Statement by Mary Harney TD, following the publication of the HIQA Report on the provision of care to Ms Rebecca O’Malley
The Minister for Health and Children, Mary Harney, TD welcomed the publication today (2 April, 2008) of the independent report by the Health Information and Quality Authority (HIQA) into the circumstances surrounding the provision of care to Ms. Rebecca O’Malley.
The Minister reiterated her earlier apology to Ms. O’Malley and praised her courage in pursuing her case with the health services during such a difficult time in her own life. The Minister also apologised to the second patient whose experiences are dealt with specifically in the HIQA report. She wished both women well on their path to recovery.
The Minister noted the main finding of the report, that the interpretive error made by a Consultant Pathologist leading to the initial misdiagnosis of Ms O’Malley, was a single mistake of human error. However, the report notes that the absence of ‘triple assessment’ review in the Limerick Regional Hospital created missed opportunities to correct the error. Triple assessment is one of the core standards of diagnosis and care that are recommended in the National Quality Assurance Standards for Symptomatic Breast Disease Services.
The Minister said: ‘As in the case of the experience at Barringtons Hospital, this report highlights the need for continued implementation of the National Quality Assurance Standards for Symptomatic Breast Disease Services which I approved last year. It also reinforces the importance of providing symptomatic breast cancer services in eight designated centres. A sum of €5.8 million has been allocated by the Director of the National Cancer Control Programme to these centres, so as to meet the Standards and build up capacity.
‘I am determined that each of these reports will lead to permanent, improved standards of patient safety and patient care in all healthcare settings.’
Other Findings of the Investigation
The report has identified weaknesses of governance, management and communication within the HSE which contributed to the failures in this case. The Minister noted that the HSE is already working to address these issues, many of which have recently been identified in the reports relating to cancer services in Portlaoise. The HSE has put in place an interim protocol for managing serious incidents, and has appointed a senior individual at national level to focus on the immediate implementation of the policy and to ensure that it is applied in relation to all future serious incidents.
The Minister welcomed the recommendations in today’s report and said that her Department will work with the Health Service Executive (HSE) and other agencies to implement them. The Minister said “Our common focus is on delivering a patient-centred service in all aspects, where the needs of each individual patient are paramount”.