Urology inquiry: Triage failures 'led to 24 red flag referrals'

Failure to triage almost 800 urology referrals in the Southern Health Trust led to 24 patients being upgraded to red flag referrals, an inquiry has heard.

It emerged during the third day of a public inquiry into work of consultant urologist Aidan O’Brien at the trust.

A further five people received a late cancer diagnosis due to the failures.

Mr O’Brien previously claimed the trust provided an “unsafe” service and was trying to shift blame on to its medics.

The former urologist told an investigation that between 2015 and 2016 he “didn’t have the time to triage” and that he was “surprised that the number of cases upgraded was so small.”

The inquiry also heard that Mr O’Brien’s private patients were given “advantageous” treatment over health service patients.

On Wednesday, the inquiry heard that Mr O’Brien had left a 6.5cm swab in a patient after surgery and failed to identify it in a scan three months later.

It was also told that almost 600 patients received “suboptimal care” from Mr O’Brien’s clinical practice.

Dr Chada, who was appointed by the trust to conduct an investigation into the consultant’s work, found that 11 private patients under Mr O’Brien’s care had completed their procedures within “much shorter timeframes” than expected for NHS patients given their clinical priority.

A doctor, who carried out an additional review, also found there was “no clinical justification” to support nine out of the 11 patients’ treatment within such a short time frame.

The inquiry heard that Mr O’Brien disputed the treatment dates and rejected the suggestion that he had been “improperly advantaging private patients”.

But after reviewing the notes, Dr Chada concluded all nine private patients had “each been scheduled earlier than their clinical needs dictated”.

She also concluded Mr O’Brien had afforded them advantages over health service patients with the same clinical priority.

Counsel for the inquiry, Martin Wolfe KC, said the trust’s investigation also found that the storage of 307 sets of patient notes at the consultant’s home was “excessive and outside normal acceptable practice”.

Mr Wolfe added it constituted a “serious data protection information governance risk” for the trust.

Mr O’Brien had told the investigation that the trust had “not developed a system for either tracking notes or had they sought to determine the extent of the problem prior to the investigation”.

The inquiry also heard of a catalogue of problems including undictated clinic notes dating back to November 2014 which affected 668 patients.

A review look back took 6 months to complete.

There had been “multiple attendances” without reciprocal letters on patient’s files, delays in sending letters to patients and cases in which no entries had been made on patients’ charts.

Additionally, Mr Wolfe said that the inquiry may have to consider along various lines which senior managers within the trust knew what and when.

In her investigation, Dr Chada found that there were “earlier opportunities” where those within the health trust could have added concern about Mr O’Brien’s work prior to 2016.

These opportunities were not taken in a consistent, planned or robust manner, she added.