Just as Cavan General Hospital struggles to pick up the pieces and regain public confidence after a spate of adverse clinical incidents which occurred late last year, the news yesterday that nine-year-old Frances Sheridan died from complications which followed the removal of her appendix at the hospital will be a further blow.
Up to this we have known only that the little girl died three weeks after her operation in January, but it was not known if her surgery had anything at all to do with her death.
Now we know it had, but so too do we know that the child was recovering well after her operation and the only problem seems to have been the growth of adhesions around her surgery wound which is apparently part of the normal healing process.
But questions remain because the child was brought to the hospital suffering from abdominal pain two days before she died and was sent home in the belief that she only had a tummy bug.
The issue for the hospital therefore will be whether or not it should or could have diagnosed at that stage the fact that the child's bowel was becoming, in the words of State pathologist, Dr Marie Cassidy, "strangled" by these adhesions. It was this which contributed to her death.
It may be that a diagnosis could not have been made at that stage, but this is likely to be thrashed out when the inquest into the girl's death reconvenes later in the year. It is also likely to be at the heart of a Garda investigation which has now begun.
The North-Eastern Health Board, which runs Cavan Hospital, is also investigating the circumstances surrounding the child's death. Its four-person inquiry team was assembled five weeks ago. Asked yesterday if its work was nearing completion or if it had been set a deadline, the health board, in a short statement, said it had asked the group to report as soon as practicable.
"Pending the receipt of this report it would be inappropriate to comment further at this time," it said.
Cavan General is one of the State's newest hospitals but it has been beset by controversy in recent times. Controversy began with the suspension of two of the three consultant surgeons at the hospital last August due to inter-personal difficulties.
They are still suspended and since their absence, the hospital has had to employ a series of locums, which has resulted in difficulty providing continuity of care for patients. There followed some 15 adverse clinical events at the hospital, mainly after surgery, between September and December last and a review of these by the health board's medical adviser published last week noted, not surprisingly, an absence of surgical leadership at the hospital.
The health board and the hospital are getting to grips with this, they say, by employing long-term locums. It now has a permanent consultant surgeon and two long-term locums. It will interview for a third long-term locum consultant surgeon today.
But they still have other problems. A significant one is a shortage of beds. The hospital has suffered serious overcrowding in its A&E unit since Monaghan Hospital was taken off call.
It has had to take all the emergencies sent by ambulance from Monaghan without additional resources being put in place. Many in the hospital believe it is not getting additional resources because the Government is waiting to see what the hospital's future should hold when the Hanly report is implemented.