Ombudsman Emily O’Reilly has described some of the healthcare-related cases in her 2009 Annual Report as “shocking and unacceptable”, reports Mary Anne Kenny
The Ombudsman Emily O’Reilly has described hospital treatment complaints profiled in her 2009 Annual Report as “shocking and unacceptable”. Of the 2,873 complaints made to her Office last year — the highest number recorded in over ten years – complaints against the HSE accounted for 26.3 per cent, down 1.2 per cent on 2008.
However, O’Reilly was highly critical of the Executive. At the launch of her seventh annual report as Ombudsman earlier this month (July 1), she urged the Government to root out a “rotten” culture of “excessive secrecy” in the HSE. She accused health chiefs of wasting public resources and frustrating her attempt to access vital family law records.
The report details some of the cases handled by the Ombudsman last year. One concerned a woman who complained about the care of her terminally ill husband.
“This was especially distressing, as was a complaint where I found that patients were experiencing disturbing ongoing and major deficiencies in hospital conditions at a public psychiatric hospital,” she said. “I can only describe these cases, particularly in the social and public healthcare services areas, as shocking and unacceptable.”
Maternity care
A woman complained about the standard of care she received at Waterford Regional Hospital (WRH) during the birth of her child in 2007. She claimed she had been deprived of pain relief because the attending midwife had failed to recognise that she was in labour. Her initial complaint to the hospital had taken two years to be examined.
The investigation found that due to neglect, the woman was deprived of the expert care and support of the midwife during labour, of having her partner or mother present at the birth, and also the opportunity to have appropriate pain relief.
“The woman had considered taking a legal case against the hospital but found she was statute bound (due to the investigation having taken so long to be completed). She came to me for assistance, seeking an apology for the pain she had suffered, counselling to help her deal with the trauma, and financial redress to reflect costs incurred in pursuing her complaint,” said O’Reilly in the report.
Negotiations with the hospital did not bring a satisfactory conclusion, no offer of financial compensation was made and, while the minutes of a meeting contained an apology, the woman felt this did not resolve the matter. After further discussions, the hospital’s manager agreed to write a full letter of apology, acknowledging that the woman had received sub-optimal care. Private counselling sessions were offered, the costs of which were met by WRH. The hospital also agreed to an ex-gratia payment of €1,000 as a goodwill gesture.
Hospital care
The Ombudsman received a complaint from a woman regarding the care her late husband received in the Midland Regional Hospital, Tullamore. She had specific concerns on: the manner in which her husband’s terminal condition was conveyed to the family (the hospital has since developed draft guidelines on breaking bad news to patients); that medication was left on his bedside locker; that his thromboembolic deterrent stockings (TEDS) had not been removed in almost three weeks; and that his nursing notes were deficient.
The nursing notes revealed that the patient’s medication was left on his locker when he was drowsy or unable to take his medication. “I suggested some staff receive refresher training on this aspect of drug administration. The hospital arranged for the issue to be addressed at nurse manager meetings and for its drug administration policy to be reviewed.”
With regard to the TEDS, the hospital suggested it was possible that they were changed more frequently than the complainant suggested. The woman had said that when she removed her husband’s stockings after three weeks, so much dry skin had come away that she could see the flesh between his toes. “The hospital developed comprehensive guidelines on TEDS use,” said O’Reilly. “I was reassured that lessons were learned… and a clear policy drawn up and implemented.”
With regard to the nursing notes, the Ombudsman asked the hospital to consider if it needed to review its record management policy in light of the National Hospitals Office Code of Practice for Healthcare Record Management. In response, it developed a policy and guidelines on best practice in nursing documentation.
“Furthermore, the hospital told me it completed a number of self-assessments in 2009. As a result, approximately 37 quality improvement plans were identified and the hospital is endeavouring to adhere to all the criteria from the various standards in this self-assessment.”
Psychiatric hospitals
The 2009 report identified major deficiencies in psychiatric hospital conditions. A woman complained about conditions in St Loman’s Psychiatric Hospital, Mullingar, where her father was a resident.
“My examination identified that the hospital seemed not to have complied with all of the recommendations contained in the Mental Health Commission Annual Report 2007,” said the Ombudsman. “It appeared there was noncompliance in relation to the introduction of multi-disciplinary team care-plans, provision of therapeutic activity, records management, residents’ personal property and possessions and privacy and physical accommodation, including toilet facilities.”
HSE officials responded that every effort was being made to address issues identified, but it was not always possible to rectify them within available resources. The HSE also said that, as a result of the sale of land to the local authority, €3.5 million had been earmarked to upgrade facilities.
“However, according to the HSE officials I dealt with, although they had intentions as to how the money generated would be used, there was no guarantee that it would be prioritised by the HSE corporately and/or by the Department of Finance for this service.
“The case speaks for itself. It is unacceptable and sad that psychiatric patients have to put up with a regime and facilities totally unsuited to their needs and that identify deficiencies not addressed,” said O’Reilly.
Child welfare
Last year’s report also included a chapter on child welfare and protection services. It gave details of cases examined by the Office, including: a grandfather fostering his three grandchildren who contacted the Ombudsman about the poor handover of case arrangement responsibilities between HSE regions; a complaint by a mother about the HSE handling of unfounded child-abuse complaints against her; and a complaint by a Midlands crèche that the HSE failed to communicate to it that a complaint against the crèche centring on child protection issues, after examination, was deemed not to stand up.
At the report launch, the Ombudsman revealed that during one investigation, her Office was led on an “Alice in Wonderland trip” around the legal system as the HSE tried to prevent a report being published: “I think there’s a huge issue around the HSE’s excessive secrecy and legalism. It strikes me that it’s a cultural thing. It’s redolent of a body that looks not to the public interest, which is the only reason it’s there, and seeks at times to protect its own interests, and that’s very wrong. It’s as if the HSE lives in a parallel universe.”
O’Reilly pointed out that others, including the Minister for Children and the Government, had not been able to secure information from the HSE recently in relation to child deaths in care, “so there’s something rotten within that system”.
In a statement, the HSE responded that its staff “makes every possible effort to provide information to and co-operate with the Office of the Ombudsman”, and pointed to its publication of reports on inquiries and investigations, HealthStat figures and performance reports as evidence of its transparency.
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