Áine Brady (Kildare North, Fianna Fail)

I am responding to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I thank the Senator for raising this important issue. The matter has been prompted in part by the circumstances surrounding the post mortem held into the recent tragic death of a young baby in Donegal. I would like to express my sympathies and those of the Minister for Health and Children to the parents and family of the child concerned on their inestimable loss. We are both concerned that, to the greatest extent possible, additional distress is not caused to families in such circumstances.

The need for a post mortem to be conducted by a paediatric pathologist was identified by the coroner who investigated the case referred to under the coroners legislation. Coroners are independent, quasi-judicial officers who have responsibility for investigating all sudden, unexpected, violent and unnatural deaths with a view to those deaths being certified. Where such a death is reported to a coroner, he or she has power to order a post mortem examination. In a case where this is deemed necessary, the arrangements are made by the coroner. This includes deciding the most appropriate pathology service for the case in question. Post mortems may require referral to regional or supra-regional centres, given the specialised expertise required. A coroner may have to arrange the transport of the deceased to facilitate the examination as quickly as possible, especially in rural regions. The objective is to ensure the most appropriate examination is carried out quickly, to minimise the distress to the family and to optimise the quality of the results.

Although the numbers of perinatal and infant deaths nationally are, thankfully, not large, the demand for paediatric and perinatal pathology services has increased. A number of factors have contributed to this . These include the increase in the number of births, and the increased specialised demand from obstetric, paediatric and genetic services. Specialist pathology expertise may also be required to conduct more complex post mortems, for example, in cases where the cause of death may be genetic or congenital. In cases of sudden unexpected death the issue arises of how best to access specialist post mortem services.

A faculty of pathology report on paediatric pathology services, issued in June 2009, concluded that the best way of providing an optimal service was by basing pathologists with a special interest and expertise in paediatric-perinatal pathology in a small number of centres performing sufficient numbers of cases to maintain expertise and liaison with relevant disciplines. This report has been circulated to stakeholders, including the HSE and the Coroners Society. The HSE is considering the faculty's report and the broader issues relating to paediatric and perinatal post mortem and pathology services arising from a number of recent reports and is developing a code of practice for post mortem services. The code will have application to adult and paediatric services and will be informed by relevant professionals in these areas as well as service users.

With regard to services in County Donegal, three full-time consultant histopathologists are employed in Letterkenny General Hospital. These doctors undertake post mortems on children and infants where deemed appropriate. The HSE has informed the Department that there are no plans to appoint a paediatric pathologist to the hospital. The question of appointing additional paediatric pathologists will fall to be examined by the HSE in the first instance in the national context that I have outlined. The potential for cross-Border collaboration can be considered in that context. I would like to again convey my condolences to the parents and family concerned on their tragic loss.