CONSULTANTS IN EMERGENCY medicine are now rostered to work at evenings and weekends – and are not just on call – in the emergency department at University Hospital Limerick (UHL), Health Minister Stephen Donnelly has said.
The spotlight been on the hospital in recent months due chronic overcrowding issues.
Trolley numbers at UHL have increased by 39% so far this year and the Department of Health said these figures are in “contrast” with trends elsewhere, with the average morning trolley count falling by 11% over the first quarter of the year.
A review is currently being carried out to consider the case for a second emergency department in the Midwest region in light of ongoing pressures at the ED in University Hospital Limerick.
Donnelly said today that even if a second emergency department is recommended, it will be “years” before it opens for patients.
The terms of reference for the review, which is to be carried out by HIQA, are yet to be decided.
Donnelly said the focus must remain on the overcrowding issues happening in the here and now at UHL, stating that this is being solved with workforce reforms and increasing capacity.
The issue of reopening emergency departments at Nenagh and Ennis featured today in the Oireachtas Public Petitions committee today, a proposal put forward by the Midwest Hospital Campaign group.
Emergency departments are part of larger hospitals and smaller ones in the region, such as in Nenagh and Ennis, closed around 15 years ago.
There are currently four injury units in the region, but only one ED at University Hospital Limerick.
Speaking at the committee meeting today, Donnelly said working practice reforms which have proven successful in other hospitals have also been agreed at UHL.
This includes senior decision makers being rostered on site both in the emergency department and throughout the hospital after hours and on the weekends.
Having paid visits to the hospital and spoken to staff, the minister said it was his experience that there were no senior decision-makers rostered on after hours and on weekends.
He said it was the “single biggest concern” at the hospital that from Friday to Monday, there were no senior consultants on site.
He said a consultant was on-call, as was referenced in the Aoife Johnston inquest, but the minister pointed out that the consultant did not come into the hospital after being called on the telephone.
Johnston died of bacterial meningitis on 19 December 2022 after a 12-hour wait in the overcrowded emergency department of University Hospital Limerick.
She had initially presented to the hospital on 17 December, and was eventually admitted to intensive care, but passed away shortly after.
A verdict of medical misadventure was returned at the inquest into the death of the teenager.
Dr Jim Gray, who was the only ED consultant on call the weekend Johnston died, but who was not required to be on site, told the inquest that not only was the ED a “death trap” on the night, “it is still a death trap”, five years after Aoife’s death.
He reiterated that he received one phone call on the night about the unfolding overcrowding crisis but that he was never told about Aoife.
Addressing the issue of reopening emergency departments in other hospitals in the region, Donnelly said the clear clinical advice he has received is that an emergency department attached to lower model hospitals, such as Nenagh and Ennis, “is simply unsafe”.
Under questioning by Sinn Féín Paul Gavan, Donnelly said Sinn Féin has not called for the reopening of the emergency departments at those hospitals.
He said the party’s spokesperson David Cullinane “deserves great credit for his resistance to those calls and said he would follow the clinical advice”.
The minister said clinical advice is to reopen emergency departments in those hospitals, as they stand “would be very dangerous”.
Fianna Fáil TD Cathal Crowe questioned the decision to close the emergency departments in 2009, stating that political players should have spoken up and said more to prevent the closures.
He said the centre of excellence which was promised by former Health Minister Mary Harney never materialised.
Donnelly told the committee that the workforce at UHL has increased by 43%, with the number of emergency medicine consultants increasing by a half, going from 10 to 15.
The minister said there is “still a lot of work to be done” to ensure the money from the state has been allocated appropriately at UHL.
Independent TD Michael Lowry said he is concerned that there is now a confidence issue with the public in which they are afraid to go into the hospital.
He said from patients he has spoken to, once someone is seen in the ED, the care is good, stating that he believes that needs to be said.
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