The HSE may now bring in an outside expert to undertake an wide-ranging independent review of surgery at Navan Hospital, it has emerged.
After weeks of anger, confusion and contradictory statements following the HSE's decision to cease surgery at the Co. Meath Hospital on September 1, it is now believed likely that the HSE will undertake a more thorough review of operations than had previously been indicated.
It is likely that a healthcare expert from outside the country will be appointed to carry out the review.
The HSE in announcing the axeing of Navan surgery on September 1, did not give any precise reasons for the decision, which it said was made on safety and quality grounds. The previous month, it had ordered the cessation of keyhole surgery operations at the hospital.
The decision has led to ongoing local protests. At the time, the HSE said it was studying the implications of its closure decision, but local interests queried why it was only doing this after it had already made this decision.
It was revealed at the time that surgeons at Navan had defended their clinical record in terms of keyhole surgery in a letter to the HSE in August.
A week after the surgery closure decision, the HSE said it had reviewed local consultants' advice regarding the provision of surgical assessment in the Navan emergency department and this was being communicated to the consultant surgeons and staff at Navan Hospital.
It acknowledged concerns expressed by some consultants on the A&E situation following the axeing of surgery, which had led to worries about a lack of on-site surgical assessment of A&E cases.
At that stage, the HSE had still not given any further details of what its clinical safety concerns were in relation to Navan.
It had told irishhealth.com the decision to cease surgery at Navan came following a review carried out by Louth-Meath Clinical Director Dr Doiminic O'Brannagain and three consultants from outside the north-east.
On September 13, Health Minister Mary Harney indicated that the Royal College of Surgeons had advised the HSE to cease surgery at Navan.
Asked to clarify this, the RCSI told irishhealth.com on September 14 that a "preliminary investigation" had raised concerns about surgical outcomes at Navan. It is understood this was the review led by Dr O'Brannagain and referred to previously by the HSE.
The RCSI said based on this information and in the interests of safety, it supported the decision of the HSE to cease emergency and acute surgical services at Navan from September 1 "pending a full investigation."
Following this, the HSE finally gave some details of its safety concerns, stating that it was about to review the files of a number of patients who underwent surgery at Navan following the discovery of "two clusters of cases with poor clinical outcomes." earlier this year.
It said one of these clusters involved four patients who had keyhole surgery and the other two involved general surgery.
According to the HSE, the two clusters of cases, along with concern on the low volume of certain types of surgery taking place at Navan, led to the suspension of surgery there on September 1.
It is understood that there is now a belief at senior HSE level that an independent inquiry into a wider range of Navan surgical cases in addition to the clusters mentioned should now be carried out, and that an expert from outside the country should carry out this review.
Meanwhile, the Irish Times reported today that the son of a patient whose surgery at Navan is being investigated wants her case removed from any review, as he was satisfied with the surgery carried out on his late mother.
A consultant at Navan was placed on administrative leave by the HSE earlier this year, but was subsequently reinstated.
The Irish Hospital Consultants Association (IHCA) has said the RCSI should now be called in to do an independent review of surgical services in Navan Hospital.
Local interest groups have queried the safety reasons for the surgery decision and have expressed concern about the future of Navan Hosital, and for the future of acute and ememrgency care for Co. Meath patients.
This appears as a bungled attempt by the HSE to close surgical services at Navan. Close surgery means acute medicine and A & E must follow out through the door. However they were not prepared for the backlash. The people of Monaghan meekly and midly let them walk all over the population but Navan had learned a lesson.The HSE are talking about 'two clusters needing review' even though one of these has already been reviewed and cleared.???
Now the HSE wants an 'independent expert' from outside the country to review all surgery at Navan. I could guess what that means. They will find someone who favours centralised services in a 'teaching hospital', who will claim that Navan does not have the sufficient volume of cases (even though research does not support that contention), who will claim that patient safety demands consultants to work in teams, who will recommend that surgery moves from Nvan to Dublin. ergo qed.
Just another way to close another small hospital for the wrong reasons.