Death of a woman who yearned for children highlights poor practices

SOME of the last pictures of Jacqueline Rushton show her playing with her niece.

The young nurse smiles. A child of her own was a dream she wanted to share with her husband. Ms Rushton set up home with her husband Danny in Mullingar, Co Westmeath. After two years of unsuccessful efforts to have children they decided to give in vitro fertilisation (IVF) treatment a go.

A rare and complicated disorder during treatment led to her death aged 32. Her family still believe she could have been saved.

More than four-and-a-half years later, they have finally received some answers.

The release of a report today from an independent inquiry into her death will focus on the management of her care at the Dublin’s Rotunda Hospital, after she was transferred from the private Human Assisted Reproduction Ireland unit, also based on the hospital site.

“There is evidence of a lack of senior control and overall accountability for Mrs Rushton’s care at the Rotunda Hospital,” says one conclusion.

The inquiry covers the period from Ms Rushton’s first consultation at the Rotunda on March 28, 2002, to her death at the Mater hospital on January 14, 2003.

By December 11, 2002, two weeks into her treatment, she had problems breathing, and essential fluids from her blood “started seeping out”.

Over a two-week period, Jacqueline had developed an overreaction to the stimulation of follicles being harnessed to create eggs. She developed a rare disorder called ovarian hyperstimulation syndrome.

“There was inconsistent compliance with Royal College of Obstetricians and Gynaecologists guidelines for Ovarian Hyperstimulation Syndrome in relation to the administration of IV fluids, use of diuretics and the use of paracentesis procedure to do the fluid imbalance,” another finding in the inquiry report says.

The critical findings today will turn attention to the regulation and guidelines used in IVF clinics. They will also focus attention on what happens when a patient gets into trouble during treatment.

A distinguished expert on medical law and ethics yesterday warned there was little if no regulation of assisted reproduction in Ireland.

Dr Deirdre Madden, who also completed the report on post-mortem practices and organ retention, said: “There isn’t really anybody — other than they can ensure that the clinic is licensed under the Irish Medicines Board (IMB) for safety and technical issues.”

Under new EU laws, all places handling human tissue and cells must be licensed. The IMB is carrying out inspections but licensing is not expected to begin until next year.

There is no public record of an IVF clinic’s success rate, admitted Dr Madden, “other than anecdotal evidence which you’d get through a support group”.

“In England, the regulatory authority keeps statistics on file for each clinic and you could go online and check what the national success rate is and you can measure the success rate of the clinic against the national average.”

There is also little legal precedent for IVF cases.

The only IVF case that has gone before the courts remains undecided. A mother of two lost her High Court action in November 2006 to have three embryos implanted in her uterus against the wishes of her estranged husband. She has appealed the decision to the Supreme Court. It is not expected to be heard until later this year.

Meanwhile, a commission report on how best to regulate assisted reproduction has not seen the light of day.

The Government set up a Commission on Assisted Human Reproduction in 2000. It reported its recommendations in May 2005. The Government has still not decided upon them as an Oireachtas committee decides what to move forward with.

Some of those findings include legislating for an authority to regulate assisted reproduction organisations, collecting statistics on IVF cases and studying children born through assisted reproduction.

It also recommends tailored counselling and advice before treatments for IVF patients.

Timeline to tragedy

* March 2002: The Rushtons seek consultation with the HARI unit in the Rotunda.

* November: Treatment begins in the Rotunda.

* December 2: Jacqueline Rushton gets IVF injection.

* Dec 5: Jacqueline’s oestrodial jumps to nearly eight times the maximum recommended level.

* Dec 8: Jacqueline goes into hospital to have her eggs harvested.

* Dec 10: She develops mild Ovarian Hyper Stimulation Syndrome.

* Dec 11: She develops problems breathing and essential fluids from her blood “seep out”.

* Dec 16: Jacqueline is transferred to the Mater Hospital.

* January 14, 2003: She dies of respiratory problems.

* February 2004: Dublin City Coroner begins an inquest.

* April: Coroner concludes a verdict of medical misadventure.

* August: Family seeks an independent inquiry from the Irish Medical Council after former Health Minister Micheál Martin says he cannot carry out one.

* September: The Irish Medical Council rejects application for an inquiry.

* November: Medical Council agrees to hold an inquiry following an appeal.

* September 2005: Inquiry finds Prof Harrison had no case to answer.

* October: Family meets Mary Harney to press for an independent inquiry.

* July 2006: HSE announces an independent inquiry.