It is almost a year since the Health Service Executive promised an investigation into whether staff should be disciplined arising from the deaths of infants at the Midland General Hospital in Portlaoise.
The process was supposed to have been concluded within three months. Official files reveal how this investigation effectively stalled, leading to tensions regarding the delays between the families in Portlaoise and the Department of Health on one hand and the HSE on the other.
The original investigation was announced by the HSE following a hard-hitting report by health watchdog Hiqa into the Portlaoise deaths. As The Irish Times reported early last year, the HSE strongly disputed the Hiqa report before its publication and at one stage warned it could take legal action.
The Hiqa report, when it was published, sparked calls for staff to be made accountable as well as bringing pressure from Minister for Health Leo Varadkar for prompt action.
The HSE agreed to set up an investigation into possible clinical and managerial failings by staff. Three former managers in the UK National Health Service were engaged to conduct the review, and an initial examination indicated up to 16 staff could have a case to answer.
The official files show that in early August last year the then interim HSE national director for human resources, Ian Tegerdine, told the Department of Health, following queries about investigations into the conduct of staff/office holders, that a preliminary process began in early July and was expected to conclude within a few weeks.
However, little progress was made, ostensibly because of fears over possible legal action by staff. Many of the staff who were “in the frame” over the failings at Portlaoise have since retired and cannot be made subject to any disciplinary review by the HSE or the bodies governing the medical professions.
Families who lost children in the hospital grew concerned over the stalling of the process and Varadkar, sharing their concerns, instructed his officials to put pressure on the HSE.
Concern
In January, ahead of a potential Dáil question on the issue to the taoiseach, the Department of Health wrote to the new head of human resources in the HSE, Rosarii Mannion, seeking further details of the investigation process.
“The families in Portlaoise were very concerned that the disciplinary investigation appears to have stalled. Can you please set out the timelines for completion of this investigation as a matter of urgency.”
The Department of Health reminded Mannion that her predecessor had advised it in August that a disciplinary investigation could commence in September.
Mannion replied that the disciplinary investigation had not stalled. However, she said: “I can clearly understand how the family might perceive this to be the case given the timelines suggested below.”
She said she did not have a specific timeline from the investigators but that the process was complex “with an extraordinary amount of documentation to be considered, potential legal challenges, potential process challenges, cross over with referrals to professional bodies etc”.
Faced with the possibility of challenges – which for some reason no one seems to have foreseen at the outset – the HSE proposed to the Department of Health that a commission of investigation be set up.
Tragic
The existing plan would end up costing €10 million in legal fees, it claimed, and the families would never find out whether anyone paid the price for the tragic events that occurred in the hospital.
The department rejected this proposal and so the HSE has now come up with a souped-up version of its original disciplinary investigation, by adding a barrister and a Northern Ireland obstetrician to the investigation team.
It says a retired judge will be appointed separately to decide on any sanctions that should be imposed after the team reports.
The HSE no longer holds to the €10 million price-tag it attached to the investigation in its letter to the department in January.
While there are differing views within the organisation on the issue, it believes the cost can be kept to “only” €1 million, dependent on the number of staff who have a case to answer for.
The department is expecting a result from this protracted process by July but the HSE says it is impossible to say exactly when it will be complete.
Sources say decisions on whether staff have a case to answer should, for the most part, be complete by the end of the year.
However, that doesn’t take account of possible legal challenges, let alone the determination of sanctions by a person not yet appointed.
It is worth remembering what happened in Portlaoise. Babies died needlessly. Others were left maimed for life.
Mothers were treated appallingly in some instances. Official reports apportioned responsibility for these events not just at clinical level, but up the managerial chain.
The HSE threatened to injunct Hiqa’s report into the affair.
Left to its own devices in setting the terms of reference of a disciplinary investigation, it is taking years to produce a result.
Once again in the health service, accountability comes incredibly slowly, if at all.
