AS MANY as 1,500 patients have either been denied treatment or had appointments to see consultants postponed at The Mater in an attempt to slash waiting list figures and meet James Reilly’s rigid targets.
Patients – some of whom have been waiting more than a year – have been told they are no longer either eligible for treatment at the Mater because they live in the wrong ‘catchment area’ .
They now face going to the bottom of waiting lists at other hospitals, even though some have conditions as serious as skin cancer, or waiting even longer for care at the Mater – despite consultants having already decided they should be seen at certain dates.
The decision to reject would-be patients from the Dublin hospital or postpone care for others was taken by admin staff.
Astonishingly, the medical consultants were not involved.
The surgeons, who learned of the changes only last week, lay much of the blame on the Health Minister’s waiting list hit squad, the Special Delivery Unit – and on the decision to fine hospitals €25,000 per patient per month if they do not meet waiting list targets.
Dr Helen O’Neill, the GP who brought the scandal to light, said last night: ‘I am very angry that my patients – many of whom have been waiting for more than a year – now have to join the end of a waiting list somewhere else.
‘This is outrageous, as is the fact that the letters cancelling their treatment came from a manager, not a doctor.
‘How dare they do this. How dare they.’
The Mater last night admitted people had been removed from the list but insisted: ‘No patients have been adversely affected.’
However, Dr O’Neill, who exposed the practice in a letter to the Irish Times last Tuesday, said last night: ‘They say that no patient will be affected, but patients have already been affected.
Because of this review, they have had their appointments cancelled and their care has been compromised.’
In one department alone, more than 150 patients’ appointments were cancelled.
A senior clinical source at the hospital said the number of patients affected is ‘definitely hundreds, possibly thousands’.
Speaking on condition they not be named, they added: ‘For patients in need of a whole range of operations, this could have devastating consequences. We are talking about people right across the entire spectrum of care – including abdominal and vascular surgery, or operations on their skin cancer.
‘People’s lives and health are being seriously put at risk. It is an utter disgrace.’
Admin staff have also changed waiting list categories for patients who are in the Mater’s catchment area and have already been seen by a consultant.
Within the past few weeks, waiting list definitions were changed from ‘Routine’, ‘Soon’, ‘Very Soon’ and ‘Urgent’ to ‘Urgent’, ‘Routine’ and ‘Planned’.
Under the original system, ‘Urgent’ meant a patient needed care within a matter of days or weeks, ‘Very Soon’ was about one to two months, ‘Soon’ was about three to four months and ‘Routine’ was anything between nine months and more than a year.
In cutting the number of categories from four to three, the new system has left many patients facing a longer wait.
Timescales for treatment that had been agreed with consultants are being changed by admin staff – not clinicians. Astonishingly, many of the surgeons had no idea about the changes until they read Dr O’Neill’s letter.
She said that, while the Mater had accepted letters of referral she had written to consultants more than a year ago, admin staff had now decided they could no longer be seen there. This was, they told her, because the patients did not fall under the hospital’s catchment area.
While about 20 patients were affected in her shared practice in Dunboyne, Co. Meath, she said that other GPs in her area had also suddenly started receiving cancellation letters.
The consultants’ group at the Mater has demanded an inquiry. In a series of angry emails among the group, the policy was roundly criticised and the manner in which it is being implemented. And they lay much of the blame on the Special Delivery Unit.
Hospitals face fines or a bill for patients’ treatment elsewhere if they are left waiting for more than a year.
That limit will be reduced to nine months in September.
Paul Connell, the Mater’s head of ophthalmology, wrote on Thursday to the hospital’s deputy operations manager Suzanne Roy demanding an explanation.
He said that if the changes had not been spotted they would have led to ‘multiple critical incidents on the basis of clinical decision-making being taken out of the hands of practising clinicians’.
‘It is evident that the consultant bodies are opposed to this but that it was proceeded with nonetheless,’ he added.
‘It is even more startling that this opposition was voiced but completely ignored.’
Dr O’Neill said last night: ‘You have to wonder just how much more of this is going on not just in the Mater but elsewhere in the country.’
In a statement last night, the Mater said it is meeting its waiting list targets and is not facing fines.
It added: ‘Potential changes to the Mater Hospital’s waiting list classification model have recently been under discussion. As adequate consultation with stakeholders at the hospital has not yet been concluded.
The hospital management has reinstated the original system pending the outcomes of the comprehensive consultation process.’
It said it does not have the resources to continue to take patients from outside its catchment area.
In a statement that reveals how much pressure it is under, the hospital said: ‘Last year the Mater’s outpatient referral numbers was 220,000 up from 160,000 four years ago. The hospital’s budget has dropped from €250million to €196million over the same period.
It said it had to review its ‘access policy’ for outpatient referals, but said no patients who were on the waiting list before the review would be affected.
However, Dr O’Neill said: ‘Until each one of my patients who have had their appointments to see a consultant cancelled receive an apology and are readmitted into the system, this statement is not worth the paper it is printed on.
I just cannot accept this statement, which has all the hallmarks of the typical language I have come to expect from the HSE.’
A leading consultant at the Mater said the statement was just ‘pure PR spin’ and added: ‘The truly shocking thing in all this is the fact that non-clinical staff are deciding who does or doesn’t get clinical care in the hospital.
That is a very, very worrying development.’
One Mater consultant told colleagues in an email: ‘There is undoubtedly a culture emerging here of administrative people “meddling” in clinical management which needs to be strongly opposed.
‘My own waiting list has also been interfered with without my knowledge or consent by someone who is neither competent nor qualified to do so.
‘The damage done to our relationship with our patients, GPs and to our own reputations is irretrievably damaged.
‘Naturally we are very upset and are also trying to deal with this through official channels.’
The writer also blasted management for ‘lack of consultation with senior clinicians prior to making willy-nilly changes which have huge implications for patient care and our and the hospital’s reputation with a view to I don’t know what… perhaps hoping to save money?
‘It does not bear any resemblance to the Mater culture which essentially puts our patients first.’
‘There have been several recent incidents where we have belatedly learnt about changes that have been already made which pose risks to patients and expose ourselves to potential medicolegal risk.’
‘I was consulted regarding this centralised waiting list booking idea and I told her it was a bad idea and that I was opposed to it.
‘My opinion, having been sought, was then ignored as it clearly didn’t suit.’