On the afternoon of March 23rd staff at the vaccination centre at the private Beacon Hospital in Dublin made a decision to pierce five vials of the AstraZeneca Covid-19 vaccine to have sufficient syringes ready to accommodate a group of healthcare workers expected in the centre.
There appeared to be some confusion as to the final check-in time that day for vaccinations but there were about 180 health staff still scheduled to receive the vaccine at the centre that afternoon.
However, within a short time after the vials were opened and nearly all of the syringes drawn up, it became evident to staff that there could be a significant surplus of doses if sufficient people could not be found to vaccinate.
The vaccines had been provided to the Beacon by the Health Service Executive to vaccinate healthcare staff in both the public and private sectors.
What happened next caused outrage both within the Government and among members of the public when it emerged that vaccines were given to teachers in a private school several miles away in Bray, Co Wicklow, in contravention of guidelines on who should be first offered what were then very scarce vaccines.
The report into the controversy, drawn up by Eugene McCague, former managing partner and chairman of legal firm Arthur Cox, says "significant efforts" were made to locate healthcare workers and others on the Beacon campus to whom the vaccines could be given within a short timeframe of one to two hours. It says that by that stage nearly everyone at Beacon who wished to be vaccinated had already received one.
However the report, released by the hospital on Monday, also says “at the time when the person extracting the doses was informed that there could be an issue in relation to finding clients for the drawn up vaccines, only one of the doses had been extracted from the 5th vial”.
“In principle, if the remaining doses had not been extracted from the 5th vial, there would have been a six-hour window in which to locate healthcare workers for the 11 doses not extracted. While that may be the case, I am satisfied that, as with the prior extraction of the doses, the extraction of the remaining doses was done in good faith.”
Option
The report says an option which was not explored was to ask the HSE community area – CHO 6, for whom the vaccination clinic at Beacon was being run that afternoon, if it could provide healthcare staff to be vaccinated.
“I was informed by CHO6 that it maintained a reserve list and could have provided healthcare workers at short notice, if requested. I am not in a position to determine whether, in the very short timeframe which was believed to exist, an approach to CHO6 would have produced sufficient people to avoid doses going to waste, but it would, in my opinion, have been appropriate to do so,” Mr McCague says.
His report concludes that Beacon Hospital chief executive Michael Cullen, alone and without consultation, approached the principal of the junior school at St Gerard's to offer access to the surplus vaccines.
The part of the report released by Beacon on Monday does not provide details as to why this particular school was chosen when there are others much closer to Sandyford. However, it is understood that the full 170-page document, which was not released, does spell out the relationship between Mr Cullen and the school which some of his children attended.
“The decision was taken by Mr Cullen in a time-pressured situation in the mistaken belief that the risk of doses being wasted entitled Beacon to administer the doses to anyone who was available, other than patients. This was based on his understanding that people other than healthcare workers, including teachers, had been referred for vaccination to the vaccination clinic by the CHOs and an incorrect interpretation of the extent of the discretion permitted in the sequencing guidelines. While the basis on which Mr Cullen made his decision was incorrect, I am satisfied that he made the decision in good faith.”
Motivation
Mr Cullen, in evidence to the review, maintained that his motivation in offering the vaccines to the Bray teachers was to avoid the surplus Covid-19 vaccine doses on the day being wasted. However, the review says Mr Cullen’s decision was not in compliance with the HSE’s vaccine priority list.
“Teachers were categorised in priority group 11 on the vaccine priority list (Priority Group 10 following the amendments to the vaccine priority list on 4 March). It follows that Mr Cullen’s decision was not in compliance with the vaccine priority list.
“The only circumstance in which Mr Cullen and Beacon could have complied with both the requirement of the sequencing guidelines that no dose be wasted and the terms of the vaccine priority list was if they had succeeded in identifying and vaccinating a further 20 healthcare workers at very short notice in addition to the 42 healthcare workers who were identified and vaccinated.”
The board of Beacon Hospital said on Monday it accepted the view of Mr McCague that while the basis on which Mr Cullen’s decision was made to contact the school was incorrect, “it was made in good faith”.
“We, as a board, regret that this series of events happened, and apologise for the upset caused. However, having considered the detailed review and the findings of the independent reviewer, the board has determined that it retains full confidence in Michael Cullen, our CEO.
“Michael has provided the hospital with strong leadership and vision resulting in substantial growth and expansion of patient services. We are confident that Beacon Hospital will continue to provide exceptional patient care into the future under his guidance.”
The hospital said it did not intend to publish the full 170-page report, citing privacy and data-protection reasons.
