The planned closure of the emergency department at Our Lady’s Hospital in Navan did not begin on Thursday because the Minister for Health "overruled it", the hospital’s clinical director told Prime Time.
Gerry McEntee said that, though the board of the HSE had arranged for the closure to start from Thursday, there was no change in arrangements at the hospital due to Minister Stephen Donnelly’s decision.
Mr McEntee said he did not know when the closure would now commence.
A spokesperson for the Minister said that Mr Donnelly had not exercised powers under Section 10 of the Health Act to direct the HSE not to close the unit.
However, he said, the Minister had always made clear his position, which was that a change from an ED to a Medical Assessment Unit at Navan could only proceed when all the other issues were addressed, including concerns at Our Lady of Lourdes in Drogheda.
The spokesperson said that, while the Minister was always in contact with HSE leaders, "nothing official happened" between the time of the HSE board meeting, which approved the closure on Wednesday, and the decision not to proceed on Thursday.
Mr McEntee told Prime Time that the planned closure would only mean up to a dozen new attendees each day at Our Lady of Lourdes emergency department.
He stoutly defended the planned closure, saying that the key concern was to ensure that people were sent to the place where they had the best chance of survival, and that the Navan hospital does not have the services to provide the critically ill with the best opportunity of survival.
"Do the people realise," Mr McEntee asked, "that this is the only cohort of critically ill patients in the entire country who, by virtue of the fact they are brought to Our Lady's Hospital, Navan, are not provided with the best opportunity for survival as in every other county in the country? Is that right? How long can that continue?"
He said the closure would affect just 10% of Navan’s acute attendees, the critically ill, with 90% of acute attendees still treated at Our Lady’s Hospital in Navan. Surgical emergencies would also go to other hospitals.
Navan hospital’s nurses, physicians, surgeons, anaesthetists and management, as well as the local Meath Faculty of GPs, the management of Ireland East, the Board of the HSE, and the National Clinical Leads in different areas of acute medicine, "have all come out and said the current situation in Our Lady's Hospital, Navan, is unsafe", he said.
However, some 17 consultants at Our Lady of Lourdes in Drogheda have written to the Minister for Health warning that without first providing extra resources in Our Lady of Lourdes, diverting patients there would also be unsafe.
Addressing those concerns, Mr McEntee said he could "understand perfectly why clinicians, who have been asked to take on more work would be concerned that they would be overwhelmed".
But he said only "about ten to twelve patients extra" would be attending Our Lady of Lourdes in Drogheda each day, and that only "about three to five of those would require hospital admission".
He said that, in contrast to Our Lady of Lourdes in Drogheda and other major hospitals in the region, such as Connolly Hospital Blanchardstown, the one in Navan was the third-smallest hospital in the country, had little or no ICU, the smallest number of ventilated patients and none of the critical care services.
He noted that, as a result, national training bodies for emergency medicine, anaesthesia and surgery do not recognise it for training purposes.
That meant it was difficult to attract junior doctors and it was dependent on locums and agency staff, he said.
Mr McEntee said that, already, Navan is bypassed by first responders for strokes and heart attacks, but currently patients with a stroke or a heart attack can walk in or be brought into its emergency unit, and staff are obliged "under difficult circumstances to make sure these patients get the best opportunity of survival".
Under the planned change, he said, it would also be bypassed for trauma, obstetrics and pediatrics. The affected patients would only be those who were "critical", "unstable" or required emergency surgery.
However, he insisted that, under the planned closure, while critical patients would go elsewhere, the hospital’s medical assessment unit would receive the vast majority of patients referred by GPs, as well as 90% of acute attendances, such as patients with pneumonia, urinary tract problems, and other less serious cardiac issues.
He said surgical attendances, which represent some 16% of Navan’s current total attendances, would, however, go to another hospital.
Commenting on the standoff between the Minister for Health and the HSE over the closure of the hospital’s emergency department, Mid-West Hospital Campaign member Marie McMahon said she felt Louth and Meath were now on course to repeat mistakes made in north Tipperary, Clare and Limerick.
"I'm thinking that was us 13 years ago", she said. "We were told we were going to have a super-duper service, state-of-the-art – everything. Thirteen years later, look where we are today. We have record numbers on trolleys, record numbers of people on waiting lists, and we have a service that's not fit for purpose."
In 2009, the Government closed the emergency departments in Ennis, Nenagh and St John’s Limerick – promising a new centre of excellence at University Hospital Limerick (UHL), with accident and emergency attendance at UHL’s emergency department.
This month, HIQA published a report that found the emergency department understaffed, overcrowded and posing a significant risk to safety, following an unannounced inspection in March.
The findings highlight the gap between the model of major hospitals acting as centres of excellence hosting specialist services, and the delivery of that model in practice.
Ms McMahon lost her husband Tommy Wynne in an over-crowded emergency corridor in UHL on 18 April 2018.
She said the people of Navan should keep fighting to retain their emergency department, because otherwise they faced a future like the Mid-West, where UHL was the only major emergency hospital for an entire region and GP services were unable to help.
"The whole system is a failure here", she said.
"After 8 o'clock at night, our minor injuries unit closes, so we have nothing until 9 o’clock the following morning other than ShannonDoc, the on-call doctor hours, and sometimes you ring and you're directed to the emergency department in Limerick."
She said people should not be afraid to go to hospital, but that was what was happening to some in her area.
"Nobody should be afraid to go to hospital and say, no, leave me at home to die, I want to die at home, I don't want to die – like my husband did – on a trolley in a corridor with other sick people watching what happened to him. He was found dead on his trolley. I don't want anybody else to have to go through that trauma," she said.
She said she was no expert on why it was not working, but there was one thing she knew: "It's not working and I've paid the price and so have other families."