At Dublin Hospitals, Surgeries Are Cancelled Time and Again

Declan Gilligan has had some problems with his health for the past eight years.

Almost as bad are his problems with getting it fixed. St James’ Hospital always seem to be cancelling his appointments for operations.

He is not the only one facing this problem. Dublin hospitals cancelled thousands of appointments for in-patient and day-case admissions last year, according to documents obtained from the HSE under a Freedom of Information (FOI) request.

Sometimes there aren’t enough beds, doctors or nurses. Other times, someone with a more urgent problem needs help more than the person with the appointment.

A spokesperson for the HSE said procedures can be cancelled by both patients and the hospital.

And “The number of cancellations should be viewed in the context of the 1.16 million people who received either inpatient or day case treatment in 2015,” the spokesperson said. “Total cancellations represent approximately 2% of all total activity.”

It seems that Dubliners aren’t too angry about cancellations – or perhaps they are fatalistic about them. Both the HSE’s ombudsman and the Irish Patients’ Association say they get few complaints about cancelled appointments.

Still, there are thousands of appointments being cancelled every year in Dublin, and this can cause all sorts of difficulties, both medical and logistical, as Gilligan’s experience illustrates.

From the Beginning

“It all started in 2008,” he says. “From that day to this, I’ve been having problems.”

In September of that year, his appendix burst and it was promptly removed. But in the process of doing that, the doctor discovered that he had a hernia.

Doctors operated on this the next year and and fixed it with mesh. But this started to cause him problems, he says, and he had another operation to try and relieve the pain caused by the mesh.

In 2011 and 2012, he continued to experience pain and went to public doctors, private doctors and tried everything to get rid of the pain.

In 2012, it was revealed that the mesh was choking his blood vessels and because of the damage this had done, he had to get right testicle removed. St James’ Hospital organised the surgery for Gilligan.

He was eager to finally get to the bottom of what was causing his pain and fix it, but this is when cancelled procedures became a real problem for him.

In 2012, he got his first date for an operation – it was set for February. But he was told the day before the surgery that there were no beds, and the operation would have to be rearranged, he says.

The hospital rearranged it for April, but cancelled. Then it rearranged for another date in April, but cancelled once again.

He counts from his records. All in all, this happened 12 times between February 2012 and August 2013. Each time he was simply told a bed wasn’t available, he says.

Keeping Records

Gilligan kept clear notes once the pattern started to emerge. They send a letter with your date stating that “a bed has been provisionally preserved”, he says, looking at one of his letters.

It gives a number and a time to call the Sunday before your surgery to check if the bed is actually available. In his experience, it’s not unusual to call at 2 o’clock, just to be told to call back in the evening, he says.

He sent a letter of complaint to St James’ Hospital in 2013, and a response from the hospital dated March of that year makes apologies for “the distress and upset which was caused by the cancellation of your previous provisional dates for admission”.

It explained that patients are prioritised based on clinical need. “All elective admissions are governed by the number of urgent requests from the Emergency Department or Outpatient Department,” the letter stated. “Regrettably on your scheduled provisional dates, there were several urgent cases that the team had to prioritise for admission at that time.”

The letter also said that previous cancellations of a patient’s provisional admission is brought to the attention of the treating consultant when reprioritising admission. But in April 2013, his procedure was cancelled again, he says.

At the end of September 2013, a new doctor finally completed the operation. But it didn’t end there. The mesh wasn’t touched and a second hernia was discovered, so he was booked in to get those things sorted out.

Finally, Success

This time he received ten cancellations, between 2014 and 2016. He takes out his calendars from the past two years, pointing out the months marked with surgery dates and times to call the hospital to check the bed is available.

The week before each provisional date there is also a reminder to stop taking medication. Last August he even made it to the hospital before his operation was cancelled, he says.

“I got into the bed and all, then the nurse came in and told me the operation was cancelled and to go home,” he recalls. “They said another patient had come in and it was an emergency.”

On that occasion he had fasted before heading to the hospital. He also had to get a taxi home, because he had no money with him as he thought he’d get picked up after the operation.

On the other occasions, he stopped taking his aspirin a week before the proposed operation. And over time, he said it definitely affected his mood. “With the amount of dates that were cancelled on me, you couldn’t plan anything,” says Gilligan.

And though he wasn’t an emergency case, he does say he’d consider his situation as pretty serious, because he was in a lot of pain. He was morphine for a few months as well, he says, and it stopped working for him.

Last month, he finally went in for his procedure – and it was actually done. “Once they get you in, it’s grand,” he says.

Once he gets a bed, he hasn’t anything bad to say about the doctors or the care he received.

All in all, he estimates that between procedures and doctors’ consultations, more than 30 have been cancelled on him since 2008. And he’s still having complications, and dreads the possibility of another bout of cancellations.

Gilligan recalls the first doctor he attended eight years ago saying to him something along the lines of, when you hit 50 you need a good overhaul.

“It’s still going on now,” he says, “and I’m 60 this year.”

The Numbers

Through a Freedom of Information (FOI) request, we received the appointment cancellation figures for Dublin’s hospitals in 2015.

The figures available were for the number of appointments cancelled for in-patient and day-case admission, which includes surgical procedures and other treatments.

The FOI response also stressed that the figures represent the cancellations reported (this was underlined) by hospitals, and that it isn’t mandatory to track this information. Some hospitals didn’t submit any figures at all.

But it should give a good indication of the current situation.

Cork University Hospital and Galway University Hospitals had highest figures in the country.

St James’ Hospital happened to have the highest number of cancellations of all Dublin hospitals, with 434 day cases cancelled and 3,268 in-patient appointments cancelled. That’s 3,702 in total.

The Royal Victoria Eye and Ear Hospital had 1,345 cancellations last year, Beaumont Hospital had 1,244. St Vincent’s University Hospital had 1,032,Connolly Hospital had 199 and the adult section of Tallaght Hospital had 2,067.

As for children’s hospitals, Temple Street had 467, Tallaght Hospital had 299, while the Rotunda and the Coombe both reported 0. Crumlin Children’s Hospital did not submit figures.

“Because of the nature of hospital bookings and the possible surges in requirements for emergency admissions, some patients may have their appointment deferred on more than one occasion,” said the FOI response.

It said procedures might be deferred because: a patient may be deemed not fit, there is a lack of capacity or beds, there is no theatre available or more urgent cases have been prioritised.

In Tallaght Hospital, cancellations represented a small percentage of overall elective admissions (5.5 percent in 2015), said a spokesperson. The cancellation rate has dropped by 14 percent over the past three years, she added.

A spokesperson representing the HSE’s children’s hospitals echoed the sentiments of the FOI response, and added: “Hospitals will aim to reschedule any patient as quickly as possible following a postponement and patients will be prioritised based on clinical need.”

St James’ Hospital did not respond to queries.

Few Complaints

The Office of the Ombudsman, which examines complaints from the public about the HSE, does not keep track of the number of complaints it receives about cancellations, but said they only come in occasionally.

Stephen McMahon of the Irish Patients’ Association said he doesn’t get too many either. “We get occasional complaints from patients who are frustrated at having cancelled operations at the last minute,” he said.

It can be hard for patients who go out of their way to make arrangements, said McMahon.

“We had a case where an elderly couple, one of the partners had to go into a nursing home while the other partner went in to have their hip done,” he said. “Then to find out last minute that the operation was cancelled, it throws all those arrangements off.”

Appointments can be cancelled because of overcrowding in emergency departments, he says, that’s a very necessary thing.

“Another thing that can impact on it is that we have staff shortages in Ireland,” McMahon said.

So you could have a theatre nurse that’s not available which means that the whole team can’t proceed, so you have the consultants sitting on their hands because you can’t proceed,” he said.

There are practical reasons for these cancellations, but the HSE need a more patient-centred approach to the issue, says Gilligan, who’s been coping with cancellations for so many years.

One of his surgeries was cancelled once because the doctor had left the hospital, Gilligan says. But no one told Gilligan until the week of the surgery.

“If we know that there’s going to be a logistical problem at the end of the week, tell the patient today,” he said. “It’s very unsettling when a patient goes into the hospital, who may have been fasting the night before, goes in and finds that their treatment has been cancelled.”