Cecilia Keaveney (Fianna Fail)
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I thank the Cathaoirleach for allowing me to raise this serious and sad issue. I thank the Minister of State, Deputy Brady, for being here. I hope the seriousness and sensitivity of the matter will be reflected in a constructive response.

Recently a two-week-old infant died in his sleep in my constituency, which was a trauma for the young couple involved, who have another child. As is the case in all incidents of sudden death, a post mortem was needed. It was assumed they would have been able to travel to Letterkenny or somewhere nearby to carry out the post mortem. However, they had to accompany the wee white coffin on a minibus with a local garda on a five-hour journey to Dublin for a post mortem because a paediatric pathologist is not available in County Donegal.

I do not say there should be a paediatric pathologist in every hole in a hedge throughout the country but Galway and Dublin currently have the two closest available pathologists. The local coroner, Dr. Madden, has highlighted the need in this area. The HSE said, in responding to this issue, that it is the responsibility of the coroner to source a paediatric pathologist and the local coroner said a protocol should be in place under which a person would be designated to carry out post mortems in Donegal. Nobody is qualified to carry them out in the county and the available pathologists do not feel comfortable about doing it. No young couple should have to be put through a five-hour journey to Dublin. Amid the trauma and awfulness, they had to stay overnight before returning the following day on a long physical and emotional journey.

Dr. Madden contacted the secretary of Donegal County Council asking for a protocol to be put in place to address the issue. Is a pathologist in Letterkenny General Hospital available for training in infant pathology? I acknowledge these cases do not occur that often but we have experienced two sudden infant deaths over the past two years in the county. Is it possible for the HSE to work with Altnagelvin Area Hospital or hospitals in Belfast regarding infant pathology? The journey from my part of Donegal to Dublin is 20 miles shorter than to Galway, which many people do not realise, whereas Derry is only 20 miles away and it only takes approximately an hour and a half to travel to Belfast.

I hope the Minister of State will outline a solution in her reply in Letterkenny General Hospital as I have great confidence in the staff there. However, I acknowledge this is a specialised area and sudden infant deaths do not occur very often. In the interest of being fair, therefore, we should look to hospitals in the region such as Sligo General Hospital or Altnagelvin Area Hospital or hospitals in Belfast to ensure parents do not have go through this experience in the future. A significant cohort of parents must experience these sad and tragic circumstances annually. A paediatric pathologist must not be appointed in Letterkenny if there is a lack of throughput because health professionals must have a throughput of cases to keep their eye in and to maintain their specialty.

In expressing my sincere sympathy to the family in this case, all I want to ensure is no other family that experiences an infant death, for which a post mortem is required, will have to travel to Dublin or Galway. Dr. Madden received a response from Our Lady's Children's Hospital, Crumlin, which stated it will not entertain requests from him or any of the four Donegal coroners in future. He says that if Temple Street Children's Hospital makes the same decision, nobody will be available to carry out these post mortems anyway. This is the time to act and to find a resolution to this most sensitive and difficult issue for families of young children. Let us find a solution that means no one has to go through this experience again.

Áine Brady (Kildare North, Fianna Fail)
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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.

Cecilia Keaveney (Fianna Fail)
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Given a review is under way, will the comments of the coroner, Dr. Madden, who is the focus of the reply and who in the past month has renewed his call for a more sensitive protocol to be put in place in the north west be taken into account? He said neither of the pathologists based in County Donegal feels qualified to carry out post mortems on infants. Thankfully, the issue does not arise often but when it does, a protocol should be in place to designate someone to carry out infant post mortems in Donegal. That may mean going across the Border rather than accessing a pathologist in Dublin or Galway. Dr. Madden is reported as saying this in the Irish Independent. That should be taken into account in the current review. I acknowledge this is specialist work and it does not necessarily have to be carried out in Letterkenny General Hospital but, in the context of a national framework, there should be a cross-Border element to the provision of this service.

Áine Brady (Kildare North, Fianna Fail)
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I will certainly pass on what Senator Keaveney has stated and will ask the Minister to take into account the comments of the coroner when the review takes place.