Lives being lost over lack of 2nd cath lab
Entire Wexforfd GP faculty back need for second cath lab
As many as 13 people a year die due to the lack of a cath lab at University Hospital Waterford, a doctor warned councillors at the monthly meeting of Wexford County Council.
Dr Aidan Buckley said the service preferred by the HSE relies on a patient suffering a cardiac arrest getting to a cath lab within 88 minutes. 'We had Brendan Howlin and Mick Wallace raise questions in the Dáil on ambulance times. Prime Time also eventually did a report. The time you get an ambulance from call to arrival if you are based in Wexford is two hours, 30 minutes. Ambulances travel at 69 km/h per hour on average with a top speed of 100 km/h. People outside of the Dublin area are living in the "death zone",' he said.
Dr Buckley said heart attacks don't respect the working week times at when Waterford Cath Lab is open. 'International studies show that within the first hour there is a 15.4 per cent risk of mortality. This raises to 30 per cent for the two to three hour mark. We are moving people who should have access to treatment within one hour. A small number of people have died because of this, but every single cardiac patient will have a worse outcome.'
Dr Buckley said there is no other region in Ireland that is excluded from having a cath lab. 'The standard in Switzerland is to get into hospital within 20 minutes. This is killing approximately seven to 13 people per year. That is one person every month or second month depending on the statistics you look at.'
Criticising the Herity Report which recommended that all cardiac patients be transferred to Cork on the basis that the ambulance journey time is 88 minutes, as 'slapdash', he said: 'The Waterford service was developed in lock-step with the Limerick service for the mid west which went 24/7 in 2012 and the south east service was circled back into the Herity process. It's a really strange political anomaly and we don't have any answers for that.'
Matt Shanahan said: 'I am sure there are many of us here who are monitored for cardiac issues. The average transfer time is two and a half hours. Over a three year period from 2015 to 2018 196 patients were transferred out of the south east for acute care. Only three of these patients managed to get to the hospital within 90 minutes. No patient from Wexford did. Prof Herity recommended a helicopter service, which is being used as a defective stop gap at €20,000 per hour. There were three helicopter transfers in July to St James's or Cork: that's €60,000. As the helicopter doesn't fly at night or in fog, it's availability is very limited,' he added. 'It's absolutely unacceptable what is going on with cardiac medicine.'
Mr Shanahan said the Secretary General of the Department of Health gave an unequivocal guarantee in 2013 that a second cath lab would be provided for Waterford, with cardiology teaching posts and Health Minister Simon Harris announced that it was a priority in 2016.
The problem of emergency cardiac patients being denied access to the hospital continues because of difficult procedures which are prioritised to be carried out. 'Minister Harris agreed to three day diagnostics a week when the waiting list was two to three years long. The lab didn't arrive on site until October 2017. In July of that year the minister announced that he was scrapping an independent review of cardiac services in the south east. It's now being looked at in a national review, set to be released in mid-2019. He said there would be no expenditure on cardiac units but two days before St Vincent's put in their tender, and it (the tender) closed within 20 days. It has not been fully commissioned as a primary centre.'
He said Dublin has ten public and 11 private interventional cath labs compared to one in the south east which has a population of around half a million people. 'University Hospital Waterford's cath lab is the most efficient in the country doing twice the procedures than Dublin hospitals do. In 2017 there were 3,200 cardiac procedures carried out compared to 1770 in St Vincent's.'
He said there were two prominent deaths in Waterford last year, a female lecturer and Thomas Maher. 'If that woman had received care in a timely manner she would have survived.'
The fact the lab is closed from Friday afternoon until the following Tuesday on bank holiday weekends is also unacceptable. He said the new lab is staffed by three to four cath lab employees from the UK who are only doing diagnostic work and not interventional life saving work they are trained for.
Mr Shanahan said imaging equipment was removed from the lab and as a result doctors can't put a stent in. 'It's not just happen-stance that this is happening. There is significant resistance within the department.'
He said a new monitoring lab would cost €2,700 per week extra to run. 'Simon Harris agreed he was going to make a permanent cath lab available but three people in the Department of Health said he couldn't afford it for the south east. The lab will not be delivered for €3.6m. With it we could Wexford patients to a cath lab in a half an hours time.'
Cllr Joe Sullivan you have painted a very bleak picture. In early 2017 I was brought to Wexford. The doctor instructed the ward sister to check with the cath lab in Waterford but I had to be transferred by ambulance to the Mater. It took 103 minutes from Wexford with no traffic. I set out on that journey not knowing if I was going to make it or not and I was lucky I got there. There were two cath labs side by side. If I was waiting on a public service I was gone. It's a sad reflection that you have to have private health insurance to get primary heart care in the south east.'
Cllr Ger Carthy said County Wexford is geographically tied between two HSE areas: south, south west and Ireland East. The ambulance paramedic relayed a story of a woman whose life was hanging in the balance as she was transported to a Dublin Hospital. 'She did survive but it should have been dealt with in Waterford.'
Calling for a council deputation to meet senior HSE officials in the region, along with Minister Simon Harris, Cllr Carthy said: 'This can has been kicked around the road long enough. People are being airlifted from the GAA pitches across this county and it's not acceptable.'
Cllr Johnny Mythen said he can't understand how pieces of vital equipment could be removed from a cath lab, asking what the cost of a full-time cardiologist would be per year. Cllr David Hynes said he had a heart attack but was one of the luck ones who lived to tell the tale.
Cllr Michael Sheehan said: 'There seems to be some person who is blocking this proposal,' while Cllr Tony Dempsey enquired if the current cath lab is working.
Mr Shanahan said: 'If you have VHI and if you are an elective patient you will absolutely get access to a cath lab in Dublin or Cork.'
He said cardiac inpatients are left waiting for up to a fortnight to be seen, when they should be treated within 36 hours. 'There is an issue where emergency patients will arrive in to a hospital where there is a complex care is ongoing that a patient does not get immediate access. Tacit approval has been given for an interventional consultant, which would be a fourth consultant to be appointed. The consultants have indicated they would implement a rota of 8 a.m. to 8 p.m. seven days a week.'
He said the piece of medical equipment was removed from the lab, adding: 'No-one wants expanded care in Waterford. I believe this is not coming from the HSE,' he said, adding that a full-time cardiologist would cost between €250,000 and €300,000. 'A doctor has been identified and would be available to come on stream. If we had that second lab open providing priority access it would free up 5,000 hospital beds in the south east needed for acutely sick patients. I do believe the pressure is coming from the very highest level in the secretary general office, not the Department of Health.'
Cllr John Hegarty said the lab was in the Programme for Government, adding that it is an enormous political failure. 'It has failed our citizens and the professional who are assisting in providing this service like people who are in driving ambulances and flying helicopters and admissions staff. They are being deprived of essential tools that are cheap. This wrong starts at the top.'
Mr Shanahan said the entire GP faculty in County Wexford and consultants have written to Mr Harris, spelling out that the lab is needed. Liam Spratt, who is part of a Wexford campaign to get the lab, said: 'All of us deserve the chance to live if we have a serious ailment and I can't think of anything more serious than a heart attack.'