Consultant committee rejects St James’s Hospital CEO appeal

The Consultant Applications Advisory Committee (CAAC) has rejected an appeal by the CEO of St James’s Hospital, Dublin, to reverse a decision to end a joint consultant cardiologist position with Midland Regional Hospital, Mullingar, the Medical Independent (MI) can reveal.

In March 2018, the CAAC considered the application to replace Consultant Cardiologist Dr John Cosgrave, who had an eight-hour (one day) weekly commitment to St James’s, in addition to his position in Mullingar.

It was decided to restructure the post so that the new consultant’s part-time commitment would be to the Mater Misericordiae University Hospital, which is also in the Ireland East Hospital Group (IEHG).

The matter was discussed again at the CAAC’s October meeting as St James’s had not agreed to the change.

The restructured post was “recommended for approval” on the basis of patient safety concerns, according to meeting minutes seen by MI through Freedom of Information legislation.

However, in November 2018, CEO of St James’s Mr Lorcan Birthistle wrote to the then Chair of the CAAC Prof Áine Carroll, asking for it to “revisit” the matter in light of patient safety and care issues.

Mr Birthistle stated that the cardiology department in St James’s provided a range of specialist cardiology services to patients referred from Mullingar.

In 2017, some 533 patients from counties Westmeath and Longford were treated in its cath lab, with the vast majority being inter-hospital emergency transfers, or emergency primary percutaneous coronary intervention (PPCI) patients.

This was an increase in the number of patients recorded from these counties in 2015 (494) and 2016 (409), added Mr Birthistle.

“The sessional commitment from the Mullingar cardiologist is a very important contribution to the provision of overall cardiology services in a safe and sustainable manner.”

Mr Birthistle said it was his understanding that the head of the national acute coronary syndrome programme wrote to the CAAC in 2017 to reject the proposal to restructure the post. Patient flow required strong links between Mullingar and St James’s and patient safety would be “compromised” if these links were not reflected in joint consultant appointments.

However, the CAAC upheld its decision, which it attributed to the structure of Hospital Groups and patient flow, patient safety, and a requirement for clinical governance through the primary Hospital Group, the IEHG.