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HSE orders scanning scandal probe
[Posted: Thu 10/06/2010 www.irishhealth.com]
The HSE is to review cases in maternity units over the past past five years where women may have had an erroneous miscarriage diagnosis. It admitted that in the fetal scanning misdiagnoses raised to date, hospital practices were unacceptable.
The health executive says it is to review cases to determine the number of patients over the past five years who were recommended drug or surgical treatment when the diagnosis of miscarriage was been made in error, and where subsequent information demonstrated that the pregnancy was viable.
However, the appropriateness of the HSE itself carrying out such a review has been questioned.
The review is in response to this week's revelations that many women have been erroneously told following scans that their unborn babies were dead. A number of women have revealed that their babies were saved only after they insisted on a second opinion.
Maternity units are also being ordered to put in place immediate measures to ensure that the decision to use drugs or surgical intervention in women who have had a miscarriage diagnosed must be approved by a consultant obstetrician.
The directive to introduce these new safeguards is being issued by Department of Health Chief Medical Officer Dr Tony Holohan and Dr Barry White, Director for Quality and Clinical Care at the HSE.
The HSE said a clinical programme for obstetric care has been established as part of a major initiative by Dr White, HSE National Director of Quality and Clinical Care, to standardise care across a range of medical specialities.
This programme will define standardised care for early pregnancy loss and other aspects of maternity care and will be led by Professor Michael Turner of the Coombe Hospital.
As part of this work, a guidance document for the management of early pregnancy loss is to be developed in conjunction with the Institute of Obstetrics and Gynaecology.
On reviewing scanning errors over the past five years, the HSE says this issue is being dealt with as a serious incident (SI).
It said number of steps are required to clarify the precise nature of individual incidents and to take appropriate actions as necessary.
Further information, including total numbers of incidents and locations, will be provided once the process is completed.
There were 89 calls to the Helpline in Our Lady of Lourdes Hospital, Drogheda yesterday. This was where the first scanning error was revealed earlier this week.
A significant number of calls to the hospital were from women who had their treatment in other maternity hospitals around the country.
The HSE national information line received between 65 and 70 calls today from callers yesterday in relation to various maternity hospitals around the country.
The HSE is advising concerned women to contact the maternity hospital where they received treatment.
Prof Michael Turner, Clinical Lead of the HSE's Obstetrics Programme, said the diagnosis of miscarriage is made on the basis of a woman's history, physical examination and investigations including ultrasound. It is important to treat the woman who is pregnant and not to consider the scan in isolation.
Dr Barry White said in a number of the cases discussed in the media in recent days, the practices were unacceptable and this reinforced the need to implement standardised care across the system and to ensure compliance with this by audit and review.
It is unlikely that the HSE review will be able to determine the number of cases where pregnancies may have been wrongly terminated following a scanning error. Mothers who have come forward this week have said their pregnancies were only saved after they insisted on a further scan which confirmed that their babies were alive.
According to a report in today's Irish Independent, serious deficiencies in ultrasound screening services in maternity units around the country were revealed in a survey four years ago.
Meanwhile, the Association for Improvements in Marternity Services Ireland (AIMSI) has said given the catalogue of controversies which have come to light involving the HSE, it is not appropriate for it to continue to conduct internal reviews of its own practices.
AIMSI said in the interests of accountability and transparency, the independent health safety body HIQA should carry out the planned review of misdiagnosed miscarriages.
In a statement today, AIMSI added that the widespread fragmentation of maternity care services, which includes huge variability in the type and standard of care available to women, is characteristic of the type of model that dominates the Irish maternity care system.
"Such a service does not create a space for the voices of women to be either heard or listened to, and allows for an unacceptable margin for error. This has resulted in the undermining of women's trust in their caregivers, and has forced many to seek reassurance through seeking advice independently or self-referral to other maternity units," according to AIMSI.
It added that it was deeply concerned that a feature of the recent scandal has been the role of women in ensuring they received adequate care.
"Women are entitled to free, impartial, reliable, evidence-based maternity care which reflects international best practice. It ought not to be the responsibility of individual women to ensure that they receive such care, but the responsibility of health professionals, the HSE, and ultimately the Minister for Health."
The Drogheda helpline number is 1800 200 529. The HSE's information line is 1850 24 1850.
See also 'Another week, another scandal...'
Read more about the Minister for Health and medical experts' response to scanning scandal here
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