Dr Muiris Houston, Medical Correspondent, outlines the result of a legal action taken against Peamount Hospital by two medical personnel.
The resolution of the High Court action between Peamount Hospital and its medical director last week has helped to clarify, at least in the short term, the nature and scope of TB services at the Co Dublin hospital.
It also enabled a full and frank discussion of the issues at a special board meeting of the Eastern Regional Health Authority (ERHA), held last Thursday.
Peamount's medical director, Prof Luke Clancy, and its senior medical officer, Dr Paul Kelly, settled their case against the hospital by agreement last Tuesday. Key elements of the settlement include:
Dr Luke Clancy is to remain as senior treating physician (but not medical director) at the hospital until December 31st, 2004. He is clinically responsible for all patients within Peamount.
Dr Paul Kelly remains as senior hospital medical officer and retains his clinical status.
In accordance with the stated wishes of the Medical Council, who reminded Peamount that a recognised consultant must be in situ in order for the hospital to be recognised for training, Dr Clancy will be responsible for supervision and training of non- consultant hospital doctors.
Peamount has agreed to co-operate with the appointment of a consultant respiratory physician with an interest in TB at St James's Hospital; the appointee will provide a number of sessions to Peamount Hospital.
At the ERHA meeting, its chief executive, Michael Lyons, told elected representatives that the authority had agreed to fund a "second post of respiratory physician". The effects of the settlement were "very positive", he added, because it secured the immediate future of Peamount in the area of TB management.
Mr Lyons also said the settlement meant there was now time to develop an orderly and agreed transition from the existing to new arrangements for the management of TB in the region.
This is seen as a coded reference to the wishes of the ERHA that the TB unit at Peamount formally link up with the respiratory unit at St James's Hospital.
The Irish Times understands management that St James's will fully support the development of TB services at its hospital.
Ironically, this very proposal was put forward by Comhairle na nOspidéal in one of two reports it produced on TB services.
So, where to next? A small group has been set up by the ERHA to develop the transitional plan. It includes a respiratory physician, a specialist nurse, a GP from the catchment area of Peamount, a hospital representative and a public health specialist from the ERHA. A new admission policy for TB patients will be presented to the board of Peamount in five weeks' time, based on advice from an independent consultant respiratory physician.
The ERHA meeting, at times heated, achieved an unusual alliance of medical, nursing and political representatives. The outcome means that Peamount and TB services will continue to be a priority at board level.
As for patients, yesterday 27 people with TB from seven countries were undergoing treatment at Peamount. They include patients with the dangerous form of multi-drug resistant TB. And the Romanian man, whose admission to the Mater Hospital and subsequent transfer to Peamount lay at the centre of the dispute, is making a steady recovery in the hospital. For all parties to the recent difficulties, the lesson must be that it is the individual with TB that matters most. They would do well to remember this in the negotiations that lie ahead.