What went wrong is less important than covering ass. It’s no way to run a health service, writes Michael Clifford
AN INQUIRY can be an instrument to establish what went wrong, and if anyone bears culpability. An inquiry can also be used as a weapon, to silence or to neutralise. The tactic is well worn in politics and the public and private sectors.
On Monday, this newspaper published an investigation into the background to an inquiry that may have been used to neutralise independent midwife Philomena Canning in the most grievous manner.
Ms Canning, who died at the age of 59 on March 22, was the leading proponent of home-births in this country. She was a thorn in the side of HSE management, where there is little support for women who choose to give birth in a domestic or natural setting as opposed to a medical one.
In 2014 an inquiry was opened up into Ms Canning’s practice. She was suspended while it was being conducted. This resulted in the effective termination of her practice. The suspension was lifted six months later when three expert reports prepared for a Supreme Court hearing emphatically rubbished the reasons for her suspension.
She sued and the HSE admitted liability in impacting adversely on her livelihood. She settled in the weeks before her death as she was desperate to get money to get access to the cancer drug that might have prolonged her life.
Ultimately, Philomena’s condition was too advanced for the drug to work a near- miracle on her.
She had wanted the whole affair to receive a public airing in court, but her terminal condition and four years of footdragging by the HSE ensured that this would not happen.
As this newspaper reported last Monday, the case was settled with a payment of €353,000 to Ms Canning. Her legal team was paid €274,016 and the HSE legal costs amounted to €206,161.
That’s a lot of money but in all likelihood the payout to Ms Canning would have been far more if the case had gone to full hearing rather than being settled as Ms Canning lay dying.
She was of the belief that the 2014 inquiry into her practice was a weapon used to target her because of a fractious relationship with the HSE. If that was the case, it would amount to a malicious and groundless attack on her professional integrity and livelihood by a State body vested with huge power.
The inquiry was certainly groundless — as evidenced by the expert reports — but because it didn’t arrive in court, it has never been established whether it was a malicious act on the part of the HSE.
In that context, it is incomprehensible that no inquiry has ever been conducted in the HSE to find out exactly what happened. Ms Canning is now dead and the whole case was closed without ever being exposed to public scrutiny.
One of the cases that the HSE attempted to blame on Ms Canning involved a homebirth that was not attended by any health professional. That such an incident could happen — with plenty of warning of the imminent birth — is an indictment of maternity care in this country.
The birth took place on October 29, 2013, nearly a year before Philomena Canning’s indemnity was suspended by the HSE. She had been providing midwifery services to Maya Benharroch, who lived in the Dublin suburb of Dalkey.
Ms Benharroch’s waters had broken the previous morning. Under her contract, Philomena was obliged to withdraw services and inform the HSE if birth had not occurred within 24 hours of waters breaking.
“Philomena told me that morning that she had to withdraw even though she herself couldn’t see the need,” Ms Benharroch told the Irish Examiner.
“If you are trying to create a safe environment for birth, that kind of pressure is not the best thing to be subjected to,” she said.
While the HSE was in constant contact with Ms Benharroch, there were no moves to find her a midwife, or do the most obvious thing and extend the terms of Ms Canning’s contract for this case.
That afternoon, Philomena met two HSE officials to hand over her case notes.
Records of the meeting suggest that it was fractious, reflecting the tense relationship that existed between the midwife and the maternity service in the HSE. The prospect of a woman giving birth without any medical professional present added to the tensions. As far as Philomena was concerned, that could be avoided if her indemnity was extended. For the HSE, the only answer was for the expectant mother to abandon her plans for a homebirth, which she was not prepared to do.
Maya made contact with Philomena at 8.15pm to let her know that she was in labour. By then, Philomena had become so concerned she had travelled to Maya’s home and was sitting outside in her car. She could not legally attend the birth but if there was any emergency, she would be immediately on hand.
Maya phoned again at 9.40pm to say she was giving birth. She asked Philomena if she could put her on speakerphone in order to talk to her for reassurance.
Philomena agreed. “At 9.59pm I heard the baby’s cry on the telephone, followed by the sound of raised emotion in the birth-room when the line was disconnected,” Philomena recorded in her notes.
Fifteen minutes later Maya’s partner beckoned Philomena to the front door to let her know the placenta had been delivered. This allowed Philomena to legally resume care and she went into the house. Crucially the unattended birth was not recorded as a “near miss” incident in the national register where all incidents of this nature are supposed to be recorded. If it had been thus recorded, responsibility would have had to have been attributable to the HSE maternity services rather than the independent midwife.
Among questions submitted by this newspaper to the HSE about the Canning case was why this incident was not recorded in the “near miss” register. The question was not answered in any form.
This is one of many cases where the HSE initially suggested that there were issues with Ms Canning’s practice. In each and every case, either medical records or outside experts completely backed up Ms Canning’s version.
An inquiry can be an instrument to establish what exactly went wrong.
Unfortunately, the culture in the HSE determines that an inquiry will only be conducted in the event of a fatality or following media, political, or public pressure.
In such an environment what went wrong is less important than covering ass. It’s no way to run a health service and offers a hint as to why things go wrong so often.