death by geography - Thurles Information

Death By Geography For Tipperary Dwellers

The massive disparity separating Urban and Rural communities continues to expand.

The Mid West Region represents an area spanning 8,248 km², taking in the geographical borders of the combined counties of Clare, Limerick, & North Tipperary. The population of these 3 areas, according to the most recent information taken on Census night 2016, are officially recorded as:- Co. Clare – 118,627 persons, Limerick – 195,175 persons (Inc. Limerick city) and North Tipperary – 71,370 persons. Total population for the Mid West Region can therefore be calculated as containing some 385,172 residents.

National Ambulance Service Review

The Siren Study set up to evaluate the development and performance of different emergency and urgent care systems (EUCS) has show that medical patient survival rates for emergency cases, in this same Mid West Region, are among the lowest in the country.

The findings of this study undertaken by University Collage Cork (UCC), which compared patient admission and outcome figures for 2000-2006 and 2007-2012, suggested that if every County had the same death rate for emergency conditions as Dublin, up to one thousand lives per year could be saved.

While admitting that fatality rates have dropped nationally during the past 10 years, the disparity still remaining between the regions continues to dwell significant.

Dublin currently has six emergency departments for a population of 1.2 million people. If the same A&E model was in place in the Mid West Region were to be used in Dublin there would only be three emergency departments available in our capital.

The excessive waiting times for ambulances and the requirement for all emergency cases to be taken to University Hospital Limerick (UHL) is acknowledged as having been a likely cause of death in a number of past emergency medical cases.

The original reasoning behind the development of a ‘Centre of Excellence’ in Limerick certainly showed some merit, as in the centralising of certain expertise and services. However based on the current demand for services alone, (UHL) at this present time is not ‘fit for need’, and to-date has not been sufficiently upgraded in the aftermath of the initial decision to downgrade Nenagh General Hospital.

Based on projected population increases alone the people of North Tipperary, in particular, continue to allow themselves to be treated as second-class citizens. Promises made to provide a new accident and emergency (A&E) department at University Hospital Limerick following the downgrading of both Ennis and Nenagh General Hospitals has now been delayed by a further two months according to confirmation by the UL Hospitals Group recently.

Their excuse “It is more important to get it right than to open too soon without the proper systems and safeguards in place”, is no longer acceptable. Building contractors, engaged at University Hospital Limerick, are due to hand over this new project at the end of the first quarter in 2017, and between 90 and 100 additional staff are being targeted for the new department, in a recruitment drive that is supposedly currently under way. The Irish Nurses and Midwives Organisation (INMO) however have expressed concerns over the likelihood of securing such medical staff in the immediate future.

Not for the first time over the last few months and in the case of UHL, yesterday showed same to be the busiest A&E in Ireland, with 36 patients reported as waiting to be provided with the luxury of a bed on a ward. To add further to this misery; fears have been expressed over the continued provision of the essential rapid response emergency ambulance services for Tipperary and Clare. The National Ambulance Service (NAS) have confirmed they are reviewing the provision of rapid response vehicles in both counties with a view to discontinuing at least some already existing services.

Back in 2009, as part of a HSE reconfiguration of hospital services, which supervised the closure of Nenagh’s A&E departments to a daytime only operation; ambulances staffed by advanced paramedic staff, specially trained in advanced life support skills and drugs administration were introduced into the Mid-West instead. This same service was touted by the HSE as ‘Tipperary’s A&E on the Road’. We were informed then, and foolishly accepted as fact, that this service was to be “A natural progression in the enhancement and development of the ambulance service in North Tipperary”.

While the HSE confirm that this review has only recently commenced and that no decision will be made until all aspects of the Mid West Review is finalised; North Tipperary needs to be aware. After all just some weeks ago our County Councillors were discussing raising Property Tax in Co Tipperary. Perhaps it’s now time to sell up or accept the fact that you will die, not as a result of any medical condition such as a heart attack, but as a result of remaining to reside in a long forgotten rural North Tipperary.

Inquest On Death Of Evan Morrissey

In 2014 Mr Evan Morrissey, aged 28, from Cashel, Co. Tipperary, who had initially attended at South Tipperary General Hospital complaining of a severe headache, vomiting and neck pain; died at Cork University Hospital, some 20 days after he had first sought help.

Late Mr Evan Morrissey

The young father of five was sent home from hospital three times, having being told he was suffering from migraine; later died following a haemorrhage from a cerebral artery aneurysm. He had been sent home three times before a scan following his fourth visit on March 18th, eventually showed he was experiencing an intra-cranial haemorrhage to the brain; latter which, according to medical personnel, at the longest, had occurred within the previous two days.

Consultant Radiologist Dr John Hynes of South Tipperary General Hospital told the Coroner’s Court that a previous scan, undertaken on March 7th, had come back showing everything was clear.

On that evening of the fourth visit, Mr Morrissey was immediately transferred to Cork University Hospital, however despite medical intervention he had sadly passed away.

A jury of four women and two men returned a verdict in line with the medical evidence produced. Mr Philip Comyn (Coroner) extended his deepest sympathies to Mr Morrissey’s partner, M/s Gwen Bradley’s and their five children.

Speaking after the inquest into the death of Mr Morrissey, M/s Bradley stated that she no longer had faith in the Irish hospital system. She instructed her solicitor Mr Cian O’Carroll to withdraw from the inquest, when the coroner refused to allow him to ask a CUH consultant about the treatment that Mr Morrissey had received on each visit to the South Tipperary General hospital facility.

The court was also informed that, since this event, new guidelines, including a check-list to identify red-flag issues, has since been introduced for emergency department staff at South Tipperary General Hospital.

Death By Geography For Tipperary Dwellers
Meanwhile last month (March 2017), Cork University Hospital (CUH) recorded the highest trolley figure nationwide at 716. Second highest for the same period was University Hospital Limerick (UHL) at 699, followed by University Hospital Galway (UHG) at 638, with hospitals outside Dublin continuing to endure the worst of the overcrowding; as already forecast by the Siren Study.

Ambulances In Mid-West Region To Avoid UHL In Treating Non-Urgent Patients.

Ambulances operating in the mid-west region, which includes and provides medical services in North Tipperary, are to begin transporting non-urgent 112/999 patients to Ennis General Hospital as and from Monday next, as part of agreed new protocols targeting the easing of pressure on the Emergency Department at University Hospital Limerick (UHL).
Same pressures are caused by chronic overcrowding, due to the massive surge in patients experiencing respiratory infections, including Covid-19, Flu and Respiratory Syncytial Virus infection (RSV).

So with a doctor shortage in Tipperary and with many doctors failing to answer their telephones, due to work pressure; who decides who is non-urgent?
For example, are mild strokes urgent or non-urgent? If you have a silent stroke, you probably won’t know it unless you happen to have a brain scan and the damage shows up.
We are told an electrocardiogram (ECG) is an important test in any suspected mild heart attacks and should be done within 10 minutes of being admitted to hospital.

Death By Geography.

Back in October 2016 we previously raised this issue.
The distance from Thurles to Ennis is 116.3 km, with a normal travelling time of 1 hr-24 min via R498 and M7. Currently for medical help, the distance from Thurles to the UHL medical facility in Limerick is 78.1 km, with normal travelling time 1 hr-6 min also via R498 and M7, or a difference of 38.2 km. This new agreed regulation now adds a further 18 minutes to those victims suffering heart attacks or strokes, where timing is all important so that the person suffering can be treated quickly.

Since 2009, the Model 4 UHL facility has provided the only 24-hour Emergency Department service for a population over 400,000, taking into account newly arrived refugees, after A&E services were closed, under a Fianna Fáil government, in Ennis and Nenagh and in St John’s Hospital Limerick.

The UL Hospitals Group, which operates the mid-west hospitals, declared a major incident at the UHL ED on last Monday, January 2nd, when management said record levels of patients attending the department could no longer be sustained.

The silence within our rural Thurles community continues. Why?

Medical Services Suspended At Nenagh Hospital

Patients, in the North Tipperary area, requiring medical assessment or indeed treatment for even minor injuries, will now be diverted to other hospitals in the Midwest region.

This scenario follows the temporary curtailment of all outpatient appointments, at Nenagh hospital, since Saturday last.

The services at Nenagh have been suspended due to a significant numbers of staff absences on covid-related leave and to reduce, in extent, the current amount of public footfall.

The University of Limerick Hospitals Group confirmed that the medial assessment unit (MAU) and injuries unit at Nenagh hospital are being closed temporarily and patients are being urged to attend other facilities such as Ennis or Limerick or contact their GP for referral.

A misleading claim made on January 15th last by Tipperary TD Mr Jackie Cahill, who stated, quote, “The Taoiseach has informed me that an initial delivery of vaccinations will be sent to Nenagh hospital tomorrow morning, for front facing staff, following representations I made to him on this matter”, alas never came to fruition, despite him having the “ear of the Taoiseach” Mr Micheál Martin and his further claim that he had been in contact with the Taoiseach’s Chief of Staff on the matter.

We understand that to-date, over two weeks later, only half of the staff at Nenagh hospital have received their vaccination.

We warned, back in October 2016, of the possibility of Tipperary dwellers suffering “Death by Geography”.

96 Patients On Trolleys In Hospitals Serving Tipperary

According to the Irish Nurses and Midwives Organisation (INMO) trolly ward watch figures, 399 patients are on trolleys in emergency departments and 117 are in wards around the 26 counties of Ireland this morning. In all a total of 456 patients wait on trolleys during the month of July.

There are 70 patients on trolleys in University Hospital Limerick, latter which serves North Tipperary, all awaiting admission to be assigned to a hospital bed.

Other hospitals seriously affected in the south and west are Cork University Hospital with 60 patients; University Hospital Waterford and University Hospital Galway with 30 each on trolleys. South Tipperary General Hospital also serving South Tipperary have 26 patients on trolleys.

It should be noted that this continuing situation is not brought about by hospital staff failures, but rather the failed responsibility of this present government, which continues to promote death by geography for residents of County Tipperary.

The Silence Continues.