Marcella Corcoran Kennedy (Offaly, Fine Gael) | Oireachtas source

I thank Deputies Daly and Coppinger for raising this very important matter. It occupied quite a considerable amount of time in the last Dáil, particularly with the cross-party report into symphysiotomy.

Judge Maureen Harding Clark submitted her report on the surgical symphysiotomy scheme on 19 October last. The Minister for Health, Deputy Harris, examined the report and submitted it to Government last week prior to its publication on the Department’s website on 22 November. The Minister, Deputy Harris, has asked me to convey his apologies to the Deputies that he cannot be here this evening.

The Government agreed in July 2014 to establish an ex gratiascheme for women who underwent the procedure. The surgical symphysiotomy payment scheme was established in November 2014 and Judge Clark was appointed independent assessor. The scheme provided an alternative, non-adversarial option for women, many of whom were elderly and did not wish to pursue their cases through the courts. The total cost of the scheme was just less than €34 million and payments of €50,000, €100,000 or €150,000 were made to 399 women who met the criteria for an award. All of the women have received their respective payments, totalling €29.85 million. The majority of claimants were aged more than 75 years and payments were made to women between the ages of 51 and 96 years of age. A total of 185 women who applied to the scheme could not establish that they had a surgical symphysiotomy. Pubiotomy was frequently claimed but was established in only one case. Significant disability was established in this case.

As the scheme was designed to be simple, straightforward and non-adversarial, the women were not expected to give oral testimonies as they might do in a court setting. In the interests of accountability, the scheme required each applicant to prove that she had a surgical symphysiotomy or pubiotomy in order to be considered for the assessment of an award. The level of proof required was clearly set out in the terms of the scheme. Judge Clark worked with each woman or her legal representative to locate medical records. The judge met some women in different parts of the county when she considered necessary. Where claims could not be reconciled with established facts, women were examined by relevant medical experts. Judge Clark encouraged women who believed they had a symphysiotomy to apply to the scheme, advising them that they did not give up their right to pursue their case through the courts by doing so. It was only on accepting an award under the scheme that a woman had to discontinue her legal proceedings. The vast majority of women opted to do so.

The scheme was established following two independent reports which were commissioned by the Department of Health and following consultation with all three support groups by the then Minister for Health. Two of the support groups welcomed the scheme and one support group did not. The first of these reports was commissioned in 2011, when the Department commissioned Professor Oonagh Walsh to undertake independent research into the practice of symphysiotomy. Professor Walsh’s research also included a public consultation. The report recommended that an ex gratiascheme be established.

In 2013, retired Judge Yvonne Murphy was commissioned by the Government to undertake a further independent review of the legal aspects of symphysiotomy in Ireland. Judge Murphy advised the Government on the merits and costs of proceeding with an ex gratiascheme relative to taking no action and allowing the court process to proceed.

Symphysiotomy was an exceptional and rare intervention in obstetric practice in Ireland. It occurred in fewer than 0.05% of deliveries between 1940 and 1985. It is estimated that around 1,500 symphysiotomy procedures were undertaken in Irish hospitals and that there are around 450 women still living who underwent the procedure. In most of the world, especially in Europe, the symphysiotomy procedure had been replaced mainly with the caesarean section procedure by the 1950s. Currently, the procedure is rarely performed in developed countries, but is still performed in rural areas and resource-poor settings of developing countries where caesarean sections are not available or obstetricians may not be available to deliver subsequent pregnancies.

The brief given to Judge Clark in November 2014 was not an easy one. At that time, the advice to the Department of Health was that many women would face an uphill struggle in proving their claims in the courts, with an uncertain outcome, as each case would be adjudicated on its merits. In her substantial report, Judge Clark has provided a comprehensive overview of the historical and medical context of symphysiotomy. Judge Clark had a unique opportunity to do this and her findings support the earlier findings of Professor Walsh.

Payments under this scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represent a comprehensive response to this issue by Government, which should help bring resolution to the women, many of whom are now elderly, and also to their families.

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