Claims and incidents vary widely in maternity units

Massive variations in the number of clinical incidents reported in different maternity units, and in claims made against the units, have been identified in a new report.

The best-performing unit reported incidents at a rate almost 12 times lower than the hospital with the highest incident rate, according to the State Claims Agency.

There was a tenfold difference between the rate of claims against the hospital with the lowest claim rate and the one with the highest. The agency is not identifying the maternity units because of issues with data comparability.

Different hospitals reported incidents differently, especially in relation to unresponsive babies and post partum haemorrhaging.

Among the largest maternity units – this includes the three Dublin maternity hospitals and Cork University Hospital – the incident rate in two of the hospitals was twice that in the other two.

Larger maternity units tend to report a higher number of incidents, but smaller units attract a higher rate of claims.

The legal costs of handling claims against maternity services more than doubled between 2010 and 2014, while the overall cost, including damages, was up 80 per cent.

Huge variations in the number of incidents in gynaecological services were also identified. These ranged from three in one medium-sized unit last year to 453 in one of the State’s largest units.

Damages

Gynaecology-related claims grew, with legal fees doubling and damages up 300 per cent.

Seventy-five “extreme incidents” causing death or serious incapacity were reported by maternity services last year, the report says. The baby died in 38 of these and the mother in four. The report says not all of the incidents were avoidable due to factors such as prematurity of the baby or congenital abnormality.

A further 11 extreme incidents were reported in gynaecology services, where the incident of delayed or cancelled surgery increased tenfold between 2010 and 2014.

The number of incidents reported by the Irish maternity services is not dissimilar to international figures where comparisons are available, according to the agency.

Thirty claims have been closed in relation to foreign bodies retained in maternity patients over the past decade and 14 in gynaecology. The report says the implementation of guidelines that are standard in operating theatres, such as counting the number of sharps and swabs used before and after delivery, is critical to improving this record.

Total expenditure on maternity-related claims increased 80 per cent in four years, from €32 million in 2010 to €58 million last year. The cost of claims in gynaecology increased almost threefold, from €1.5 million to €4.2 million.

Agency director Ciarán Breen said he had “no doubt” the cost of maternity-related claims would fall if victims of clinical negligence were awarded periodic payments rather than lump sums.