I propose to take Questions Nos. 183 and 184 together.
As I have said in previous replies to Parliamentary Questions on this issue I have been advised that the circumstances surrounding this very unfortunate case were investigated by the Health Service Executive (HSE) under the National Incident Protocol following which 11 actions were recommended. The recommendations are as follows:
1. The need to identify clinical pathways relating to management of women with an intrauterine death in third trimester to complement existing medical management policy.
2. The Guidelines for Medical Management of Intrauterine Death should be revised in line with a review of the medical literature.
3. Details of all patients for Induction of Labour, regardless of place of induction should be centrally documented.
4. This recommendation cannot be disclosed as it contains personal, private, sensitive and confidential information relating to the individual patient.
5. Develop a brief operational outline of the Gynaecology Department to assist staff who are sent there on an occasional/intermittent basis.
6. Due to the complexity of work, there is a need for an updated training needs analysis of all midwifery and nursing staff on the gynaecology ward.
7. There should be a designated individual with responsibility for coordinating, monitoring and auditing the Basic Life Support attendance and Advanced Life Support Skills attendance, ideally a designated Resuscitation Training Officer.
8. An Obstetric Early Warning System should be introduced and evaluated.
9. Install additional phone lines in the ward.
10. A review of the possibility of emergency call bells or designated phones for emergencies in each room should be carried out and measures taken to address this.
11. Hospital wide analysis of all doorways in clinical areas to establish the feasibility of moving a bed in a critical event.
I have been informed by the HSE that the Rotunda Hospital has implemented all 11 recommendations.
It is my expectation that patients should be informed of all the risks to themselves arising from any medical procedure to which they give informed consent.