NO REFERENCES were received by the Health Service Executive (HSE) in respect of one-fifth of the temporary or locum consultants now employed in the northeast region, according to an internal report.
The alarming report also indicates no interviews were held for a third of the 39 locum consultant positions currently filled in the region.
In the case of half the locum positions filled, those in them are not on the Medical Council's specialist register. Furthermore the report, which has been seen by The Irish Times, indicates there was no recruitment policy for temporary and locum consultant posts in place when 35 of the locums were recruited to work at Our Lady of Lourdes Hospital in Drogheda, Monaghan General Hospital, Louth County Hospital in Dundalk and Our Lady's Hospital in Navan. There was a policy in place at Cavan General.
The HSE said last night the findings "await final validation".
The new information, from a survey conducted by the HSE, will cause concern as in many of the recent cases in which cancers were misdiagnosed errors were made by locum consultants.
A review of thousands of X-rays read by a locum consultant radiologist who worked in the northeast has been under way now for a number of months since it emerged a small number of chest X-rays had been misread. Its findings are expected to be published shortly.
In a recent Health Information and Quality Authority investigation. a locum consultant pathologist who worked at the laboratory of Galway's University College Hospital from September 2006 to March 2007 was foundto have made a significant number of diagnostic errors.
The work of another locum pathologist who worked at UCHG in February and March 2004 is now also being reviewed.
In addition a recent internal HSE report on the case of Ann Moriarty, whose cancer was not picked up at Ennis General Hospital last year, found a locum consultant radiologist had misread as normal a chest X-ray carried out on her in June 2007.
Correspondence seen by this newspaper shows the head of the HSE Prof Brendan Drumm is concerned about the risks posed by locums. In a letter to the HSE's head of human resources on August 22nd, last he referred to a "serious untoward incident" which had brought home to him again "the risks" associated with locum posts. He said these posts had been an even greater problem over the past couple of years due to the delay in negotiating a new consultants contract.
"Because of the huge risks for patients and the organisation associated with clinical appointments, we have to be completely reassured that we have appropriate processes in place for both the hospital and community services that are consistently used in appointing locums," he wrote.
"I would be specifically concerned if we have policies that are different based on the duration of appointment as the risks associated with a one-day appointment may be as significant as those associated with a one-year appointment when clinical capability is an issue," he added.
The study of locum posts in the northeast indicates most of the temporary consultants are working in anaesthesia or as general physicians but three are also working as consultant radiologists.
Asked to comment on the survey findings, a HSE spokeswoman in the northeast said the survey was "still in draft format and the findings await final validation".
She said it was carried out earlier this year and before new guidance documents on consultant appointments were issued in late March and in May to each hospital and recruitment agency.
She added that all hospitals in the northeast had in place a procedure for the recruitment of permanent staff and this was also used for the recruitment of temporary and locum consultant staff.
"Prior to the new guidance documents, it was not a requirement for persons appointed to such posts to be on or eligible to be on the register of medical specialists maintained by the Medical Council," she said. "In cases where no formal interview took place, the person appointed would typically be a registrar or specialist registrar and known to the consultant or be already working in the system."
Total number of locums:
39
Age range:
35 to 63 years
Recruitment policy for temporary and locum consultant posts:
For 35 of them there was no such policy in place. There was for four.
Post approved by HSE consultant appointments unit/Comhairle na nOspidéal:
There was no such approval for 26 of the posts, but there was for 13 of them.
Are the consultants members of the medical council's specialists' register?
13 are, 21 are not and this detail is not given for five.
References received?
References were received for 30 of those in posts, they were not for eight and it is not stated whether they were or not in one other case
Was an interview held?
It was for 25 of them, it was not for 13 of them and for one it is unclear.
Specialities in which they are working:
10 are working as physicians, 10 as anaesthetists, two in surgery, three in radiology, three in orthopaedics, five in medicine, one in palliative care, one in obstetrics and gynaecology, three in paediatrics and one in histopathology.
Hospitals they are working in:
The majority, 18, are working at Our Lady of Lourdes Hospital in Drogheda, 11 are working at Monaghan General Hospital, four at Cavan General Hospital, one at the Louth County Hospital in Dundalk and five at Our Lady's Hospital in Navan
Agency used in recruitment?
Yes in eight cases, not for the rest