YET AGAIN, serious questions must be asked concerning the safety of our public health system. Concerns about how accurately women with suspected miscarriage are managed in our hospitals are but the latest in a series of avoidable health scandals that have shaken public confidence to its core. And it is the health of women in the Republic that has once again been threatened by an incompetent system.
About 20 per cent of confirmed pregnancies end in miscarriage, making it unfortunately common. But being routine should mean that dealing with suspected miscarriage is a well-planned and well-practised function of our maternity services. However, this does not appear to be the case: a rising number of women who attended different maternity units have described how, if not for their persistence and “sixth sense”, their viable babies would have been surgically removed.
Their stories point to the absence of a standardised approach to the management of suspected early miscarriage. The use of ultrasound is central to this process. In a minority of cases, the scan will suggest the absence of a foetal heartbeat, even though the baby is alive. Its accuracy will be influenced by the skill of the sonographer and the quality of the scanning equipment. International standards suggest scans in early pregnancy should be performed by experienced personnel, who are subject to audit and peer review. The ultrasound machine must be capable of producing consistently high quality images.
Perhaps the greatest indictment of the Health Service Executive (HSE) in this matter is the revelation that a critical incident involving the incorrect diagnosis of miscarriage occurred at Galway University Hospital in 2006. Following a review, a new standard operating procedure, including a requirement for a second opinion, was put in place for cases where the baby’s heart cannot be seen or heard on ultrasound. Yet this incident and the resulting new procedures do not appear to have been disseminated to other maternity units outside HSE West.
Regrettably, this is a familiar pattern that features in most of the patient safety issues of the last number of years. The HSE is aware of problems but seems unable or unwilling to act on them. It has yet to demonstrate a culture whereby the implementation of recommendations involving adverse incidents is prioritised across the health system. This is absolutely unacceptable. In the absence of adequate political accountability for the day to day running of our health service, it is difficult to see how a dysfunctional HSE can be rehabilitated.