Why would a hospital fight SO hard to stop our health watchdog examining the death of a healthy patient?

IF there is one thing all expectant mothers want to know it is that they and their baby will be safe: and for the most part, in this country they are. In Ireland, we traditionally delivered high-quality maternity services, with low rates of infant and maternal mortality, and that is something to be hugely proud of.

Generations of mothers have been through the doors of our maternity hospitals and emerged with nothing more serious than tiredness, along with the proverbial bundle of joy. That is the outcome for which every mother hopes.

In recent years, though, a few highprofile and profoundly tragic cases in the Midlands and in Dublin have shown that there always is room for improvement and that we never must become complacent. One assumes such a desire is shared from the top to the bottom in our maternity services.

Bereavement

Yes, sometimes things go wrong, and horribly so. One of these cases was that of Malak Thawley, a 34-year-old woman who died in the National Maternity Hospital in Holles Street when her aorta was torn by a doctor during surgery for an ectopic pregnancy. I’ll leave the details there, because I have no wish to further exacerbate the pain of Mrs Thawley’s husband, Alan, who has suffered a dreadful bereavement, one you would not wish on anyone. But it remains the case that a healthy young woman went for a ‘routine’ procedure in our National Maternity Hospital – and an hour later was dead.

In the wake of Mrs Thawley’s death, three investigations were carried out – one by the hospital itself, one by the HSE, and the third by the coroner. To give the general public the final reassurance it needed that all was well in Holles Street, Minister for Health Simon Harris ordered another investigation, this one by the independent Health Information and Quality Authority.

HIQA has a good track record in policing health provision, especially in the area of care homes for the elderly, and has earned a high level of respect. You therefore might have thought that the National Maternity Hospital would welcome this intervention, and cooperate fully to send a very clear signal that all was well. A clean bill of health from HIQA brings with it the weight of all its successful work in the past.

Nor, you would have thought, was there anything to fear. In medicine, as in every area of life, accidents can happen, and no one wanted to demonise those who were present the day Mrs Thawley died. The only thing a HIQA investigation would seek to do was ensure that such a tragedy could happen again.

The fact that the inquiry was ordered by the Minister for Health gave this extra impetus. He, after all, is the man who holds the purse strings for the National Maternity Hospital, on behalf of the taxpayer who funds it, and one would imagine that when the ultimate paymaster of an entire organisation wants something done, everyone would act upon his wish.

Not Holles Street, though. Instead, the hospital went to the High Court to challenge the ministerial order, and yesterday, Judge Charles Meehan found in its favour and quashed Mr Harris’s decision. In his ruling, the judge said Mr Harris had not properly considered the findings and recommendations of the three previous reports, and found that the grounds for another investigation fell short of what was legally required.

Answerable

There is no arguing with that decision. That is how the law was written: it must be respected. What the entire episode does, though, is raise questions about whether or not the National Maternity Hospital is sufficiently answerable to the taxpayers who fund it, and the wages of all its staff. (Though obviously many top Holles Street consultants, including its Master Dr Rhona Mahony, earn massive additional sums from their private practices, which are located next door to the National Maternity Hospital; their private patients enjoy full access to the taxpayerfunded hospital next door.)

So, given that it’s taxpayer-funded, what precisely is the NMH’s beef with the minister? Dr Mahony, said in evidence in July that the reasons for Mr Harris’s request did not make sense and ignored the unique features of maternity medicine, and argued that the three existing reports were all that was needed.

That’s entirely possible: but none of the organisations that carried out those reviews is the State’s official health watchdog. HIQA is, as its website says, ‘an independent authority established to drive high-quality and safe care for people using our health services’.

Nobody is saying that the other inquir- ies were not excellent, and thorough: but they weren’t carried out by the State’s ‘independent authority established to drive high-quality and safe care for people using our health services’. To the public, an Irish hospital refusing to allow itself be investigated by the State’s own independent health watchdog looks like the gardaí going to court to stop an investigation by the Garda Síochána Ombudsman Commission; or a TD going to court to stop an investigation by the Standards In Public Office Commission.

Consequences

In his judgment, Mr Justice Meehan reiterated a point made in the HSE report, which stated that ‘the potential for learning from some patient safety incidents… is so great, or the consequences so significant, that these incidents require a comprehensive response’. He added that there at least was agreement between the hospital and the minister of the need for a further review.

But he also noted that, because of this High Court action, relations between the parties had deteriorated.

That they have soured just as the National Maternity Hospital is to move from Holles Street to be co-located with St Vincent’s University Hospital in Elm Park does not bode well for the easy path to completion of that project. Why on earth would a hospital funded by taxpayers risk starting a war with the minister… in order to block an investigation into a death of a patient in its care?

Whether the Master or the board like it or not, Mr Harris is the man empowered by the people, through the Oireachtas, with being answerable for our health system; and he is the man who hands out, on our behalf, the taxpayers’ funds which allow Holles Street to exist. To most people, it seems to be very little to ask that the hospital funded with our money willingly submit to any investigation he, as our representative, might ask for.

In agreeing to block the HIQA inquiry, Mr Justice Meehan said yesterday he believed that good governance of the hospital entailed ‘maintaining the confidence of patients in the services provided. This is all the more so when those attending are women at a particularly vulnerable time of their lives.’

From the public’s point of view, though, the hospital has done just the opposite. After all, if Holles Street has done everything right from start to finish, the HIQA report will endorse that finding – and the public will be reassured. And if, perhaps, the other reviews missed something; or if HIQA took a different view, based on its expertise as ‘the State’s independent authority established to drive high-quality and safe care for people using our health services’, then Holles Street should be delighted to have it pointed out to them. The hospital may have won in court: but in the court of public opinion, this ‘victory’ may ultimately go down as a very costly defeat.