Update: Concerns over governance at NMH not raised due to anger over legal action, court hears
The State's chief medical officer told the fourth day of the NMH's case challenging an inquiry arising out of the death of Malak Thawley that the raising of governance concerns at the hospital did not arise out of anger or annoyance at the taking of the legal action.
Dr Tony Holohan also denied, under cross-examination, that he only began to justify his claim of the need for another inquiry because of the NMH taking this case and that was then used to put the co-location of maternity services to St Vincents' grounds on hold.
He agreed engagement with the NMH over the co-location ceased after the hospital launched its case in January and no Department of Health representative attended meetings on the issue since last February.
He said a letter from his department earlier this month expressing unhappiness with the case in the context of the co-location plans was not a threat. It was an expression of concern over governance issues in the light of the hospital's attitude to patient safety and the experience of engagement between the department and the NMH.
Earlier, he repeatedly insisted the purpose of a further investigation was to find answers to questions which had not been answered by the HSE review of the NMH's own investigation following the Thawley death. It was also being done to assuage outstanding concerns of the minister and others.
He refused a number of requests from Mr Gallagher to withdraw his "unexplained circumstances" claims because, counsel said, they had all been explained in previous reports. He insisted there were and remained unexplained circumstances which needed answering.
He said one of the main objectives of an inquiry would be to look at situations, where there is not a full complement of staff in a hospital, whether there is a procedure and checklist for actions which help increase patient safety.
These can be monitored rather than have an arrangement whereby phone calls take place between staff which makes for very little auditing to ensure best practice.
The question arose in the Thawley case whether they were in existence in the NMH during the Thawley case, whether they were followed and whether there was room for improvement, he said.
Dr Holohan said an early warning score system, such as had been adopted after the Savita Halappanavar in Galway in 2012, had saved hundreds of lives.
It brought formality to vital sign measurements by nursing and medical staff which meant it was not just left to the judgment of individual doctors or nurses and was "much more superior to the total judgments" of staff.
Dr Holohan also told the court the proposed HIQA investigation would cost €328,000. However, it could be done in one year rather than the three it was expected to take because it would only examine the NMH rather than the wider maternity services, he said.
In its judicial review action, the NMH says a statutory HIQA inquiry will be highly disruptive, demotivate staff and undermine public confidence in all maternity services. The Minister denies the claims.
The case resumes before Mr Justice Charles Meenan on Tuesday.
The State's chief medical officer has denied a plan to co-locate the National Maternity Hospital (NMH) with St Vincents in Dublin has been put on hold because of the hospital's High Court challenge to the setting up of an inquiry into patient safety.
Dr Tony Holohan said however that the Minister for Health had to consider what the governance arrangements of a new co-located service in light of his ongoing "genuine concerns" about the NMH's attitude to patient safety.
This was in the light of engagements so far with the NMH over the setting up of a statutory inquiry by the Health Information and Quality Authority (HIQA) "which have not given us confidence", he said.
He disagreed with NMH's senior counsel Paul Gallagher that the whole co-location project was on hold because the hospital had initiated these legal proceedings.
He agreed however that no Department of Health representative has attended meetings on the issue since last February. The legal proceedings were launched in January.
He said a letter he co-signed earlier this month expressing unhappiness with the legal case in the context of the co-location plans had not been a threat but an expression of concern over governance issues in the light of the hospital's attitude to patient safety.
The inquiry was set up in the wake of the death of Malak Thawley during surgery for an ectopic pregnancy in the NMH in 2016.
Dr Holohan also told the court that the lack of ice to cool Mrs Thawley during her surgery was due to a policy preventing hospitals keeping ice due for infection reasons.
During the settlement last year of her widower Alan Thawley’s case over her death, the High Court was told there was a "cascade of negligence" including the lack of ice to cool Mrs Thawley's brain and two doctors were sent ot a nearby pub to get some ice.
Today, Dr Holohan agreed the coroner's report into the death had noted the reason for hospitals not having ice was because they were not allowed to keep it for infection reasons.
He also agreed there was no issue about lack of blood for Mrs Thawley because she had received 33 of the 55 units of O-negative blood available that day. This was compatible with her blood type.
There was however an issue about her blood type not having been cross-matched before she required surgery, Dr Holohan said.
Earlier, Dr Holohan said the HIQA investigation would cost €328,000. However, it could be done in one year rather than the three it was expected to take because it would only examine the NMH rather than the wider maternity services, he said.
He was continuing to give evidence in the NMH's action to quash the Minister for Health's decision to hold a statutory inquiry into practices affecting patient safety at the hospital in the wake of the death of Malak Thawley.
The NMH says it will be highly disruptive, demotivate staff and undermine public confidence in all materniity services. The Minister opposes the action.
Dr Holohan repeatedly insisted the purpose of a further investigation was to find answers to questions which had not been answered by the HSE review report and to assuage those outstanding concerns.
It was a "never event with unexplained circumstances" and the aim of an inquiry was to find out about what exactly happened from the time Mrs Thawley entered the hospital to when she underwent surgery.
He said one of the main objectives of an inquiry would be to look at, when in situations where there is not a full staff on in a hospital, whether there is a procedure and checklist for actions which help increase patient safety.
These can be monitored rather than have an arrangement whereby phone calls take place between staff which makes for very little auditing
The question arose in the Thawley case whether they were in existence in the NMH in the Thawley case or whether they were followed and whether there was room for improvement, he said.
Dr Holohan said an early warning score system, such as had been adopted after the Savita Halappanavar in Galway in 2012, had saved hundreds of lives. It brought formality to vital sign measurements by nursing and medical staff which meant it was not just left to the judgment of individual doctors or nurses and was "much more superior to the total judgments" of staff.
The court has heard the NMH carried out its own internal inquiry which resulted in the implementation of 18 out f 19 recommendations to improve services.
That was reviewed by a HSE panel which said the NMH investigation not only complied with national guidelines but exceeded them in some respects. The was also a coroner's inquest which approved the recommendations in the NMH report.
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