What next?
Two events within the past two weeks again pose questions regarding the removal of
services from Monaghan General Hospital. First we had the tragic death of Enda Watterson
due to a traffic accident and then we had another roadside birth - only this one
had no ambulance for over 20 minutes after the birth of the baby.
As in any similar case it is very difficult to prove that the delay in getting Enda
to hospital caused or contributed to his death. However it has been claimed by a
Consultant in Emergency Medicine that it is likely that 350 – 400 patients die each
year in Ireland as a result of delays and overcrowding in A & Es. We hear very little
about these deaths as they seem to be accepted as OK. Some of the cases, which have
come into the public domain, get highlighted for a day or two and that is it. It
is also claimed that trauma cases have better outcomes when taken to a major A &
E centre where there is a high volume passing through. Therein lies a problem as
the major centres are overcrowded and that is where the delays are – the delays which
cause death. And we still have no answer to our question - what happens when the
person dies en route? Is the major centre of any use in those circumstances? Now
we are told that Junior Doctors and Registrars in local hospital A & Es are not qualified
to deal with trauma and emergencies generally and that is one of the reasons HIQA
deems small A & Es unsafe. However we are also told that being transported for an
hour in a speeding ambulance, which is rocking violently from side to side and up
and down, is a better alternative. We think it is putting the ambulance personnel
in a terrible situation where they are expected to keep a seriously ill patient alive
during that long journey. Common sense tells us that a seriously ill patient’s condition
will definitely deteriorate in those circumstances and that getting to Monaghan,
as it used be configured, would be a safer option and give the patient a better chance
of survival.
We do not know the extent of Enda’s injuries but we would claim that the journey
to Cavan and the 1hour 45 minutes he had to wait to get hospital treatment did not
give him the best chance of survival. What effect would the delay and journey have
had on a patient with somewhat lesser injuries? Even if injuries are slight the delay
in getting hospital treatment will mean longer and more expensive treatment schedules
and poorer outcomes and death for some. However, if minor injuries are taken to a
major centre, it is a waste of time and money as such an emergency can and should
be treated in the local hospital.
Regarding the roadside birth - we congratulate the parents and we extend a welcome
to little Parker. It must be a terrifying experience for the parents to have to pull
in to a lay-by or forecourt and give birth to the interior light of the car. On a
wet, cold winter night or a frosty foggy night that terror would be increased considerably.
The birth was fine except that the umbilical chord had to be taken from around Parker’s
neck. Stephen and Niamh did a great job but in the next case who can say that all
will go smoothly. What would happen if the mother had a haemorrhage, if the child
did not start breathing, if the chord could not be removed from around the neck,
if .. and the possibilities go on? An ambulance arriving 25 minutes later is not
much of a consolation and then having to get to hospital – another 20 minutes or
much more if the birth is in North Monaghan – a fatality is a dreaded outcome. We
just hope we do not have to say to the Minister – ‘we told you so’, but what will
be next?
