Dr. Mary McCaffrey:

Can I just clarify what I actually meant? Any person - male or female, pregnant or not - who arrives at an accident and emergency unit in any hospital or at a psychiatric unit tonight or tomorrow night will be dealt with acutely, assessed and admitted. All the services will be rolled out for them. Some psychiatric services in smaller hospitals are concerned that if there is a larger number of review committees and review processes, or if assessments for two psychiatrists have to be done together, that rather than the acute situation might put a strain on the resources of the department in question. As the legislation is enacted and brought into practice, it will be important for the health services to watch what level of resources is needed to allow obstetrics and psychiatry to continue to provide safe practice. My earlier comments did not relate to the safety of the acute situation. They were about the ongoing assessments that might arise. We have all seen how the mental health tribunals are costing a fortune and have taken on a life of their own. That is really what my remarks were about. I apologise if I came at it in a circuitous manner.

Deputy Flanagan raised the issue of viability, which is obviously very important in a smaller unit. We have to acknowledge that the dates of many pregnant patients are actually wrong, despite good ultrasound scanning. If they present very late on in a pregnancy, there is always the possibility that their due date might fall a week or two either way. My personal practice in such situations is to transfer the patients in question to a place where all the neo-natal services are available. I suspect anyone in a smaller unit would do the same. It strikes me now that I did not answer Deputy Naughten's question about neo-natal services and I apologise for that. If the woman is too ill to be transferred, we can deliver the baby locally before getting a neo-natal transfer team to come down, provide the services in the smaller hospital and, if the baby survives, take it to a larger unit. That happens in smaller units on a regular basis.

Senator Bradford asked whether there will be a change in law or in practice. Obviously, if a new law is on the books, then it is a change in law. On the question of whether there will be a change in our practice, my personal feeling is that there will be much more reassurance and clarity in terms of dealing with difficult situations. I know there is great concern about the possibility of opening the floodgates. I think the law is so tight, for example in requiring two psychiatrists and all the support services for the diagnosis, that I do not think the things we do will change hugely. It will provide huge security. It is very hard to be on one's own on a Sunday afternoon in a small hospital, trying to decide whether one will be reported to the Medical Council if one does something and worrying whether there will be gardaí in the hospital the following morning.

There is great security in knowing that I can deliver this seriously ill woman and there is not going to be a witch hunt outside my door the following morning. It is a worry for a lot of people in the current climate with patients.