James Reilly (Dublin North, Fine Gael)
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Question 39: To ask the Minister for Health and Children if she will report on the recent cases of misdiagnosis in maternity hospitals and the steps she will take to address the issue and the serious concerns of the public; and if she will make a statement on the matter. [26183/10]

Mary Harney (Dublin Mid West, Independent)
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Incidents of this kind are distressing to the women and families involved and I again express my sincerest sympathies to all of those who were affected. They are serious incidents and are treated as such. A number of actions have been taken to support the safe management of early pregnancy loss across the country.

The chief medical officer of my Department and the director of quality and clinical care in the HSE wrote recently to all obstetric units advising them to ensure that the decision to use drugs or surgical intervention in these circumstances must be approved by a consultant obstetrician.

The HSE has now announced details of a miscarriage misdiagnosis review team and its terms of reference. The review team is being chaired by an independent expert in obstetrics and gynaecology, Professor William Ledger, vice president of the Royal College of Obstetrics in the UK who will be joined by Professor Michael Turner, national clinical lead of the HSE's obstetrics programme and Ms Sheila Sugrue, HSE national lead midwife. Service user representation in the management of this incident is being provided by Cathriona Molloy from Patient Focus. It is expected that the review will be completed within six months and the report will be published.

In addition, a clinical programme for obstetric care has been established by the HSE's national director of quality and clinical care. This will define best practice and standardise it throughout the country.

It is important that I put this in context. Ireland has, by international standards, a very high quality maternity service. Maternal mortality, perinatal mortality and infant mortality are all low by comparison to other jurisdictions. Women can be satisfied and confident as they come to use this service.

It is important to understand that the use of scans and other technology must be guided by expert clinical opinion based on careful clinical history and examination. Scans will not always be necessary or appropriate.

James Reilly (Dublin North, Fine Gael)
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I join with the Minister in offering my sympathy to those who have been affected. This is yet another scandal which was left uncovered and unanswered until Melissa Redmond and her husband Michael decided to go public with it. I commend them on their courage in doing that. Many women have come forward since then. Some 250 telephone calls have been made to the helpline by women and their families since this issue arose.

Does the Minister know how many cases will be included in the HSE review and if not, when will she know? Will she call on the Health Information and Quality Authority to conduct an urgent audit of antenatal and maternity services, including the standard and safety of equipment, staff workloads, care protocols and training of personnel? It should be borne in mind that there are only between 100 and 120 foetal assessment machines in the country. It is farcical for HSE representatives to suggest, notwithstanding they did nothing for six months about replacing the equipment that had been described as "fatigued", that retaining a professional sonographer four hours a day five days a week will be the solution to this problem. There are 3,500 deliveries in that maternity unit each year and, by international standards, it should have at least two, if not four, full-time sonographers. When will the terms of reference be made available to us by the HSE? Why will there not be a truly independent investigation by HIQA?

Mary Harney (Dublin Mid West, Independent)
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It is a truly independent investigation. It is being chaired by somebody from outside the country and HIQA officials have been involved in discussing the terms of reference with HSE officials. I can give them to the Deputy because I do not want to read them out here. However, they have been published. The investigation will review the past five years and will examine any case outside that period where the circumstances may lead to the HSE learning from that experience. It is not correct to say that nothing happened in this case. The lawyers for the Redmond family wrote on 7 August and, within a week, the letter was acted on seriously by the HSE, the chief medical officer in my Department and all senior officials and a review took place within the hospital. That is a fact and that is the truth.

Last week, Professor Turner addressed this issue and I attended a press briefing he did. He made the point that, notwithstanding machinery and scans, there is nothing to substitute for clinical examination. The Deputy will know this being a doctor. We need a standardised approach in this area in the country. Professor Turner was appointed in May as the lead clinician in this area. He was appointed like many other experts in the State to do clinical care pathways. We have never had such a position and I am confident, as a result of his appointment in this field by the HSE before this issue ever came into the public domain, that we will have a standardised approach not only in the 19 public maternity hospitals, but also the private ones, and it is important that would happen..

James Reilly (Dublin North, Fine Gael)
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The HSE is in charge of this investigation and if it appoints to people to do it, it remains under its remit. That is totally unacceptable to the Opposition and to the vast number of patients who use our health service. The executive has not been found to be suitable to investigate itself no more than any other group in the country is suitable to investigate itself. We should have a patient safety authority because if cases like this emerge, people would not have to go their solicitors. They could go to the authority, which would act as an advocate for them and address their issue.

The HSE undertaking a review did not result in the machinery being moved or a sonographer being made available. The Minister can refer to extraneous issues as activity but if the core issue, which is faulty equipment and lack of fully trained professional, is not addressed, one can review the service until the cows come home and patients will be left at risk.

Mary Harney (Dublin Mid West, Independent)
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We have a patient safety authority, otherwise known as HIQA.

James Reilly (Dublin North, Fine Gael)
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I have to dispute that. HIQA officials say they cannot act as patient advocates.

Mary Harney (Dublin Mid West, Independent)
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They set and enforce standards.

James Reilly (Dublin North, Fine Gael)
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I have to correct the record.

Mary Harney (Dublin Mid West, Independent)
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When they do that, they are subject to a great deal of criticism from the Deputy and his colleagues.

The obstetrician from the UK is completely independent, as are Professor Turner and Ms Cathriona Molloy from Patient Focus. They are capable of carrying out the appropriate investigation and reporting accordingly with a view to making sure we have appropriate procedures in place and, in particular, a standardised approach across the country. The service varied because we did not have a standardised approach to this service.