient as soon as they are aware that a clinical error as occurred.
Quoting from a Health Service Executive report, Mr Boylan stated that there was evidence to suggest that patients often forgave the clinical error when it is disclosed promptly, fully and compassionately, and not only would this action reduce the trauma and distress of patients and their families upon discovery, but also reduce the amount of legal costs arising from contested medical negligence actions.
The first proposal from the working group was contained in a report published in November 2010. The report recommended that people who sustain catastrophic injuries would benefit more from periodic compensation payments than one lump sum. Mr Boylan hoped that the report would be acted upon and legislation introduced, although he acknowledged that the overall cost to the State could be greater and feared that this might prevent it from being adopted into law.

A senior surgical registrar, who´s career ended after he contracted the HIV virus from a patient, has settle his claim against the HSE, the State and the hospital in which he worked at the High Court.
The doctor, who cannot be named by court order, is believed to have contracted the virus in 1997 due to a needle stick injury as he performed an operation. Due to the fact that he had performed more than one hundred operations in the three months prior to his diagnosis, he was unable to be specific about the actual patient, but claimed that a lack of screening of hospital patients for HIV had exposed him to a risk of harm.
The doctor further claimed that under the Hippocratic Oath taken by all doctors he had a duty to perform surgery on patients irrespective of their condition; however the HSE did not have a policy of mandatory testing on the grounds that it was uneconomical and that only patients suspected of carrying the virus were asked if they were contaminated. Since contracting his infection, the doctor has had to give up his duties as a senior surgical registrar and suffers all the consequences of having an HIV virus – including tiredness, lethargy and depression. He has undergone therapy to deal with the illness which has substantially altered his lifestyle and prevented the doctor and his wife from having children.
In their defence, the defendants stated that circulars and guidelines were issue to health boards about controlling infection through blood-borne disease and that the doctor had failed to have adequate regard for these guidelines and the risk of HIV infection while carrying out invasive surgery. The HSE denied the claims but admitted contributory negligence. The terms of the settlement were not disclosed.

A new superbug called CRE (Carbapenem Resistant Enterobacteriaceae) has been discovered in Irish hospitals for the first time. The new superbug is potentially fatal and can cause kidney infection and pneumonia. Four cases have been discovered so far in Ireland, causing concern with medical professionals because it is difficult to eliminate once it takes hold in a country’s medical system (which has already occurred in Greece and parts of the United States).

One of the problems with treating the superbug is that the general population is less responsive to treatments for CRE because of the widespread using of board spectrum antibiotics.

If CRE spreads in Irish hospitals, it it likely to be for the same reasons as the recent MRSA outbreak – contaminated surfaces, especially medical equipment.

The State Claims Agency has already paid out 20% more in compensation in the first eight months of the year compared with the whole of the 2009. The State Claims Agency had already paid compensation of €59.9 million up to August 2010, compared with total compensation payments of €48 million in 2009.  At the current rate,  the Agency will make compensation payments of nearly €90 million in 2010.  This represents an increase in compensation of nearly 50% in 2010 compared with 2009.

The Minister for Health, Mary Harney, has announced some measures to improve patient safety.  The most significant are draft healthcare standards developed by the Health Information and Quality Authority (Hiqa), which has now entered into a public consultation phase.

Minster Harney has said that about 10% of people admitted to hospital experienced an ‘adverse event’, and about 1% of the adverse events would result in injury or death.  Speaking about the adverse events, the minister said “Many of them are systemic failings and many of them are avoidable”.

It should also be pointed out that although the rate of adverse events in HSE run hospitals is particularly high, the HSE is not always responsible, such as the recent DePuy recall.

A Medical Council fitness-to-practice committee ruling has attracted significant media comment over the past few days in the case involving the removal of the wrong kidney from a young child. After hearing most of the evidence in the case, the committee had decided to invoke Section 67 of the Medical Practitioners Act 2007 that allows doctors to undertake not to repeat their errors while avoiding being found guilty of professional misconduct. The incident occurred at Our Lady’s Hospital for Sick Children in Crumlin, Dublin, in March 2008 when junior doctor Sri Paran, under the supervision of Professor Martin Corbally, removed a perfectly healthy kidney while leaving in place a barely functioning kidney.

The young boys’ parents, Jennifer Stewart and Oliver Conroy, repeatedly asked hospital staff to confirm which kidney was scheduled to be removed before the operation.  Despite this, it was revealed that nobody had reviewed the X-rays that were available in the operating theatre before the operation. The boy, now 8 years old, is left with a right kidney with 9 per cent functionality, leaving him requiring regular dialysis until he obtains a kidney transplant.

Professor Corbally immediately met with the parents of the boy and apologised.

This type of medical error happens all the time as is known as a “wrong-site operation”.  The problem is mainly due to poor procedures in operating theatre, where surgeons seem to resist the ‘checklist’ approach to operations that are common in other professions.  A good example is the pre-flight checklist used by all pilots all over the world, where they check even the most obvious things like fuel levels and radio signals.

Since there were no proper checklists in place for a kidney removal operation, there was no medical malpractice resulting from not following the non-existent checklist.  It was a simple case of human error.

There has been much commentary in the media about the new Health Services Executive (HSE) chief executive Cathal Magee facing a difficult first year implementing significant budget cuts. However, he also has a significant challenge changing the internal staff culture of the HSE, which was most recently criticised by the Ombudsman for its “rotten culture of secrecy” when dealing with medical malpractice.

Cathal Magree should start by reading the paper in August 17th issue of the Annals of Internal Medicine about a program launched by the University of Michigan Health System that encouraged health workers to report medical mistakes. The program included a procedure for telling victims about errors, who exactly made the error, what steps were made to prevent similar mistakes in the future, and mostly importantly, making a sincere apology to the patient or family. The procedure also included a process for offering fair compensation.

Reporting and explaining errors honestly to patients obviously leads to faster resolution of disputes, but also reduced the number of lawsuits by 36%.

A survey by Red C on behalf of the Health Information and Quality Authority (Hiqa) has found that over 40 percent of Irish people feel that healthcare services they or their families have received are below the expected standards. The survey statistics were obtained using a representative sample of over 1,000 adults.

But only one third of the people that were dissatified with the healthcare they received actually made a complaint about the below-standard level of care.  One of the primary reasons was that 52 percent felt too intimidated to make a complaint. Over 80 percent of survey respondents said it was difficult to know where to make a complaint. The actual number of complaints received in 2009 by the Health Services Executive (HSE) was 7,984  which is an increase of 63 percent on 2008.

Hiqa is preparing draft national standards for better and safer healthcare that will eventually apply across the entire health sector.  The Hiqa survey found that 99 percent of people wanted to be informed when there was a problem with their treatment so it seems likely that Hiqa will propose better disclosure procedures in the new national standards. It remains to be seen if the HSE, which has a reputation for secrecy, will accept a more open approarch to patient disclosure when it comes to medical negligence.