Is the Chief Medical Officers Position Tenable

bonkers

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The Doctor from the Uk who has been drafted in says he cant get on with the inquiry to find out what happened because the people he needs to interview are wasting time attending at Dail Committees.
What has the PAC to do with what happened, Mc Sharry is adding nothing helpful at all but is happy to shout the loudest.
The New Acting Head of the HSE has stated that whoever drafted the memos that O Brien was forced to step down over was right, this was the correct approach to take in the circumstances so really O Brien should have stayed put.
If I was dying of terminal cncer I have to say I would be out enjoying the sunshine and not wasting my time appearing before committees, what on earth is going to be gained by Ms Phelan appearing there to listen to the likes of Marc Mc Sharry.
Are you really that stupid?
 


bonkers

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For Ms Phelan very little.

For the rest of us, nothing.

For McSharry - well he can grub around for votes using dying and dead women.
Ms Phelan is trying to ensure this will never happen again. She’s also calling for the HSE to be totally overhauled. We should all be very grateful to her.
 

ruman

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Ms Phelan is trying to ensure this will never happen again. She’s also calling for the HSE to be totally overhauled. We should all be very grateful to her.
Yep. She has realized that Senior Management in the DOH/HSE dont give a toss. The politicians dont give a toss about her either but they do care about publicity and the potential loss of votes.
Anyone who has had the bully boys in the HSE go after them is cheering Vicky Phelan on. The bully boys are being bullied now and they dont seem to be able to take it half as well as they are able to give it.
 

bonkers

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Yep. She has realized that Senior Management in the DOH/HSE dont give a toss. The politicians dont give a toss about her either but they do care about publicity and the potential loss of votes.
Anyone who has had the bully boys in the HSE go after them is cheering Vicky Phelan on. The bully boys are being bullied now and they dont seem to be able to take it half as well as they are able to give it.
These people have been unaccountable for decades. It’s time they were made pay for their bad management.
 

ruman

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What Deirdre Madden said about Mandatory dosclosure on This week last Sunday;



The less than clear-cut issue of disclosure, which has been highlighted internationally (Australia in this particular case)
I note you ignored the Francis inquiry from the UK and also the US state that introduced it and saw legal costs drop enormously. Here's a summary from Francis -

"Mr Francis’ recommendation 181 provides that there should be a statutory obligation of candour on healthcare providers, registered medical practitioners, nurses and other registered health professionals where there is a belief or suspicion that any treatment or care provided to a patient by or on behalf of their employing healthcare provider has caused death or serious injury.
Promptly identifying negligence and providing redress for the patient and their family should be encouraged. Doing so quickly and efficiently will reduce expenditure on legal costs and should provide a better experience for the patient and their family. This has been borne out by studies which show that while (in the short term at least) a duty of candour may increase the number of claims brought the number will settle down and reduce in the longer term.

One study at the University of Michigan Health System showed that their damages payments per case reduced by 47 per cent and the average settlement time for claims reduced from 20 months to six months following the introduction of an apology and disclosure programme in 2001".


If the DOH were afraid of upsetting the unnamed vested interest groups they could have gone for the New Zealand no fault approach instead. However they decided to throw patients under a bus instead. There's big money for the legal profession and the army of "medical experts" in the status quo of course.

Now who were those unnamed vested interest groups that lobbied Doctor Holohan ?!
 
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Noble Guardian

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I note you ignored the Francis inquiry from the UK and also the US state that introduced it and saw legal costs drop enormously. Here's a summary from Francis -

"Mr Francis’ recommendation 181 provides that there should be a statutory obligation of candour on healthcare providers, registered medical practitioners, nurses and other registered health professionals where there is a belief or suspicion that any treatment or care provided to a patient by or on behalf of their employing healthcare provider has caused death or serious injury.
Promptly identifying negligence and providing redress for the patient and their family should be encouraged. Doing so quickly and efficiently will reduce expenditure on legal costs and should provide a better experience for the patient and their family. This has been borne out by studies which show that while (in the short term at least) a duty of candour may increase the number of claims brought the number will settle down and reduce in the longer term.

One study at the University of Michigan Health System showed that their damages payments per case reduced by 47 per cent and the average settlement time for claims reduced from 20 months to six months following the introduction of an apology and disclosure programme in 2001".
Thanks for that. I had come across mentions of the Francis report before, but in the context of it being cited by research conducted by the University of Sheffield into barriers to implementation following the introduction of mandatory disclosure in the UK (http://eprints.whiterose.ac.uk/125994/1/ClinicalEthics_RevisionstoReviewersPVS.pdf). The point of the post was to present the known, accepted and rational fears of healthcare providers around the topic of disclosure. Many if not all of these fears can be addressed, but simply bolting legislation on top of the situation won’t do this in the absence of supportive measures to address these fears. If legislation was a panacea, there would be no crime.

For clarity, I am in full support of the notion of open disclosure, having experienced both the professional and personal sides of the process.

The Michigan model is one which should be implemented universally, but it didn’t happen overnight and with the isolated introduction of mandatory disclosure. A vital prerequisite was the reform of the medical malpractice laws in the preceding decide, which created a less confrontational atmosphere in which complainants and healthcare providers could come to a resolution.
https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs

“We’re fortunate to be located in Michigan, a state that passed sensible medical malpractice reform in the 1990s and is not having some of the same crisis situations as other states. Our state law, among other things, builds a six-month “cooling off” period into the malpractice lawsuit process. If a patient is thinking about bringing suit against a doctor or hospital for medical malpractice, the patient must first alert prospective defendants of their complaints with a “notice of intent,” and both parties then have six months to consider their cases before going to court. UMHS systematically uses that period to investigate complaints and establish a dialogue with our patients, and their attorneys if they are represented, which often eliminates their need to resort to litigation.”

That atmosphere is not evident here, not legally and certainly not politically.

It isn’t just the legal aspect however which interferes with HCP’s confidence in an open disclosure process. The perceived lack of support from colleagues is a significant factor in these matters. I once had to give medical evidence in a criminal trial, and approached a senior colleague for advice. Even though the case wasn’t a professional practise issue, the guy just didn’t want to know (to quote, “you’re on your own there”). His attitude wasn’t unique. There are also many other examples of “accidents waiting to happen” being laid at the feet of the poor schmuck to whom it happened. A well-known example from the past is using the wrong solution for diluting injections, where (in the past) water for injections was stored beside concentrated potassium chloride (the stuff used in judicial lethal injections). It happened to one colleague, and nearly happened to another that these two solutions were accidently substituted. In the former, the poor guy became a cautionary tale, (“you don’t want to end up like X, his career’s finished now”). Eventually, the systemic fault was fixed, with the dangerous solution being stored elsewhere, away from the common diluents.

As such, the belief, real or imagined, that admitting to mistakes will have a detrimental effect on one’s professional reputation and career is significant, especially for junior staff for whom their career depends on their references from their superiors. This will only change when there’s s a cultural change in the profession through reassurance and education, as well as an appropriate legislative environment.

Tere are other factors (hierarchical structures, some doctors being sh1theads, etc.) which are also mentioned in both the Australian paper and the University of Sheffield work, all of which will need to be tackled.


If the DOH were afraid of upsetting the unnamed vested interest groups they could have gone for the New Zealand no fault approach instead.
I agree that a no-fault system would be far better for all concerned. Patients would get the help they need far quicker than having to prove negligence against an individual, who will of course seek to defend themselves for the reasons I’ve stated above. There’s a myth that “no-fault is the same as no accountability, as poor professional performance would still need to be addressed through retraining and monitoring, or through expulsion at the extreme.

This however is also complex , and deserves a separate discussion.
 

fifilawe

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All these people appointed are there for a long time and will be longer in a job than any Health Minister.They know a Minister has only a short shelf life so they bide their time and keep stumm till any scandal blows over and it is "Back to normal" as if nothing happened.If anyone informs the DOH or the Heath Minister s/he is finished in that dept as s/he landed his colleagues in the sh1t and will be regarded by the others as a "whistleblower" and we all know the treatment they get .
 

ruman

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Thanks for that. I had come across mentions of the Francis report before, but in the context of it being cited by research conducted by the University of Sheffield into barriers to implementation following the introduction of mandatory disclosure in the UK (http://eprints.whiterose.ac.uk/125994/1/ClinicalEthics_RevisionstoReviewersPVS.pdf). The point of the post was to present the known, accepted and rational fears of healthcare providers around the topic of disclosure. Many if not all of these fears can be addressed, but simply bolting legislation on top of the situation won’t do this in the absence of supportive measures to address these fears. If legislation was a panacea, there would be no crime.

For clarity, I am in full support of the notion of open disclosure, having experienced both the professional and personal sides of the process.

The Michigan model is one which should be implemented universally, but it didn’t happen overnight and with the isolated introduction of mandatory disclosure. A vital prerequisite was the reform of the medical malpractice laws in the preceding decide, which created a less confrontational atmosphere in which complainants and healthcare providers could come to a resolution.
https://www.uofmhealth.org/michigan-model-medical-malpractice-and-patient-safety-umhs

We’re fortunate to be located in Michigan, a state that passed sensible medical malpractice reform in the 1990s and is not having some of the same crisis situations as other states. Our state law, among other things, builds a six-month “cooling off” period into the malpractice lawsuit process. If a patient is thinking about bringing suit against a doctor or hospital for medical malpractice, the patient must first alert prospective defendants of their complaints with a “notice of intent,” and both parties then have six months to consider their cases before going to court. UMHS systematically uses that period to investigate complaints and establish a dialogue with our patients, and their attorneys if they are represented, which often eliminates their need to resort to litigation.”

That atmosphere is not evident here, not legally and certainly not politically.

It isn’t just the legal aspect however which interferes with HCP’s confidence in an open disclosure process. The perceived lack of support from colleagues is a significant factor in these matters. I once had to give medical evidence in a criminal trial, and approached a senior colleague for advice. Even though the case wasn’t a professional practise issue, the guy just didn’t want to know (to quote, “you’re on your own there”). His attitude wasn’t unique. There are also many other examples of “accidents waiting to happen” being laid at the feet of the poor schmuck to whom it happened. A well-known example from the past is using the wrong solution for diluting injections, where (in the past) water for injections was stored beside concentrated potassium chloride (the stuff used in judicial lethal injections). It happened to one colleague, and nearly happened to another that these two solutions were accidently substituted. In the former, the poor guy became a cautionary tale, (“you don’t want to end up like X, his career’s finished now”). Eventually, the systemic fault was fixed, with the dangerous solution being stored elsewhere, away from the common diluents.

As such, the belief, real or imagined, that admitting to mistakes will have a detrimental effect on one’s professional reputation and career is significant, especially for junior staff for whom their career depends on their references from their superiors. This will only change when there’s s a cultural change in the profession through reassurance and education, as well as an appropriate legislative environment.

Tere are other factors (hierarchical structures, some doctors being sh1theads, etc.) which are also mentioned in both the Australian paper and the University of Sheffield work, all of which will need to be tackled.




I agree that a no-fault system would be far better for all concerned. Patients would get the help they need far quicker than having to prove negligence against an individual, who will of course seek to defend themselves for the reasons I’ve stated above. There’s a myth that “no-fault is the same as no accountability, as poor professional performance would still need to be addressed through retraining and monitoring, or through expulsion at the extreme.

This however is also complex , and deserves a separate discussion.
Thanks for your informative reply.
I dont have a problem with medics making mistakes, we are all human and mistakes can happen. The issue is the reaction to mistakes. You can't investigate mistakes and prevent re-occurrence (which should be the priority) under the current system where denial is the standard approach (no matter how clear the mistake is).

In regard to accountability unfortunately there is an issue in Ireland. The President of the Medical Council here flagged the almost non existence of complaints from the HSE. A total of one received in 2016 where the standard in the UK and other comparable countries is 25% -

https://www.irishtimes.com/news/hea...-complaints-against-doctors-rise-20-1.2768116

When negligence occurs in Ireland the medic, hospital and HSE wash their hands completely. It is left to the patient/victim to go through the courts to obtain funding to provide care for the injuries they suffer. This is an extremely expensive process. We all know about the exorbitant legal fees however there are also significant fees paid to medical experts to testify. When victims are already having to bear medical fees as a result of injury, many simply cannot afford the expense. In terms of accountability this is a completely separate process. Again it is left to the patient/victim to file a complaint with the regulatory body with the HSE and hospital washing their hands completely.

Finally while you can file a complaint against a doctor/nurse it is almost impossible to file a complaint against managers. I don't know how doctors and nursing unions have allowed a situation where there are regulatory bodies to investigate them but Hospital Manager complaints are investigated (if at all) by the HSE. HSE managers investigating HSE managers.
My own view is consultants should be siding with patients, certainly if there was support from the IHCA and nursing unions for reform it would happen.

The DOH as legislators are primarily responsible and you have the situation of medical records being altered, going missing and medics losing their memories or ringing in sick following "adverse incidents". I could blame individuals for this but that would be to ignore the frequency of these occurrences. Ultimately responsibility for the current mess of a medical negligence system resides with the Department of Health and Health Ministers past and present.
 
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ruman

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Resurrecting this thread in light of the Scally reports scathing comments in regard to the voluntary nature of the Open Disclosure policy.
Just to go back. Leo Varadkar while Health Minister promised to implement a mandatory disclosure policy but did a u turn after Holohan was lobbied by "powerful interest groups".

Less shouting and more legislating by TDs would have served Vicky Phelan better

Does Holohan have questions to answer in regard to what he told Varadkar to do in 2015 ?
Why arent our subservient media asking Leo to explain his decision ?
 

Disillusioned democrat

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Resurrecting this thread in light of the Scally reports scathing comments in regard to the voluntary nature of the Open Disclosure policy.
Just to go back. Leo Varadkar while Health Minister promised to implement a mandatory disclosure policy but did a u turn after Holohan was lobbied by "powerful interest groups".

Less shouting and more legislating by TDs would have served Vicky Phelan better

Does Holohan have questions to answer in regard to what he told Varadkar to do in 2015 ?
Why arent our subservient media asking Leo to explain his decision ?

That indeed is the most interesting question....Leo given free rein to pull on his puppy-dog face and "call" for a new era of openness and disclosure on the 6 and 9 news last night and no one thought to remind him he had the chance and blew it....like he's blown every ministry role he's had, like he's blowing the job as Taoiseach.
 

ruman

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That indeed is the most interesting question....Leo given free rein to pull on his puppy-dog face and "call" for a new era of openness and disclosure on the 6 and 9 news last night and no one thought to remind him he had the chance and blew it....like he's blown every ministry role he's had, like he's blowing the job as Taoiseach.
He's spinning

“It wasn’t a u-turn. We made a particular set of decisions that we would ensure that it was policy first and it has been policy for a very long time. Secondly, that we would legislate to protect open disclosure on a voluntary basis and that we would then legislate after that for mandatory open disclosure. That is what we are going to do. That’s what is in my party’s manifesto back in 2016, long before the CervicalCheck scandal broke and was also in the programme for government.”

Leo Varadkar denies making u-turn on manadatory disclosure in health
 

Massey

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If there is voluntary disclosure , as in the cervical sreening , it will cost the country billions.
 

ruman

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If there is voluntary disclosure , as in the cervical sreening , it will cost the country billions.
There already is voluntary disclosure, Dr Scally has strongly recommended mandatory disclosure as the voluntary mechanism is being ignored by medics.
Disclosure doesn't cost the taxpayer a cent as you well know, it is the mistakes of medics that costs taxpayers. Currently medics deny mistakes have happened thereby increasing the likelihood of them reoccurring and increasing the cost to the Irish taxpayer in the long run.
Denying mistakes also means lengthy legal costs with the taxpayer having to foot the bill for legal experts and reports by medical experts.

In the US over the long term a mandatory disclosure system has been proven to cut legal costs significantly. There may be some additional costs in the short term but that is preferable to dragging a mother through the courts for years denying her funding for her severely disabled child because some halfwit doctor didnt do his job.

Scally is scathing of the method of dealing with mistakes. Mandatory disclosure is coming. It would already be law if Leo hadnt capitulated to his doctor buddies.
 

Massey

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There already is voluntary disclosure, Dr Scally has strongly recommended mandatory disclosure as the voluntary mechanism is being ignored by medics.
Disclosure doesn't cost the taxpayer a cent as you well know, it is the mistakes of medics that costs taxpayers. Currently medics deny mistakes have happened thereby increasing the likelihood of them reoccurring and increasing the cost to the Irish taxpayer in the long run.
Denying mistakes also means lengthy legal costs with the taxpayer having to foot the bill for legal experts and reports by medical experts.

In the US over the long term a mandatory disclosure system has been proven to cut legal costs significantly. There may be some additional costs in the short term but that is preferable to dragging a mother through the courts for years denying her funding for her severely disabled child because some halfwit doctor didnt do his job.

Scally is scathing of the method of dealing with mistakes. Mandatory disclosure is coming. It would already be law if Leo hadnt capitulated to his doctor buddies.
Most medics would have no issue with mandatory disclosure, and would welcome it , it may save money, but if we go by the screening experience , where a false negative leads to a 7 million pay out and the screening company considering withdrawing from the Irish system.

I think that the screening will become unaffordable, but agree mandatory disclosure should come. Stemming the costs resulting will be a challenge.

For example, overcrowding leads to delays and delays lead to poor outcomes:: should every patient be informed that the were treated in an overcroded department. or that the machine used in their diagniosis is being 5 years past the manufactures recommendation?
 

ruman

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Most medics would have no issue with mandatory disclosure, and would welcome it , it may save money, but if we go by the screening experience , where a false negative leads to a 7 million pay out and the screening company considering withdrawing from the Irish system.

I think that the screening will become unaffordable, but agree mandatory disclosure should come. Stemming the costs resulting will be a challenge.

For example, overcrowding leads to delays and delays lead to poor outcomes:: should every patient be informed that the were treated in an overcroded department. or that the machine used in their diagniosis is being 5 years past the manufactures recommendation?
And yet they lobbied the CMO and Leo against it !
We already have evidence mandatory disclosure reduces costs and is already being operated in proper countries. Leo bottled it, Harris no longer has a choice. Well done Dr Scally.
 

ruman

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The Phoenix running with it :

Varadkar told the Irish Times last week that open disclosure was in the programme for government, which it was. What he did not say is that he did a 180-degree U-turn – twice – on this pledge between 2015 and 2017. He was responsible for its deletion from the Health Information Bill in 2016 when he was health minister and as taoiseach in late 2017 he stood over a second decision by the government to delete that measure from the legislation

https://www.thephoenix.ie/article/leo-varadkars-non-disclosures/

Any of the subservient mainstream media or "opposition" politcians going to challenge Leo on this ?
 
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ruman

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Resurrecting this thread given Holohan is back in the news. On this occassion he apparently has been threatening whistleblowers.

Between this and his steering of his boy Varadkar to abandon mandatory disclosure is this man the single biggest danger to Irish patients?


"There are calls on the Department of Health to explain how it treated a CervicalCheck patient advocate.
A letter from the Chief Medical Officer Dr Tony Holohan to Lorraine Walsh on March 13 accused her of making false statements on Twitter and in the media when she criticsed the management of the crisis.
"Correspondence between the Chief Medical Officer (CMO), and patient advocate Lorraine Walsh shows the toxic atmosphere that has existed between officials and those who have sought answers on the Cervical Check scandal," Mr Kelly said, adding that Health Minister Simon Harris needed to answer how this was allowed to happen."
 
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Lumpy Talbot

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No
A patient is entitled to discuss his or her own issues with medical care and policy as they wish.

it isn't the CMOs job to govern what communications channels a patient uses to do that.

CMO should stick to the limits of their role and back away from any notion of complaining how a patient communicates about an issue personal to them.

A patient or taxpayer is quite entitled to take issue with health policy or how the Dept of Health, HSE etc handles an issue.

If Ms Walsh decides to stand on an upturned bucket in Phoenix Park to discuss the cervical check scandal she is quite entitled to do so and it is nowhere in the purview of the CMO to gainsay her.
 

ruman

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A patient is entitled to discuss his or her own issues with medical care and policy as they wish.

it isn't the CMOs job to govern what communications channels a patient uses to do that.

CMO should stick to the limits of their role and back away from any notion of complaining how a patient communicates about an issue personal to them.

A patient or taxpayer is quite entitled to take issue with health policy or how the Dept of Health, HSE etc handles an issue.

If Ms Walsh decides to stand on an upturned bucket in Phoenix Park to discuss the cervical check scandal she is quite entitled to do so and it is nowhere in the purview of the CMO to gainsay her.
One wonders did the taxpayer have to bear legal costs for the CMO to threaten people?
 


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