By Louise Walsh

HSE bosses have dismissed concerns by a locum consultant cardiologist who placed a disclaimer on 2,500 patient reports because of what he says was 'poor imaging' from an alleged 'obsolete' cardioechogram (ECG) machine.

Dr Boban Thomas says he first informed the HSE by email over two years ago about the 'problematic' machine, which he claims has led to at least one misdiagnosis at Our Lady's Hospital in Navan, Co. Meath.

The HSE, however, say that after a review of 100 of the reports involving a "leading and expert cardiologist", it was "satisfied that there is no requirement to recall patients who had an echocardiogram between 2016 and after a new machine was commissioned at the end of 2017".

In a recent email telling HSE bosses that he was bringing the issue into the public domain, Dr Thomas said he had "not been willing to sign off on studies that were performed on such a unit for ethical reasons primarily and other medicolegal issues that may arise eventually

"I then instructed for the disclaimer to be placed on reports where neither I nor the technicians were willing to take responsibility for the quality of the studies and the subsequent clinical decisions that may be taken."

In a series of older emails from May 30, 2016, to May 2, 2017, the consultant cardiologist asked for replacement machine saying that the continued use of the machine was "morally unethical".

At the end of May, he emailed a number of hospital chiefs describing the situation as "critical" and saying: "The echocardiography unit, as you know, has an end of life certificate from March 2016. Suffice to say it has been on life support since then.

"The unit has started to shut off spontaneously and we may have to stop doing echocardiograms here and transfer in-patients on ambulances to get echocardiograms elsewhere."

An internal email between departments from the HSE on June 13, 2016, and copied to Mr Thomas asks for funding and says the machine was on the "obsolete list".

"This equipment was on the register of obsolete equipment. I realise you have already allocated funding to Navan but is there a possibility of funding a replacement for this machine as it is increasingly becoming problematic and is resulting in delayed scans and subsequent diagnosis."

In the email of December 2, 2016, Dr Thomas said: "Please do the needful to get us our unit by early January as what we are doing with our current unit is morally unethical.

"We are doing studies on patients that are suboptimal and maybe missing things on patients and telling them that something is okay when it is not.

"We would not want that with ourselves or our family members and it's unfair to others that we do that."

In the latest email, Dr Thomas cites one case of discrepancy where he says the machine in question showed the presence of aortic stenosis (valve disease problem) but missed it in a repeat study. A clarification on a new machine confirmed aortic stenosis.

He said: "Therefore, it is my contention that there have been studies that have been substandard that have put the lives of patients at risk."

Mr Thomas left his role at Navan after four years in June to take up a senior position in Lisbon in Portugal.

Speaking from Portugal last week, he said he put the disclaimer on all reports from April 2016 to August 2017. Most of the patients, he said, were from Meath.

Dr Thomas said: "I read more than 4,000 studies internationally from hospitals across the world as a central independent reader based on specific criteria and the studies in Navan would not meet those criteria and that is why I kept ringing those alarm bells

"I am absolutely sure that mistakes could have been made in reading patient reports because of very poor imagery. No-one spoke to me or called me into a meeting about my concerns.

"I was the only cardiologist there for four years and I couldn't sign off on an exam which could prove dubious. It was also an attempt to put pressure on the HSE to get a new or temporary machine.

"I even negotiated for the new machine in the end. This issue was one of the reasons I resigned and I don't intend on coming back to Ireland."

"If something happens, it is now the responsibility of the Ireland East group. I don't want my name or reputation blemished."

Dr Thomas said he would be contacting both HIQA and the Medical Council on the issue.

The HSE said: "Patient safety and quality of care delivered is a key priority in all Hospitals and services provided across the Ireland East Hospital Group.

"The Ireland East Hospital Group commissioned a review, in May 2018, of the diagnostic quality of echocardiographic studies in Our Lady’s Hospital, Navan over the period between April 4, 2016, and August 16, 2018.

"A leading and expert Cardiologist from the Mater Misericordiae University Hospital in Dublin was tasked with conducting the review. 2213 studies were accessed with 100 of these randomly selected to be personally reviewed by the Cardiologist.

"The recommendations from the subsequent report outlined that no full-scale review was required as the diagnostic quality of the studies were of an appropriate standard. That report was then circulated, through the Local Integrated Care Committee, to all local GPs.

"An Echocardiogram is a very subjective diagnostic tool and can vary for several reasons depending on the patient being reviewed. All Echocardiograms conducted in Our Lady’s Hospital, Navan where anomalies or visual complexities were identified were escalated for enhanced imaging and the referring consultant informed.

"The Ireland East Hospital Group and Management at Our Lady’s Hospital, Navan are satisfied following a full review of the circumstances surrounding this issue that there is no requirement to recall patients who had an Echocardiogram in the period referenced."

Meanwhile, local Sinn Féin TD Peadar Toibin, who initially raised the matter last April, said: "It is deeply worrying when a consultant cardiologist does not have clinical confidence in a key diagnostic machine he is using, especially since problems with the heart are life-and-death issues.

"It is beyond worrying when a Clinical Engineering Lead in the HSE states that an echocardioechogram machine is on a register of obsolete equipment for over a year and is still being used to diagnose thousands of patients.

"Initially when this came to my attention I was told that hundreds of “re-echos” would be undertaken to ensure no misdiagnosis. This has clearly not happened.

"I urge the HSE to restore confidence and make the results of their testing available or re-echo those who seek it, so that people can be sure of their true medical condition. Given all the scandals that have happened in the Health Service in recent times, as citizens we have no choice but to make sure that we are being treated correctly.

"The Minister has a responsibility here. It is clear that the hospital sought funding for a new machine to replace an obsolete machine for over a year but were refused. This is just another example of a disastrous Health service that is broken to the core and an incompetent Minister at sea in his portfolio."