A consultant working at Children’s Health Ireland (CHI) who was at the centre of an internal review for allegedly referring patients to a weekend clinic did not fulfil his on-call hours for more than three years due to “health issues”, a confidential report has found.
However, during this period, the doctor went “above and beyond his contractual hours” to conduct weekend clinics designed to reduce waiting lists and for which he received additional money.
An internal CHI review from 2021-2022 highlighted how one consultant was allegedly referring patients to public weekend clinics at the hospital that were funded by the National Treatment Purchase Fund (NTPF) in a bid to tackle waiting lists.
This consultant was seeing twice the number of patients in the weekend clinic than during his regular weekday equivalent, the review said. He received €35,800 for the weekend work, it added.
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According to the report, which CHI said it cannot publish for legal reasons, the consultant was indefinitely removed from on-call duty for “health reasons” in 2019, a commitment under his public contract.
CHI hired a locum to fill these hours, spending around €450,000 on the locum between 2019 and when the review took place in 2021.
The report stated: “It needs to be explored how one consultant can undertake a series of NTPF-funded clinics over numerous Saturdays and during these clinics see a much greater number of patients than they are able to see in their routine public clinics, working at a very fast pace with significant throughput - a substantial undertaking of additional work, yet is unfit for any on-call duties for the past three years.”
The NTPF-funded clinics were not sought or offered to any of the other eight general surgeons in CHI, it added.
In a statement, CHI said the NTPF-funded clinics were a waiting-list initiative and were “over and above the consultant’s contractual hours”.
According to the report, the findings “strongly suggest” patients were placed on waiting lists, despite other general consultants being available “for quicker treatment and care”.
Some patients requiring surgery were waiting “far in excess of the recommended timeline for treatment”, the report added, which placed the children “at real and known risk for fertility issues and or cancer in later life”.
The report recommended all consultants identified as facilitating “inequitable and unfair” distribution of referrals “should be held to account”. It added that consideration should be given for a referral to the Irish Medical Council or other relevant body.
The consultant did not face disciplinary action, nor was he referred to the medical council. He retired following the report.
The practices identified in the audit were “not in the best interest of the child”, the report said, adding that CHI has a “broken culture” which “has the potential to put patients at risk”.
“CHI, and indeed the HSE, cannot and will not stand over behaviour or practice which undermines the integrity of public organisations,” the review said.
The NTPF has, meanwhile, suspended all funding for in-sourcing arrangements at the children’s hospital group on foot of concerns raised about how such schemes have been operated in the past.
In-sourcing is where public hospital facilities and staff - such as in CHI - are funded by the NTPF to provide additional services, outside core working hours, to provide treatment to those waiting longest for care.
The NTPF receives over €200 million each year to buy treatment in the public and private systems for patients on long waiting lists for treatment.
Taoiseach Micheál Martin said on Tuesday that the “essence” of the internal report, which also covered negative and toxic work culture at a hospital run by CHI, should be made public.
In a statement, a spokeswoman for CHI said recommendations from the review “have been implemented and are ongoing”.
“Work on CHI’s culture is ongoing, as should be expected when you look at international examples of transformation programmes of this nature.”
