THE HEAD of New York’s largest private healthcare system and Limerick native Michael Dowling said Ireland should have “mini emergency departments” located in local communities to help prevent the type of persistent overcrowding occurring every day at University Hospital Limerick (UHL) and other hospitals around the country.
Mr Dowling, who operates 28 hospitals under Northwell Health, said Ireland should be looking to providing more outpatient facilities in order to reduce patient overcrowding in hospitals.
At the time of going to print, Health Minister Stephen Donnelly and the head of the Health Service Executive (HSE), Bernard Gloster, were preparing to travel to the Limerick hospital for crisis talks with management over concerns about patient deaths amid chronic overcrowding at the hospital.
“Regarding urgent care, we should have mini emergency departments located close to where people live to decamp them away from the hospitals, so that the hospitals don’t get as crowded as they are here,” Mr Dowling, originally from Knockaderry, County Limerick, told the Limerick Post.
There were 92 patients languishing on trolleys on the emergency department and wards at UHL on Wednesday (April 3) as this article was going to print.
“There are an awful lot of things that are done here in hospitals that should be done outside of hospitals,” Mr Dowling said.
“While I have 28 hospitals, there are about a thousand outpatient locations, so most of my healthcare. Only 45 per cent of my business is hospital business now – it was 90 per cent at one stage, it’s (now) mostly outpatient ambulatory.”
Mr Dowling said that “cancer is mostly outpatient, imaging, surgery, orthopaedic surgery, it all will be outpatient except for major spine surgery”.
“If you get shoulder surgery in my place now, you don’t go to the hospital at all.
“Cardiac care is almost all outpatient, even putting stents in people in the future will be outpatient.”
Mr Dowling, who was the keynote speaker at the JP McManus sponsored All-Ireland scholarship awards presentation ceremony at University of Limerick over the Easter bank holiday weekend, is responsible for about 106,000 employees at Northwell Health, a company, he estimates, generating around $21billion in revenue.
A graduate of University College Cork, the Limerick man previously served as Commissioner of New York State Department of Social Services, New York State Director of Health, Education, and Human Services, as well as Deputy Secretary under former governor Mario Cuomo.
One major problem for hospitals in Ireland is staff recruitment and staff, Mr Dowling says, adding that he believes the country should follow his idea of providing a “corporate university” for nurses and doctors at Northwell to keep them at his hospitals while furthering their medical careers.
“I have had discussions with many people here about this. I did create what I consider my corporate universities for continuing the education of my employees, I think there are models like this that would definitely be applicable here in Ireland.”
Many believe Limerick’s patient overcrowding epidemic has been fuelled by the reconfiguration of 24-hour emergency department services in Clare, north Tipperary, and at St John’s Hospital in Limerick to UHL in 2009.
Fianna Fáil TD Willie O’Dea recently called on the government, co-led by his party leader and Tániaste Michael Martin, to consider reopening at least one of the other emerhency department units in the region to ease pressure on UHL.
However, the government has said it is not for turning on the issue and that the decision to close the regional emergency departments was made on receipt of best medical advice and practice at the time.
Michael Dowling said he believes that making progress on important public health issues “is incremental”.
“You gotta take what you can take and you gotta keep working on it, just like smoking in Ireland”.
Citing the world’s first ever smoking ban, introduced in Ireland in 2004, with his ongoing fight to campaign to treat US gun violence as a public health issue, Mr Dowling offered: “One time if you tried to eliminate smoking in Ireland in unlicensed spaces, there would be a revolution, but over the course of many decades and many people working to emphasis the issue, look at the change.”
“It’s the same with Ralph Nader, he talked about putting safety belts and airbags in cars and everybody thought he was nuts. 20 years later it happened. So you can’t give up, you stick with it and over time we will make positive change.”
