DEAR MR HARRIS,

Our father, Michael Gallagher (born in 1942), died at University Hospital Waterford (UHW) on 17 December 2017. Here, we would like to highlight issues of concern relating to our father’s journey while at the hospital, particularly relating to the dire state of emergency services there.

In raising these issues, we request that these preventable risks around patient safety be addressed with urgency, so as to avoid undue suffering.

Our father was admitted to the Emergency Department of UHW on Friday 1 December 2017. He was very breathless with a very large distended abdomen. Having had a recent cardiac history, initially this was thought to be of cardiac origin. However, his abdomen was massive which clearly indicated something more concerning; however, the medical team were unable to scan (ultrasound) until Monday 4 December 2017, as this facility was unavailable at the weekends.

Our father remained, like many others this weekend, on a trolley in the Emergency Department in a corridor for 3 nights (Friday, Saturday and Sunday night); he was ‘upgraded’ on Monday 4 December 2017 to a bed in a corridor on Surgical 7 ward. On Wednesday 6 December 2017, he was settled in Medical 1 ward.

Overstretching of resources

Our main concerns relate to the clear overstretching of resources within the Emergency Department. We witnessed not only our father but many vulnerable patients on trolleys, with lights on 24/7 in the corridor; accordingly, sleeping was not an option, neither was calling for assistance.

In fact, we witnessed patients needing to assist each other at times, with only one accessible toilet for many to use. Alternatively, one had to leave the unit out of view of the healthcare professionals. This was not an environment which promoted patient safety, dignity, privacy or confidentiality.

Our father himself was unable to sleep. Placed at the end of the corridor, he was frequently requested to push a door release button through a busy area as needed, or staff had to lean over to him to do this. The attention of the nursing and medical staff was impeccable despite these difficult circumstances.

An open, unsafe area

However, to have vulnerable people on trollies in an open (unsafe) area for three nights is NOT acceptable.

To provide some additional context, our father finally received diagnoses of advanced peritoneal cancer on Thursday 7 December 2017, following a CT scan. Subsequently, he had 17 litres of fluid drained from his abdomen due to the advanced stage of his cancer, highlighting the extent of the swelling presented at the Emergency Department on 1 December 2017.

We had no indication that my father was so seriously ill before this. While we are more than aware that the outcome in relation to his death would most likely have been the same, the initial period in the Emergency Department delayed active palliative treatment and allowed additional suffering that was not necessary. Moreover, three nights on a trolley did not allow for any rest or dignity.

Crucially, the lack of resources around timely investigations did not promote efficiency. While highlighting the above concerns relating to the emergency services at UHW, we would like to take this opportunity to thank the nursing and medical staff whom took excellent care of my father in his last days, particularly members of the oncology team there.

We are requesting further information

We are making a formal request for further information, as follows:

1. What has been the reduction in bed numbers at UHW in the last 5-10 years? It is reported that in the region of 70 beds have been lost? How can this be justified if the case?
2. How often is the Emergency Department at UHW filled to capacity and what is the average wait time for a bona fide bed?
3. Given the well-reported challenges around the Emergency Department at UHW, what are the plans to invest to allow efficient and safe flow through this department? Surely additional investment in staff and beds, as well as key investigations, at weekends will improve efficiency and allow for a better flow though the hospital?
4. In Waterford, we have an increased and aging population. Is this acknowledged when planning services and investment around resources, especially around the winter crisis? Particularly resources around provision for investigations which would surely provide a much more cost effective service in the longer term.
5. What is being done to protect staff in the Emergency Department, whom are clearly doing their best with limited resources? What measures are being put in place deliver safe and effect care to vulnerable people, on trolleys or otherwise?

On a final note, I (Caitriona Gallagher) originally trained at the, then, Waterford Regional Hospital. I left in 1994 and continue to work as a nurse in the UK.

My father repeatedly said to me in his final days, “How did I manage on that trolley for all those days?” and “How do people manage that have nobody?”

Our father, who was 75 when he died, provided good service to the Irish State and the economy over many years. His last days were prefaced by an extended period of unnecessary suffering in the Emergency Department of his local hospital.

While his passing is a major personal loss to our family, we feel adamant that his suffering should not be replicated by others. We, therefore, urge you to respond appropriately to this letter. We have also communicated this material to the relevant press, so as to appropriately air this issue of public concern relating to the state of emergency services at UHW.

Yours sincerely,

Caitriona O’Neill and William Gallagher.

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