The State's chief medical officer has told the High Court the Minister for Health is concerned that questions remain unanswered about decision-making in the National Maternity Hospital (NMH) between the time a woman walked into it and ended up on an operating table where she died.
Dr Tony Holohan was giving evidence on the third day of an action by the NMH against the Minister, Simon Harris, seeking to quash his decision to set up a statutory inquiry into practices at the hospital in the wake of the death there of Malak Thawley during surgery for an ectopic pregnancy in May 2016.
The NMH says such an inquiry would have consequences for maternity services throughout Ireland, be highly disruptive and de-motivate staff working in the sector. It favours a non-statutory review carried out by the Royal College of Obstetrics and Gynaecology in the UK.
The Minister denies claims he is acting irrationally, disproportionately and outside his powers.
Dr Holohan was called to give evidence after the Minister’s side objected to the opening by Paul Gallagher SC, for the NMH, of what the State says was without prejudice correspondence but which the NMH said was open correspondence.
Dr Holohan agreed with Mr Gallagher that he had said, in a minute of a meeting with NMH representatives in 2016 about setting up a proposed further investigation, it was not because of any deficiencies in one which had already been undertaken by the Health Service Executive.
While the note was accurate, there were still concerns about the decision-making between the Sunday morning when Mrs Thawley walked into the hospital to when surgery took place on her and the basis for the decision to do so, he said.
He disputed he was making any finding but said it was a concern and any finding would have to be a matter for a further investigation. He said there had been substantial efforts to have a meeting between department officials and NMH representatives.
While at the first meeting the hospital representatives were most concerned about the previous HSE report, a decision had been made for an external review and the Minister wanted to move it on as quickly as possible, he said.
The Minister wanted to hear from the NMH as to its modus operandis, the way it should be done.
Dr Holohan said he did not go into detail at that meeting about the reasons for the further inquiry and was not comfortable doing so. He didn’t think, from a public interest point of view, the Minister had to explain all his reasons in the context of the Thawley case.
‘Further learning’
He agreed he had told NMH representatives that “further learning” was the aim of the inquiry. He said this had already happened in other cases such as following the death of Savita Halappanavar in 2012 where an early warning score system was developed which is now used by hospitals in Ireland and abroad.
He said there was no reason to identify further concerns to the NMH people where it was “not a good-quality meeting”, was “acrimonious” and had taken so long to set up.
Asked by counsel were there any reasons why he could not identify his concerns, which later turned about to be about patient safety rather than further learning, Dr Holohan said there was no specific reasons but the important thing was to move forward and have an independent investigation.
In his 10 years as chief medical officer, he had never experienced the kind of engagement they had with the NMH over a patient safety investigation, he said. There was this “fruitless engagement” where the NMH side wanted a meeting with the Minister and department officials wanted a meeting with them.
Asked by counsel was there any material shortcoming in the HSE report, Dr Holohan said that while the HSE report agreed with the NMH’s own investigation, it did not deal with how Mrs Thawley ended up losing her life in the context of the on-site consultant’s presence, out-of-hours surgery and other matters which were, however, referenced in that report.
The justification for having a further inquiry came from a variety of sources and not just the HSE report, he said.
The hearing continues.