The annual birth rate at the hospital has fallen by 900, following revelations three years ago that five babies died at the hospital over a number of years due to suffering lack of oxygen.
Yesterday, the HSE published its Maternity Clinical Complaints Review. The review came about after the broadcast of RTÉ’s Prime Time Investigates programme ‘Fatal Failures’ in January 2014.
The objective of the review was to examine patient complaints concerning care experienced in the MRHP and at eight other hospitals around the country between 1975 and 2015.
“Overall, the birth rate in the country has dipped. There has been a marked decline in attendance at Portlaoise on top of that.
"If you were to look at statistics for last year, 2016, I think there were 1,470 births and this is 900 fewer than 2010 (2,370), which was their high spot,” said Dr Susan O’Reilly, CEO of the Dublin Midlands Hospital Group.
“I think that’s principally [because] people have chosen to go elsewhere, plus there’s an element of decline in the national birth rate at the moment (5%),” she added.
Angela Dunne, director of nursing at the MRHP, offered an explanation as to why there had been a decline in the birth rate.
“The drop in numbers is where people are nervous about coming to the hospital because of the media coverage,” she said.
However, Ms Dunne pointed out that “second-time” mothers are returning to have their babies at MRHP after having a positive experience with their first child.
Dr Peter Boylan, who is chairman of the Institute of Obstetricians and Gynaecologists at the Royal College of Physicians of Ireland, was chair of the review team.
Dr Boylan said the MRHP is a safe place to have a baby.
“Portlaoise is a safe place to have a baby, it’s as safe as any other unit in the country now. Mothers should be reassured about that, couples should be reassured about that on a national scale,” he said.
Speaking more broadly, Dr Boylan referred to a key recommendation from yesterday’s report which reviewed 203 complaints relating to nine maternity hospitals over a 40-year period.
“Governance of maternity services is really important. One of the important things about governance is that you have somebody who has authority but is also accountable,” he said.
“In order to have proper accountability and authority, they need to have budgetary allocation which is appropriate for delivering a high-quality service.”
Brigid Doherty from Patient Focus said that people should no longer have to turn to the media to have their complaints aired.
Yesterday’s report also recommends that the HSE apologise to 14 families.
Shauna Keyes and Joseph Cornally’s son Joshua died shortly after birth at the MRHP on October 28, 2008. A subsequent report revealed significant failings in his care. On Monday, the couple received a written apology, however, both of their surnames were misspelt.
“After participating in a review into the practices at Portlaoise hospital, I finally received the apology myself and my husband had been waiting for.
"A matter-of-fact, ‘sorry we screwed it up’ apology, signed by the CEO of the Dublin-Midland hospital group and general manager of MRHP which, honestly, is all we ever wanted.
“I breathed a massive sigh of relief. It didn’t take long to double check this personal letter and discover our surnames were both wrong,” said Ms Keyes.
203: The number of complaints the HSE received for its review into maternity care.
1975 to 2015: The period over which the complaints related to.
153: The number of patients that consented to participate in the review out of the 203 complaints that were initially received.
2014: The year the review was instigated following the broadcast of RTÉ’s Prime Time Investigates programme ‘Fatal Failures’ in January of the same year.
9: The number of maternity hospitals that the complaints related to.
31: The number of complaints that specifically related to perinatal deaths (the death of any baby from the 24th week of gestation to one week after birth).
130: The number of complaints that related to the Midland Regional Hospital Portlaoise (MRHP).
3: The number of phases in the review process. Phase I began in 2014, Phase II in 2015 and Phase III in November 2016.
Twelve key recommendations arose from Phase II and III of the HSE’s Maternity Clinical Complaints Review.
Each hospital must have a robust clinical governance system in place, with a clearly identified individual responsible for ensuring quality of care and implementing any necessary improvements.
The CTG (cardiotocography — a way of recording a baby’s heartbeat and contractions of the uterus during pregnancy) monitoring equipment must be serviced regularly.
CTG interpretation training needs to be mandatory and updated every two years in all maternity units. These recommendations were made because the historical review of CTGs related to 90 perinatal
deaths from 1985 to 2014 in the Midlands Regional Hospital Portlaoise.
There should be immediate communication with the patient and family when there is a concern, when an “adverse event” has occurred, or when there has been a bereavement.
External oversight should be provided in order to assure the public of the quality of the State’s maternal services.
The National Women and Infants’ Health Programme (NWIHP) should develop a model to ensure that external oversight is applied across each hospital group.
A culture of empathetic care for patients needs to be fostered across the spectrum of maternity and obstetrical care.
Timely and open disclosure to patients and families needs to be mandatory in the event of a possible “adverse experience.” Hospitals should provide support and education to their obstetrical staff to enhance not only professional development but to equip them with coping strategies in their “demanding roles.” In the event of perinatal death, every effort should be made to gain consent for a postmortem by a perinatal pathologist.
There needs to be a single point of contact for a patient who has a complaint or a poor outcome from a pregnancy, “so that they don’t experience undue difficulty”.