Portlaoise deaths: Buck rarely stops when inquiries involve white coats

In Ireland, the best protection against proper investigation seems to be a white collar.

In banking and planning, we have seen the difficulties that arose in prosecuting white collar crime over recent decades.

But even where no criminal matters are involved, and the purpose of investigation is solely to establish whether there is a disciplinary case to answer, the possession of a white collar (or a white coat), sometimes seems to inoculate the wearer against proper examination. Or, at the very least, to play out the process for a very long time.

While politicians and governments come and go, and the media’s attention jumps from issue to issue, the system plays the long game.

Complainants are worn down by time and the obstacles in their way, and ultimately resolve to get on with their lives. Those under potential fire get the time to retire, or otherwise bow out gracefully.

For all the controversies we have seen in health in recent years, there has been relatively little fallout for those allegedly at fault. Only a tiny proportion of complaints against doctors and nurses make it to public hearing. As for managers and politicians who make decisions affecting patients, there is no process for holding them accountable.

Witch-hunt

No one in medicine sets out to do harm, and no one wants to see a witch-hunt of hard- pressed staff working under often difficult situations, but on occasions mistakes are made again and again, and it seems neither the people involved nor the system learns. In other cases, important information about mishaps is ignored or even swept under the carpet. And so the repeated errors of the few continue to colour the good work of the many.

In Portlaoise hospital, five babies died between 2006 and 2013 in similar circumstances. They had developed normally until they reached the maternity unit, where staff struggled to correctly monitor the baby’s heartbeat and administer drugs designed to progress labour.

As a result, the babies were starved of oxygen to the brain and died.

A subsequent report found bereaved mothers were treated appallingly and Health Service Executive director general Tony O’Brien admitted that “sometimes there are appalling lapses in the way” people were cared for.

The reports showed concerns were raised and issues escalated along the chain of management within the health service, but the warnings were not acted upon. Two years after the cluster of deaths was revealed, no action has been taken to discipline staff whose actions contributed to this sorry tale.

Flawed process

The HSE was deeply unhappy with the reports that were published on the deaths, and threatened to prevent the publication of one of them.

It then set up a disciplinary process that, it is now apparent, is flawed and may collapse.

This, it seems, is because staff have the right to be consulted about the form of disciplinary investigation to which they might be subjected, and this didn’t happen in the Portlaoise case. The investigation of staff, and a decision on any sanctions to be imposed, are two functions that need to be separated in order for due process to be followed.

This is likely to take some time. Under the HSE's disciplinary code, there is then an appeal stage, and a further ad misericordiam process. Meanwhile, staff who have retired remain beyond the reach of any investigation.

Long-running investigations are not in the interests of anyone – not patients, staff, the health service or the public. In the long run, legislative change may provide the only answer to the call by patients for greater accountability.