The chairperson of the HSE West’s regional health forum is calling for a public inquiry into baby scan errors at University Hospital Galway which could have resulted in the lives of two unborn children being terminated.
Cllr Padraic Conneely says the shocking cases - the second and third in this country to hit the headlines in recent days - did not surprise him.
The first local incident involved Athenry woman Martha O’Neill Brennan when she was expecting her son in 2006. Her consultant obstetrician/gynaecologist diagnosed a six week old viable foetus and a foetal heartbeat at her first appointment. When she experienced heavy bleeding a week later she went to see him at UHG. He carried out a scan and told her there was no heartbeat. She said he suggested a D&C procedure but she decided not to go ahead with that for a few days. She still felt pregnant, she is quoted as saying, and asked for another scan on her return to hospital. It revealed her baby was alive.
Sharon Murphy, who is originally from Galway city but now lives in Gort, had a similar experience in 2008. She was referred to UHG for a scan after her GP failed to detect her baby’s heartbeat. However, “nothing showed up on the screen”. The hospital doctor told Ms Murphy her baby must have died and that she had a miscarriage. She offered her a “hormone tablet” and asked her to come back in a few days for a pregnancy test. Later, when the Galway woman insisted on a second opinion and on being scanned in the main scanning room, “my baby’s image came up straight away”.
The two Galway women’s experiences mirror that of Dublin woman Melissa Redmond who was wrongly told by Our Lady of Lourdes Hospital in Drogheda that the baby she was carrying was dead.
Cllr Conneely says UHG has “serious questions” to answer. “I am demanding to find out what procedures are in place since these incidents. Nothing but full accountability and transparency is acceptable from UHG.
“Unfortunately I regret to say these errors do not surprise me. The HSE is a dysfunctional organisation which seems to be in chaos. It seems to be a case of crisis management from day to day. Nothing comes out of the HSE until it’s exposed by the media. I want a public inquiry into this, I don’t want internal reports where things can be swept under the carpet. Public scrutiny is demanded now by the Irish population.”
He is calling on Dr David O’Keeffe, the newly appointed clinical director of acute and continuing care services for Galway/Roscommon [his role includes the duties of the former general manager post at UHG] to prove himself.
“I am challenging the new general manager of the hospital to prove he is going to be the new broom. I challenge him to put the old ways behind and go forward with new ways. This is a life or death situation. We expect to get the best advice from a professional, our lives are in their hands. I don’t want them saying the machinery or the unit is at fault. If so, why was it? Somebody must be held responsible, this is only the tip of the iceberg.”
The former mayor says the Minister for Health must demand “total clarity, openness and transparency” from the HSE.
“The buck stops with her. I don’t want this dragging on. The incident involving Mrs O’Neil Brennan happened in August 2006. That’s four years ago and there wasn’t a word about it. The health service is not a business, it is a matter of life and death. To think of the circumstances, that woman was being prepared for a D&C only for she had the courage to go for a second opinion. Now she has a healthy bouncing boy. Somebody must be held responsible.”
Senator Fidelma Healy Eames describes the misdiagnoses as “absolutely shocking”. She is urging patients to trust their instincts and to take time out to “reflect” on medical diagnoses.
“It is so important to trust your instincts, no-one is better than the patient to make their own self-assessment. Trust your judgment, feelings and instinct and seek a second opinion, if necessary. In these cases lives have been saved because of mothers’ judgments. I’d urge patients to have the courage to ask questions for both their own sakes and that of the doctors.”
Mary Tierney, a local member of the patients’ advocacy group Patient Focus, says her reaction is one of being “sad, mad and glad”.
“I’m sad that there may be so many women out there who don’t know and are possibly mourning lost babies, I’m mad that trust has been broken and we have to fight in one way for the life of the unborn and I’m glad there are women who have the courage to speak out and who have supportive families who believe them.”
The HSE West confirmed that following an incident in August 2006, where a patient had an incorrect diagnosis of a “missed miscarriage”, a review was undertaken at the hospital. Following that review a new standard operating procedure was put in place to eliminate the risk of a similar near miss incident occurring.
“The measures put in place in Galway University Hospital since 2006 include that a second opinion from another health care worker is given in cases where a foetal heartbeat is not seen or heard. If there is still no foetal heart beat recorded then a second scan is performed to ensure an accurate diagnosis takes place.
“There is a level of uncertainty in ultrasound scanning in that scanning is not infallible, especially in the early stages of a pregnancy. It is rare but situations can occur when a scan will suggest that the pregnancy is lost but subsequent scans may show a foetal heartbeat. Therefore repeat scanning is undertaken when appropriate.
“The HSE’s clinical programme for obstetrics and gynaecology has identified the need to introduce standard national guidelines and care pathways across the country to ensure that the international criteria for the management of non viable pregnancy are being followed. The process to introduce standard care is now under way and a national clinical lead has been appointed in the HSE’s directorate of quality and clinical care.”
A HSE helpline, 1800 252016, has been established and is open from 9am to 5pm Monday to Friday.