Deputy McDowell has been given permission to raise on the Adjournment the question of the deaths of two people, a baby and a mother, in two Dublin hospitals. Deputy McDowell will have a maximum of 20 minutes.
Adjournment Debate. - Deaths of Mother and Baby.
Thank you for making available this facility to debate this this evening. Tonight's debate arises out of the death of a young woman, Antoinette Pepper, who was aged 26 at the date of her death, and her baby, at Holles Street and St. Vincent's Hospitals on 16 and 17 March of this year. In bringing up this matter I am aware that it is a sensitive matter and I am not in any sense attempting to make any political points out of it or in any sense prejudge the issues that arise in this debate or to attribute blame to anybody. I hope the Minister will accept that I am pursuing this on the basis of a genuine concern for the issues which arise out of the circumstances of this young woman's death.
From information available to me it appears that Antoinette Pepper, a young woman in very good physical health and with no medical problems, was expecting a child in February of this year and, as is often the case in first pregnancies, the birth was overdue. I am satisfied that the birth was approximately four weeks later than the expected delivery date. I know that this is an inexact matter but that that was the extent of the delay in giving birth in this case.
Antoinette and her mother had expressed grave anxiety about the length of time during which she had been overdue but they were assured by the National Maternity Hospital at Holles Street that there was no reason for alarm. I am also informed and believe that it is the policy of that hospital to permit, wherever possible, pregnancies to go to full term without induction and to avoid, wherever possible Caesarean deliveries. I am a lay man and I have to accept that that is a legitimate policy for a hospital to adopt, with this comment, that some hospitals adopt a slightly different policy in relation to these issues and it is up to institutions and their management to decide the way in which they will hold the balance between the various policies and medical considerations which decide these matters in the minds of doctors. I am also informed that Miss Pepper had in the previous week attended at the hospital for the purposes of an ante-natal examination in the hope that they would bring her in to have her child by way of induced delivery but they told her they would not be doing so at that time. She was told to hold on until the following Monday, 14 March.
When she went to Holles Street Hospital on Monday, 14 March she was kept in and I am told that on that day several attempts were made to induce the child, even though I cannot be specific on the details, and that these were unsuccessful. I am also told that during these procedures Antoinette suffered some considerable pain and distress and there is some reason to believe that at that stage she suffered some internal injuries. It seems that heart monitoring of her child on that day showed that the child was alive and well and this continued to be the case into the early hours of Tuesday, 15 March when she went into labour in the fullest sense.
The father of the child and Antoinette's family have been given no clear indication as to when exactly the child died — whether it was prior to, during or immediately after delivery. They have been given conflicting versions as to the exact moment of the child's death. They are particularly concerned that a child who died quite shortly after delivery or in the course of delivery was not delivered by way of Caesarean section given the immense difficulties which this mother had had in giving birth to a child in the normal period. In this regard I ask the Minister to take it from me that there is some concern arising out of the fact that apparently the child in utero was healthy and not giving cause for concern on the day the mother was admitted to hospital and there was no indication of distress on the part of the child before delivery, such as would indicate the application of Caesarean section as a means of seeing the child delivered in a healthy state.
The father of the child and the family and relatives of Antoinette were informed in the early hours of Tuesday, 15 March that the child was dead and that Antoinette was weak but no indication was given that she was suffering from any serious condition apart from normal exhaustion associated with the birth of a child and emotional distress over the death of the child which she had been made aware of shortly after the child was delivered. Subsequently, her family were informed that she had been removed to St. Vincent's Hospital suffering from an acute infectious condition where she died in the latter part of 17 March.
In the circumstances the family were obviously deeply upset and from what I have gathered from them they accept that this made it difficult for them there and then in the aftermath of the child's death to come to terms with that fact and to get all the information in a cold and rational way from the hospital. However, they are very anxious to know the precise cause of the child's death, whether it could have been avoided by an earlier induction, whether it could have been avoided by the application of a Caesarean section, how Antoinette became infected and whether this infection was related to any of the procedures involved during the delivery of her child and whether it was related to her child's death.
While I appreciate that the circumstances were difficult for the hospital and the family I am concerned that these circumstances could occur without there being any obligation on the part of anyone to explain as much as was known on Antoinette's death and the death of her child to the father of the child and to Antoinette's family. Naturally, they are anxious to ascertain the facts surrounding this double tragedy and it would be entirely wrong if the mere fact that legal proceedings might follow should prevent them from gaining access, to the greatest possible extent, to the available information. My colleague, Deputy Harney, tabled a question in this House seeking information on the cause of death and the circumstances surrounding the death of Antoinette and her child. The question was not answered on the basis that there was a possibility that legal proceedings might ensue.
I appreciate without any difficulty that the Minister in this matter is dependent on the information furnished to him by the hospital authorities at Holles Street but it does seem wrong that information which is available to a medical institution, a public medical institution in this case, should be withheld or kept back in any way from those who have the most intimate and obvious right to have access to that information at a time when it would do them most good, the time when they are most upset and most anxious to find out what exactly happened.
I appreciate that a fair balance has to be struck between the rights of the relatives and patients and the rights of those engaged in delivering medical services. I appreciate that doctors have reputations and that their reputations cannot be, which I am not doing here, flippantly or unfairly challenged in a public forum or be the subject of public controversy in circumstances which are unfair to those people. On the other hand, it seems that institutions delivering services to the public, where deaths can occur, owe an obligation to the relatives of people who die in those institutions to make available all of the information which is at their disposal even if the circumstances are such that legal proceedings may be contemplated.
It is entirely wrong to say to the relatives of anyone who dies in hospital that information will not be made available because they may sue on foot of that information. With the greatest of respect, it is even more wrong to suggest that the way someone finds out that information is to commence legal proceedings alleging negligence on the part of some doctor or hospital to obtain all of the documents in the possession of the hospital by way of a compulsory court order of discovery. That would entail asking people to go to law to ascertain what the available information is, putting the cart before the horse, and asking parents to resort to legal procedures to obtain information which should be their as of right.
I think the Minister is aware that in this case a very competent solicitor has been retained by the family, not with instructions to sue everybody but merely to ascertain the facts and if the facts are such as to give rise to legal liability on the part of someone then that is a matter for the family of Antoinette Pepper to consider further. It is wrong that they should be effectively excluded from gaining access to the information on how their daughter and her baby died.
I would also like to draw the Minister's attention to the position in the event of an inquest. Section 17 of the Coroners Act, 1962 places a general duty on coroners to hold an inquest — the words are very important — where in the opinion of the coroner the death may have occurred in an unnatural manner. First, he is not obliged to come to the conclusion that it did arise in an unnatural manner but that it may have done. He is not obliged to pre-judge the issue in determining whether or not to hold an inquest; all that is required of a coroner is to decide that there is a bona fide question to be considered. Of course, the question then arises: what is an unnatural manner? If somebody dies in the course of medical procedures or in the course of childbirth it might be argued that the circumstances are such, because they are accidental and there was no deliberate act on the part of any person which gave rise to the death, it is not unnatural for the purposes of the Act.
For that reason, it is well worth while looking at similar law in England and the procedures which are applied in English coroners' courts. The English textbook, the third edition of "Thursten's Coronership" deals with this matter in some detail. To cut a long story short, even though someone may die of an acute infection, and the infection is in a sense the result of a natural process because it is a virus which has multiplied and caused death, and even though a child may naturally die in childbirth, where — and the English case authorities are clear on this — there is a question as to whether or not the death was occasioned or contributed to by an absence of medical help, inappropriate medical help or by a failure to adopt proper medical procedures, so far as English law is concerned — and I think there is no difference here so far as Irish law is concerned — that is an unnatural death and a coroner has a duty under section 17 of the Act to consider whether or not he should hold an inquest. In other words, the mere fact that it was not a deliberate act or an accident in the sense of a car crash, an industrial accident or whatever, does not take it out of the category of an unnatural death. From that point of view, I say to the Minister that the Coroners Act, 1962, does allow for the holding of an inquest in circumstances such as these. Not only does it allow that but in another context the Coroners Act leaves it open to a coroner to hold an inquest where there is in his view a set of circumstances in existence which, if repeated, might give rise to other deaths or a repetition of the circumstances in question.
In that context I should like to call to the Minister's attention that if mothers to be are allowed to go to full term and go past the normal — and I know the word "normal" has to be taken with a good deal of qualification to it — period of bearing their child, there must be a medical policy as to when and in what circumstances they will be induced and, if they are to be induced, what safeguards will be taken in relation to the care of the child being delivered and in what circumstances, if there is a difficulty or complication with a delivery, resort will be had to a Caesarean section. I know that doctors differ and I know the other side of that adage but in this case there are questions which certainly need to be resolved so far as the relatives of Antoinette Pepper and the father of her child are concerned. They are entitled to have those questions resolved in so far as it is possible so to do by an inquiry.
Section 24 of the same Act allows the Attorney General, presumably on the advice of the Government, to direct that an inquest be held. I understand that in this case the coroner has expressed some reluctance to hold an inquest. If there is such reluctance the Government and the Minister have an adequate remedy because it is within the ambit of the Act for such an inquest to be held. I understand from press reports — and I know I have to take them with some degree of caution — that the Minister has directed an inquiry into the matters I have referred to. He has sought reports from the hospital and a newspaper of last Monday week indicated that the reports were now in the hands of the Chief Medical Officer, Dr. Alfie Walsh. I believe that in those circumstances the reports and records in relation to this mother's confinement, the delivery of her child and her treatment should be both made available and interpreted sufficiently for the parents of Antoinette Pepper and the father of the child.
I call on the Minister to take all the necessary steps to ensure that there is an inquest held into this tragic case; to furnish all relevant information in his procurement to the father of the child and to the Pepper family; and have an inquiry held into the policies relating to late deliveries and Caesarean sections in the National Maternity Hospital. I hope the Minister will appreciate that I have been deliberately downbeat and have not in any way attempted to sensationalise this matter nor attempted in any way, as some others do on these occasions, to pre-judge the issue but merely to ask that this information, which I believe is available be made available and delivered to the people who are most concerned — the parents of Antoinette Pepper and the father of the child.
I have listened to what Deputy McDowell has said and I have taken careful note of his comments. On the question of whether or not there should be an inquest I have no power to direct a coroner to hold an inquest. A coroner has his powers under the Coroners Act and any amendment to that Act would be a matter for the Minister for Justice. I understand that legal proceedings are being contemplated in this case and as I said to Deputy Harney last month I believe it would be inappropriate for me to make a statement on the matter at this stage. I hope the Deputy appreciates that position.
The Dáil adjourned at 7.30 p.m. until 10.30 a.m. on Friday, 24 June 1988.