For more than six years, emergency medicine doctor James Gray has been a thorn in the side of the management of Tallaght Hospital.
Gray’s repeated and outspoken criticisms of the way patients are treated in his overcrowded emergency department have made Tallaght a byword for the problems of the Irish health system and its inability to raise its game.
It’s a fair guess that the knives have been sharpened for the fearless doctor for some time, but it was only this week that hospital management got the opportunity to put a stop to his gallop. The latest exemplar for what Gray refers to as the “torture” of patients in overcrowded emergency departments – a 91-year-old man who spent more than 24 hours on a trolley – was less than pleased to see his case highlighted in the media.
Actively advised by its public relations consultants Drury Communications (paid for by the taxpayer), the hospital seized its opportunity by announcing an inquiry into the leaking of the patient's details. A story about the mistreatment of older people and the shambles in the health system was turned, in the blink of a spin-doctor's eye, into an interrogation of the whistleblower.
Never mind that Gray copied his memo about the case to numerous parties, including Minister for Health Leo Varadkar, so anyone could have leaked the details. Or that his email contained next to no personal details about the patient, other than the fact his wife also languished on a trolley in the hospital.
Taoiseach Enda Kenny could see the wrong involved in allowing a 91-year-old to languish so long in a corridor, but the hospital’s main concern was to staunch the flow of negative coverage. Once again, a health-service dispute pitted managers with a control agenda against doctors fighting for patients’ rights.
Gray trained at Trinity College, Dublin and cut his medical teeth in the UK before returning to Ireland and a post in Tallaght in 2006. He lectures in Trinity, serves as an examiner for the College of Emergency Medicine in London and works as an expert witness, in addition to his work at the emergency department.
Outspoken advocate
As whistleblowers go, Dr Gray is a modern form of the species, frequently resorting to social media to vent his anger at the failings of the health service. A favourite medium is Twitter, where he describes himself as an “outspoken advocate” and the father of two daughters, “so seriously outnumbered”.
Earlier this year, while sitting at home watching the news, he sent Varadkar a tweet asking whether it was possible his Cabinet colleague, Minister for Finance Michael Noonan, who was on film attending an EU meeting, had an eye problem.
As it happened, Noonan had already noticed the bulging of his eye and made an appointment with a specialist. He was operated on and made a full recovery.
Landmark investigation
Gray was partly responsible for triggering the landmark investigation by the Health Information and Quality Authority into Tallaght hospital. Giving evidence in 2011 at the inquest of a Dublin man who died at the hospital while on a trolley, he criticised the “appallingly poor standards of sanitation” in his department due to overcrowding; the coroner remarked that Tallaght sounded like “a dangerous place”.
That report was critical of standards and governance at Tallaght and other emergency departments, prompting major reforms in the way the hospital was run. The board was pared down and a new management team put in place.
Tallaght has made strides since that low point and its trolley figures are far from the worst. But unlike other hospitals, Tallaght has emergency department staff who actively complain when things go wrong. Earlier this year, the hospital was again in the news when a 101-year-old patient spent a night on a trolley, the publicity again arising from Gray’s complaints to management.
He has been inundated by expressions of support from colleagues and others since he ended up in the spotlight this week. Despite being on the receiving end of an internal inquiry, he shows no signs of going quiet.
Perhaps the best way to understand his frustration can be gauged from this hopeful line from a letter he and colleagues penned to The Irish Times three years ago: "We welcome the current Minister's [James Reilly's] public promise to end emergency department overcrowding nationwide by year's end 2012."
