The families of four babies who died in one hospital in similar circumstances over several years suffered poor and appalling treatment by health chiefs.
A report into the deaths at the Midlands Regional Hospital Portlaoise found their mothers and fathers got limited respect, kindness, courtesy and consideration after raising concerns about the deaths.
Chief medical officer Dr Tony Holohan reviewed the deaths, which took place from 2006, and found information that should have been given to families was withheld for no justifiable reason.
Families have been pressing for an independent inquiry, including Mark and Roisin Molloy whose son Mark died 22 minutes after birth at the hospital on January 24 2012.
All four babies died either during labour or within seven days of birth and a feature common to all of their deaths was anoxia, oxygen starvation to the brain.
It is believed foetal distress was not properly recognised or acted on while mothers were in labour.
Health Minister Dr James Reilly praised the families involved for persevering with demands for answers from the hospital – ultimately some of them went public.
“I very much admire their strength and tenacity and I respect their commitment to ensure that their babies’ stories have been heard,” he said.
“I can assure them that the actions they have taken resulting in this report will make a significant difference to how we manage our maternity services in future.”
Dr Reilly said the chief medical officer’s report identified clear failures, at local and national level, in the management of risk and patient safety in the Portlaoise maternity unit.
It found the unit unsafe under its current governance and a transition team has been put in control of maternity services.
“I am conscious that recent events in Portlaoise have damaged public confidence in the hospital,” Dr Reilly said.
“However, I am satisfied that Portlaoise Hospital will, through the establishment of a managed clinical network with the Coombe, be supported to ensure the provision of improved, safer, patient-centred maternity services.”
The watchdog, the Health Information and Quality Authority (HIQA) has been asked to investigate Portlaoise maternity services and report by the end of the year.
Ahead of that inquiry, the chief medical officer also found poor outcomes that could likely have been prevented were identified and known by the hospital but not adequately and satisfactorily acted upon.
The maternity unit lacks many of the important criteria required to deliver, on a stand-alone basis, a safe and sustainable maternity service.
External support and oversight from HSE should have been stronger and more proactive, given the issues identified in 2007, the report found.
Two of the families met Dr Reilly and Dr Holohan in the wake of an RTÉ Prime Time programme which exposed the families’ quest for answers and treatment by hospital chiefs.
The Molloys, from Co Offaly, who had to seek to have their son’s death register changed from stillborn to newborn, sought explanations on their son’s death from the HSE for two years.
View the report in full here.