The level of concern about conditions for staff and patients at Ennis General Hospital led the Medical Council to consider withdrawing approval for junior hospital doctor posts at the hospital from January 2001, The Irish Times has learned.
According to details of a Medical Council assessment visit to Ennis hospital in October 2000, obtained under the 1997 Freedom of Information Act, the council also took "the unusual step" of forwarding a copy of its report to the Minister for Health, Mr Martin, for his attention.
Among the main concerns listed in the report were:
(a) The hospital should not be regarded by the Mid-Western Health Board and the local population as a suitable site to provide care for sick children.
(b) The absence of a bleep system to deal with medical emergencies.
(c) No evidence of regionalisation of hospital services in the area.
(d) The accident and emergency department had inadequate facilities and equipment to cope with its workload.
The Medical Council took the unusual step of revisiting Ennis hospital in April 2001 to review the progress in the implementation of the recommendations that it had suggested seven months previously.
It found that significant capital investment in the accident and emergency department had occurred and that an internal bleep system had been installed.
Non-consultant hospital doctors told the assessors that "an absolute transformation" had taken place since October 2000.
However, concern was expressed about the paediatric service; specifically that "management was not aggressive enough in re-directing paedicatric patients to Limerick" and "transfer of critically-ill patients had proven to be an ongoing problem".
The second assessment report recommended that a mechanism be established whereby Limerick Regional Hospital would provide a service for the transfer of critically-ill patients using an appropriately equipped ambulance.
It also requested that the appointment of an accident and emergency consultant "be advanced" and that electrocardiogram and blood taking services be available at weekends.
The Medical Council asked for a written updated progress report in March 2002 to "ensure that the recommendations continue to be
implemented".
Asked for an update on the Medical Council's recommendations, Mr John O'Brien, assistant executive officer of the Mid-Western Health Board told The Irish Times that a clinical auditor had been appointed to Ennis Hospital .
He confirmed that two phlebotomists and two ward clerks had been recruited.
Weekend phlebotomy (blood taking) is still not available because of difficulty recruiting an individual for the post.
A fully registered doctor now fills the newly created post of casualty officer on a 9 a.m. to 5 p.m., Monday to Friday basis.
Mr O'Brien said that when a third accident and emergency consultant post for the region is filled, it is the board's intention that an A&E specialist will provide sessional cover at Ennis General Hospital.
Questioned about the specific availability of a nurse for the transfer of obstetric emergencies in the light of the recent difficulties at Monaghan General Hospital, Mr O'Brien said that the board had sent a report to the Department of Health in which it highlighted "certain obstetric issues" which it was concerned about.
He also drew attention to the Mid-Western Health Board's strategy for acute hospital services.
The Mid-Western Health Board's strategy for acute hospital services envisages a full specialist service in Ennis and Nenagh hospitals for general medicine, general surgery, anaesthetics and acute psychiatry.
It foresees a limited service for accident and emergency, gynaecology and radiology with daycare facilities for specialties such as ear, nose and throat problems, orthopaedics, eye diseases and urology.
"There is a prolonged delay in proceeding with a development plan for Ennis General Hospital which includes an upgrade of facilities and an extension of the hospital," he said.