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Dublin: 12 °C Thursday 23 May, 2019
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This is the letter a doctor wrote after a couple in their 90s spent hours on a trolley

It has sparked outrage today.

Updated 11.31 pm

Tallaght hospital X-Ray scandal Source: PA WIRE

THERE HAS BEEN outrage over the revelations that an elderly man with Parkinson’s disease was left in ‘torturous’ conditions on a trolley at Tallaght Hospital for 29 hours until a bed in a suitable spot was available.

His wife, also in her 90s, was later admitted to the hospital as well, and waited for treatment for seven hours.

Taoiseach Enda Kenny said he ‘didn’t understand’ how something like this could happen. The hospital has apologised unreservedly.

TheJournal.ie has obtained the memo the sparked the controvery, sent by emergency medicine consultant Dr James Gray to the hospital’s CEO. It is published in full below.

*     *     *     *     *

The grave and dangerous governance failures continue at Tallaght Hospital emergency department today.

This evening at 10.11pm we had 79 patients in the department in total with 19 admitted boarders. Two of these unfortunate patients were in the department for more than two days. Another four were admitted boarders in the department for more than 24 hours. All ‘notifiable incidents’, not that it seems to matter.

Earlier in the day, a 91-year-old man had been boarded for one day and five hours – that’s right, 29 hours.

I reviewed him this afternoon and he told me how painful and sore he was from lying on the trolley. He has advanced Parkinson’s but a clear sensorium. I saw him on a trolley on a conduit between the psychiatric rooms and some cubicles.

Married to his beloved wife for more than five decades, he told me. Shortly after we learned that his wife had presented, also in her 90s, to the emergency department for review and has also been referred for admission.

She is now also boarding and has been in the department seven hours at time of writing.

This elderly man is an example of how a dysfunctional system disgracefully treats some of our senior citizens, among the most vulnerable in our society, being allowed to fester on a trolley initially in a cubicle then transferred to a non-designated patient area conduit in the emergency department.

This man, like the others in non-designated patient conduits, have no privacy, no dignity, are subjected to constant noise torture, constant light torture, resulting in major sleep deprivation, pressure effects causing pain as lying for advanced periods on a trolley not designed for same, as well as boarding conditions that constitute an infection control hazard.

Nobody of any age should be subjected to this inhumanity.

A clear violation of basic human rights.

These trolleys with boarded patients in non-patient conduits constitute a fire evacuation hazard as they reduce egress and flow in the Majors area of the emergency department.

We all remember the disgrace of having a 101-year-old lady on a trolley earlier this year and we were told lessons would be learned to avoid a recurrence of frail, elderly, vulnerable patients being allowed to board in the emergency department beyond an absolute maximum time.

Clearly not the reality. This is most unacceptable and a ‘slap in the face’ for our most weak and vulnerable. An even bigger ‘slap’ for to those who stated this would never to happen again.

Also, more gross governance failure evidenced by two patients who were boarded and deemed to be requiring ‘isolation’. Now here’s the worrying bit. They should be have been admitted to designated isolation rooms. A first-world standard of care, right? So, were they being isolated in a room? Even a bog-standard room with four walls and a door? Surely, you would think.

But think again. They were being isolated in cubicles in the emergency department with three walls and a curtain. Isolation indeed.

The rules of infection control are very different for the emergency department but it is okay as long as we monitor diligently the HIQA hand hygiene standards while patients are boarded head-to-toe in conduits and isolated patients are boarded in open cubicles.

The man was festering for two days and 11 hrs at the time of writing as an admitted boarder.

Of course, there is a dedicated pressure controlled isolation room that currently lies idle in the expanded new emergency department along with eight cubicles again lying idle since June this year for want of staffing. Capacity that is needed immediately as we approach the winter – but not to become an ‘admissions lounge’.

The hospital continues to blatantly breach many HIQA recommendations from the Tallaght Statutory Inquiry, all HSE targets including 9 hr PETs, 24hr PETs, greater than 75 notifiable incidents, and HSA basic fire evacuation safety standards.

A modicum of better news. There were no admitted patients languishing in the Rapid Assessment Unit this evening unlike last week with no dedicated staff but does continue to remain idle since December 2014. Last week’s response from the Executive Management Team suggesting a ‘meeting’ this week sums up for me the institutional paralysis and anhedonia on crowding issues in this organisation.

As relayed to your office today I am adverse to attending any further local meetings as a response to grave disclosures unless there is a clear agenda, objectives, action plans with dates and individuals responsible/accountable, meeting to be recorded, minuted and cascaded for records. Nationally, the EDTF met again today.

Grave and gross governance failures will continue to be highlighted when there is a duty to disclose as a patient advocate.

It is only a matter of time before we disclose our next crowding related death at Tallaght Hospital while crowding is tolerated.

This memo has been edited for clarity.

- First published 2.31 pm

Taoiseach: ‘I don’t understand how an elderly couple could be left on a trolley for 29 hours’ >

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Nicky Ryan

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