The State’s only 24-hour treatment service for children and adolescents who have been sexually assaulted has been forced to close following a breakdown in talks on its future.
Four forensic examiners with the Galway-based Child and Adolescent Sexual Assault Treatment Service (CASATS) said they had to withdraw their specialist services “with deep regret” from December 30th due to the HSE’s failure to offer medical indemnity insurance.
Clinical director Dr Joanne Nelson said discussions with the HSE had taken place for some time on the finance and governance of the service.
Service gap
The service was established in 2011 by Dr Nelson and Dr
Roger Derham
to fill a gap where child victims of sexual violence were not being offered appropriate access to forensic medical care.
Only 14-year-olds and older can avail of support, examination and treatment at adult sexual assault and treatment units.
Dr Nelson took the post of clinical director on an voluntary basis, a situation “not mirrored in other clinical delivery services”, she noted.
She said the service has provided the only 24-hour acute and historic forensic medical service for children anywhere in Ireland, both North and South.
"There is as yet no comparable comprehensive national service provided for children aged less than 14 years," she said, "despite repeated assurances to the contrary by Ireland to the United Nations. "
According to Dr Nelson, elsewhere "the development of services has been haphazard and CASATS-Galway has had, despite limited resources and funding, to prop up deficits in other areas of the country, especially Dublin, where no out of normal working hours service exists."
The Manuela Riedo Foundation and Children at Risk in Ireland initiated a crisis worker programme last year to support the service, providing advocacy for children and families in the aftermath of abuse, right up to and including court hearings.
Sense of commitment
In the absence of adequate sustainable governance structures, Dr Nelson said, staff continued to work with the service out of a sense of commitment. But she said the HSE refuses to recognise it as a professional medical entity.
Dr Nelson said a business contract for external service providers was “entirely inappropriate”, especially with no medical indemnity insurance provided.
She said examiners were not provided with protected time to attend essential case conferences, and the current HSE funding model does not allow for adequate follow-up of children who attend the service.
“Child victims of sexual assault in Ireland deserve better,” Dr Nelson said.
The HSE said that “arrangements have been put in place to ensure that full and appropriate indemnity is provided for any care that might arise in the short term”.
It added: “Communication with the medical examiners is ongoing in an effort to ensure the continuity of this service.”
