Rotunda’s medical notes system could increase patient risk, consultant tells baby inquest

The electronic system for keeping medical notes at the Rotunda maternity hospital in Dublin could increase the risk to patients rather than help to improve the care of pregnant women, according to a senior hospital consultant.

Professor Sam Coulter-Smith, a consultant obstetrician and gynaecologist, told an inquest on Tuesday that the Rotunda had “lost control of the process” of how it kept medical records.

He claimed the electronic record-keeping system in use at the hospital had been “parachuted in”, with any changes to it subject to the approval of the HSE, and was “not user-friendly”.

“It does not work particularly well for the management and monitoring of [women in] labour,” he added.

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Prof Coulter-Smith, a former Master of the Rotunda, made his comments on the second day of an inquest into the death of a perfectly formed baby 25 minutes after being delivered following a normal pregnancy at the Rotunda on July 14, 2018, which her parents attributed to “a series of failings”.

The baby, Molly McEvoy, had to be resuscitated almost immediately after her birth when she struggled to breathe and her heartbeat dropped rapidly.

A post-mortem showed the baby girl had died from congenital pneumonia after inhaling infected amniotic fluid from her mother’s uterus. An obstruction of the arteries and veins in the fetal placenta was deemed a minor contributory factor.

Molly’s mother, Gemma McEvoy (32) from Casement Road, Finglas, claimed she should have been given antibiotics to reduce the risk of infection after informing a midwife at the Rotunda that her waters had broken on the morning of July 13th, 2018 – 29 hours before her first child was born.

Evidence had been heard from several hospital staff at the Dublin District Coroner’s Court of key decisions about the care and treatment of Ms McEvoy not being logged on the Rotunda’s electronic record system.

Prof Coulter-Smith told the coroner, Cróna Gallagher, that the documentation of medical notes often occurred after an event.

He said it could regularly be up to two hours before medical staff would get an opportunity to log on to a computer to record their notes. “It is a very unsatisfactory situation,” the consultant observed.

He added: “The electronic charts can add to clinical risk rather than remove clinical risk.”

Asked about the failure of Rotunda staff to give antibiotics to Ms McEvoy within 18 hours of her waters having broken as stipulated in the hospital’s guidelines, Prof Coulter-Smith acknowledged compliance “does not always happen.”

The inquest heard that a set of recommendations had been made by the Rotunda following a clinical review of the circumstances of baby Molly’s death. Prof Coulter-Smith said they related to communications, the monitoring of foetal heartbeats and use of electronic charts as well as neonatal resuscitation.

Returning a narrative verdict, the coroner said it reflected the complexity of the evidence and the many issues raised.

She issued a series of recommendations including that the hospital provide leaflets for patients being discharged after the rupturing of their membranes were either suspected or confirmed.

Dr Cróna Gallagher said she endorsed ongoing work to develop a user-friendly electronic records system for hospitals which she said should be modified for maternity and other specialist facilities to reflect their specific needs.

Speaking after the hearing, Ms McEvoy, said she believed the Rotunda had protocols in place which she firmly believed could have saved her daughter’s life but which were not followed.

“I returned again. I spoke again. I questioned again and still guidelines were not followed,” she remarked.

Ms McEvoy, who subsequently had a baby girl (3) and triplets (7 months), said that when she was worried she had gone to a place that she believed would deliver her daughter safely into her arms.

“We as a family were let down in the most devastating of ways,” she added.