Patient consent issue just one of a number of problems at hospital’s maternity unit

The patient consent issue that has arisen at St Luke’s Hospital, Kilkenny is one of a number of problems affecting its maternity unit.

The deaths of two pregnant patients of the unit in 2017 and last year has prompted investigations and an action plan to change its operations.

The deaths – one from flu and the other from an embolism – were reviewed by outside experts under the HSE’s system for investigating serious incidents. While making no adverse findings about the standard of care provided to the two women, the reports made recommendations for change within the unit.

Separately, inspectors from the Health Information and Quality Authority (Hiqa) have made urgent recommendations for change, after its inspectors visited the unit as part of its review of standards in all 19 public maternity units in the State, which started last year.

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In May, a “risk summit” of senior decision-makers in the health service was convened to discuss what changes need to be made in the light of the reports into the two maternal death and the preliminary findings by Hiqa.

Among the measures under consideration were methods to ensure around-the-clock consultant cover and new systems to log the skills of junior doctors. A greater focus on teamwork and inter-disciplinary work within the hospital was also planned, as were clearer protocols for the transfer of serious cases to tertiary hospitals in Dublin.

Additional staff

Hiqa’s focus is on the response of the maternity service to obstetric emergencies. While the national review is ongoing, the watchdog is seeking the urgent appointment of additional staff to the Kilkenny unit. One additional obstetrician is being recruited, and it is hoped a second post will be approved.

Mediators were brought in to help with internal staff relations. Last month, former master of the National Maternity Hospital Dr Rhona Mahony took up a role as director of women's health with the Ireland East Hospital Group, and in this role she has been tasked with advancing the reform plan.

Kilkenny is one of 11 maternity units delivering fewer than 2,000 babies a year, a quarter of the number delivered in bigger hospitals in Dublin and Cork. In 2017, there were 1,609 births in the unit.

Smaller units have a more narrow range of specialities so they often have to transfer complex cases to the bigger hospitals. Some hospitals, such as Portlaoise, have formal transfer protocols with a bigger hospital.

In the past, the high rate of caesarean sections in Kilkenny attracted criticism. The rate reached almost 60 per cent for first-time mothers in one month in 2017 and surpassed 50 per cent in some months last year.

Caesarean rate

The latest figures, for March, show an overall caesarean rate of 41 per cent, and 42 per cent for new mothers, lower than in some small units. The World Health Organisation says rates should ideally be below 15 per cent.

Kilkenny is one of nine maternity units not providing the new abortion service that began last January. Last week, the four obstetricians in the unit wrote to Mary Day, the chief executive of Ireland East Hospital Group saying they had decided unanimously the hospital was not an "appropriate location for medical or surgical terminations".

This would remain the case even if staff were trained up to provide the service, they warned.