'I’ve run out of time': Terminally ill midwife who battled the HSE says her fight is over

Midwife Philomena Canning has been battling the HSE in court for years. Now, after being diagnosed with terminal cancer, she says her fight is over, writes Michael Clifford

PHILOMENA Canning isn’t going to get her day in court. She has a terminal illness, but even if she manages to defy the odds, it’s unlikely that her case will ever go to a hearing.

Ms Canning is a midwife of considerable repute. She is suing the HSE over what she considers a serious injustice. More than that though, she believes the safety of mothers was compromised by the HSE in a manner that has gone unacknowledged.

She was determined that these matters would receive a public airing which would highlight both the nature of her grievance and the safety issues which she believes are paramount.

Now that prospect looks to have been denied to her.

“I’ve run out of time,” she told the Irish Examiner. “The HSE strategy since I said I wouldn’t settle has been to prolong, to drag their heels, and this has been going on since 2014.

“I was diagnosed [with ovarian cancer] last year and the only thought on my mind since that day was, ‘am I going to last till I get to court with this case?’. The idea of going to my grave without getting to the end is unbearable.”

Ms Canning is greeted by supporters as she arrived at the High Court in 2014

Ms Canning, a native of Co Donegal, worked in Australia and New Zealand before returning to this country 20 years ago and establishing herself as an independent midwife.

In that capacity, she delivered around 500 babies in homebirths. She had an exemplary safety record. Those who have availed of her services speak in terms that vary from affection and respect to veneration. She was also a public advocate for homebirths, which reflected her vocational dedication to the service.

By August 2014, she had advanced plans to open a homebirth centre, a facility that is common in the UK and Europe. The HSE wasn’t keen on the idea and rejected it.

The following month, she received a call on a Friday evening. Her indemnity insurance was being cancelled without notice as two cases involving safety risk had come to the attention of the HSE. One of these involved a post-partum haemorrhage, a loss of blood soon after childbirth.

Ms Canning was stunned. Neither of the two mothers had complained and were perfectly happy with their midwife. In fact, both only became aware that the midwife was under investigation when they were informed some months later.

At the time of the suspension, she had up to 30 expectant mothers at different stages of pregnancy.

All were forced to seek alternative midwifery services.

Ms Canning applied to the High Court to have her indemnity reinstated. The judge ruled in favour of the HSE. In preparation for a Supreme Court appeal, her legal team commissioned two expert reports — from an obstetrician in the UK and midwifery expert in Trinity College — to examine the cases at issue. The HSE commissioned its own expert report. All three came to the conclusion that she had not in any way acted unprofessionally or with negligence.

Faced with such a body of evidence, the HSE backed down just before the scheduled Supreme Court hearing in February 2015 and agreed to reinstate her indemnity. There was, however, a sting in the tail.

The HSE was conducting a “systems analysis” into what had occurred in the two cases. This was supposed to be completed in March but went on for another six months.

“So I had to wait for the systems analysis because they might decide to suspend me permanently,” she says. “In those circumstances, I couldn’t take any mother on and start providing care for her in the knowledge that I might have to drop her.”

During this time, then minister for health Leo Varadkar met Ms Canning. Afterwards, he said he had asked the HSE to hurry up its investigations.

Parallel to the systems analysis, the HSE conducted a peer midwifery review of Ms Canning’s practice. Again, this found entirely in her favour apart from a minor issue over interpersonal relations with a HSE official.

Notably, at no point was Ms Canning’s practice referred to the professional body, the Nursing and Midwifery Board of Ireland, which investigates fitness to practice. If there were genuine concerns about Ms Canning’s practice, that was the body to determine whether they were valid.

The systems analysis was a different matter. It was conducted by two individuals, an administrator and a physiotherapist. It was overseen by the official who had suspended Ms Canning.

The analysis ultimately laid the blame for the post-partum bleed with Ms Canning, a finding that was completely at odds with all the professional reports into the matter.

Despite that, she was free to resume practice, but what she had been through had left its mark.

“It was all over,” she says. “I was never going to be able to go back into practice as a midwife in that context because I couldn’t trust them — I would be continually looking over my shoulder.

“You need support. Any clinician needs to be in an environment of support and there was no way I was going to put a mother and baby’s life at risk.”

She had by then received the first tranche of discovery in her legal action which, she says, reinforced her belief that the HSE had not acted with propriety in the matter. A settlement offer was made, but she rejected it.

“I said no. Of course I wanted money to compensate me for my loss of earnings but the overriding thing for me was that it would be known publicly what they did in my case and that I believe a serious safety incident was covered up here for which I was to be blamed.”

Philomena with children she helped deliver as she challenged the withdrawl of indemnity cover from her practice.

THE HSE has not conceded liability in the case Philomena Canning is bringing against it. Since 2015, the case has dragged on, despite Ms Canning’s urgency to have it brought to court.

Discovery from the HSE has been painfully slow.

Meanwhile, she was forced to sell her home because she couldn’t make the repayments. Then last year, she was diagnosed with ovarian cancer, which has now advanced to a terminal condition.

Her only hope, she believes, is access to the immunotherapy drug, Pembro.

This costs €6,000 per treatment — money she doesn’t have. She feels she has no choice but to get the matter settled so she can access money for the drug that may help prolong her life.

“I don’t know how long I have but I want it settled now,” she says. “I fear it could be weeks but I don’t have weeks. I want my lawyers to get their fees and whatever money I can get out of it to fund my own treatment.

“There’s no way I’m going to get a hearing now. I always wanted a hearing. I wanted the public to understand what was done to me and how I believe there was mismanagement at a high level. I wanted the story to go into the public domain so it would be there for all to see.”