The need to stop making the same mistakes
Here is my column from 29 May on why swift diagnosis and quality care are vital.
The HSE has settled with the family of Sharon McEneaney in May 2014, just over four years after her death.
Sharon McEneaney was a crèche manager from Carrickmacross, Co Monaghan. Aged 29, she presented to Our Lady of Lourdes Drogheda on several occasions between October 2007 and July 2008. She had surgery in November 2007, but it was not until July 2008 that she was diagnosed with a virulent and aggressive cancer. She underwent some treatment but died aged 31 from a tumour in her abdomen in April 2009. Her family’s case was, that if diagnosed earlier, she could have been saved.
The HSE review of her treatment is not publicly available but from what is in the public domain in terms of the High Court case, a Fitness to Practice case of one of the doctors involved and the recommendations from the HSE review, there were a litany of mishaps in Sharon McEneaney’s care. These include delayed diagnosis, surgery to remove a ‘mass’ where there was no biopsy, poor co-ordination and communication within the hospital and between the hospital and her GP (despite her GP’s best efforts), and poor record-keeping. When she was eventually diagnosed, she was told over the phone.
The HSE has admitted it completely failed Sharon and apologised unreservedly to her family. The Medical Council found that the doctor involved was guilty of poor professional conduct on two counts. The HSE review raises very serious concerns about standards of care and safety in Drogheda at that time.
Our Lady of Lourdes, Drogheda, has had a disproportionate number of high-profile catastrophic cases – the two most high-profile being the Michael Neary cases, and Garda Tanya McCabe, who died after giving birth just months before Sharon presented at the Emergency Department there.
The fact that incidents such as these continued even after high-profile investigations into both these cases would indicate that previous lessons had not been learnt by the time Sharon was using the hospital in 2007 and 2008.
The review of her case was completed in June 2010 and the hospital says the 36 recommendations for action in the hospital are fully implemented or ‘underway’, meaning they are being implemented and continuously monitored.
So could this happen again — if a young woman presents to an emergency department with abdominal pain, will her cancer be picked up?
Cancer services in Ireland have been transformed since Sharon McEneaney first presented to Our Lady of Lourdes in Drogheda. Head of the National Cancer Control Programme, Susan O’Reilly, is confident that really good progress has been made on the commonest cancers — breast, prostate, lung, stomach and colorectal cancers. Surgical and cancer treatment have been centralised into eight hospitals; for some of the more rare cancers, just one or two hospitals provide treatment.
However, the Programme is still a work in progress and addressing the less common cancers and ovarian cancer is one of their top priorities.
Some cancers, such as ovarian, are very hard to diagnose, rare, and often diagnosed late, with a 40 per cent survival after five years. There are only about 350 ovarian cancers each year in Ireland compared to 2,500-plus breast cancers, so each GP is on average dealing with just one ovarian cancer diagnosis every eight years.
Research carried out by the ICGP found that if one cannot afford to pay privately, it can take weeks or months to get an essential scan. Because of this, the HSE and the Cancer Control Programme are working with GPs to put a ‘rapid pathway’ in place for symptomatic ovarian cancer. And once diagnosed, one is dealt with in one of the seven designated hospitals which provide care through multi-disciplinary teams. However, it’s getting the diagnosis that’s the problem.
Progress has been made in recent years on access to diagnosis. Now, 100 per cent of all urgent colonoscopies are provided for within four weeks, while the vast majority of routine ones take place within 13 weeks. Breast cancer and cervical screening and national, rapid-access clinics for lung cancer are now in place, while over 100,000 people have been screened for bowel cancer to date.
But access to diagnosis is not in place for all cancers, in all places, so early diagnosis can be dependent on GPs and hospitals following good practice and having access to diagnosis, such as scans, and quick referral to a specialist in a designated cancer centre.
Central to tragedies such as Sharon’s is that we learn from the past. The Portlaoise babies case showed that previous HSE reviews were not learned from or acted upon. What we need to see from cases like this is that the hospital and HSE has learnt from the past so that people are reassured of timely diagnosis and quality treatment in the public health system.