The case of the late Una McDermott highlights the lack of proper cardiac services for some 500,000 people in the southeast and the gross inequality that exists within the health system depending on where people live, according to a campaign group pressing for 24/7 cardiac cover in the region.
Matt Shanahan, spokesman for the Health Equality for the South East (HEFSE) lobby group, said it was "very likely" Ms McDermott would have survived if there was a cath lab open at University Hospital Waterford on Sunday, March 4th, when she presented after a cardiac event.
"Una McDermott was conscious and able to converse with staff when she presented at University Hospital Waterford [UHW] – had a cath lab been open and available, staff could have carried out an intervention before she had a second cardiac event some 40-45 minutes after she presented."
Mr Shanahan pointed out that UHW was the designated emergency cardiac referral centre for the southeast, covering Waterford, South Kilkenny, South Tipperary and Wexford, and was one of six such centres nationally but was the only one that is not operational 24/7.
Percutaneous Coronary Intervention
“These designated emergency cardiac referral centres provide what is known as Primary PCI or Percutaneous Coronary Intervention – providing intervention by going through the blood vessels through normal stenting and angioplasty, and a primary centre provides it within 10-15 minutes.
“All the other designated centres have two or more cath labs, whereas Waterford is the only one with a single cath lab and it can only operate 39 hours a week because it’s not properly resourced in terms of staff, so if you get a cardiac event at weekends in the southeast, you have to go elsewhere.”
Mr Shanahan said that under the National Clinical Care Programme for dealing with acute coronary syndrome, each Primary PCI Centre should be operating two cath labs – one to deal with elective work and one to deal with emergencies, and this happens elsewhere in the country.
He instanced Dublin, where there are 10 public cath labs and 11 private cath labs, and Cork where there are four public cath labs and two private labs, while both Limerick and Galway each have two cath labs and all four Primary PCI Centres operate 24/7.
“Meanwhile the southeast region has one part-time cath lab for a 500,000-patient population, and for only 39 hours of the 168-hour week, and UHW is the only national Primary PCI centre forced to operate outside and below the NCCP standard of two cath labs for elective and emergency work,” he said.
Mr Shanahan said a report by Prof Kieran Daly of the Acute Coronary Syndrome Programme in November 2017 found there were an expected 203 STEMI heart attacks in the southeast per annum, which is 53 cases more than what the British Cardiac Society sets as the level for a 24/7 centre.
According to Mr Shanahan, a modular cath lab could be provided at UHW to complement the existing cath lab for a once-off capital cost of between €2 million and €3 million, while it could be staffed and fully resourced to help provide a 24/7 service for between €2.8 million and €3.2 million per annum.
Opening a second modular cath lab at UHW would enable the HSE to drastically reduce the emergency waiting list for the existing permanent southeast cath lab at UHW, which currently stands at over 500, with waiting times extending to over six months, he said.
"This is the same figure waiting when Minister for Health Simon Harris visited UHW in November 2016 and decided to implement a mobile diagnostic lab to reduce the emergency waiting list number – we have the largest emergency waiting list number in the country and it's not reducing."
A response or comment from the Hospitals South/South West Group in relation to the current situation regarding the provision of cardiac services at UHW was not available at time of publication.
