Update on move of NMH to SVUH campus

This update today is from the Irish Examiner:

Update 2.10pm: The Health Minister said he intends to have a discussion at cabinet about the ownership structures of hospitals.

It is after the Sisters of Charity announced it would be divesting its interest in the new national maternity hospital.

However under current plans the state still will not own the hospital, despite paying for it.

Minister Simon Harris said it is one of the issues that still needs to be teased out.

“There are still a number of discussions that need to take place with both hospitals in terms of how do you protect what is a substantial investment by the state.

“There are many different ways that you do that and just like I asked for a period of a month to work with the hospitals to address a number of concerns, I would ask for a little more time to tease out those issues.”

Earlier: There is a warning that the new National Maternity Hospital still will not have clinical independence.

That is despite the fact the Sisters of Charity announced yesterday that it would be divesting its interests in the project and St Vincent’s Healthcare Group.

The religious order is to sell the land on which the facility will be built to a new charity called St. Vincent’s.

Doctor Peter Boylan (pictured) claims the hospital’s new master will be part of a chain of command that ultimately reports to the CEO of the St Vincent’s Hospital Group – rather than the maternity hospital’s own board.

Meanwhile Fianna Fáil said there needs to be clarity on the charitable status of the new national maternity hospital.

Fianna Fáil Health Spokesperson Deputy Billy Kelleher said the new charitable status will have to be scrutinised.

“We need to see the legal detail of that to ensure the state’s investment is both recognised and protected.

“The other key area is the issue around corporate governance. We welcome that fact there will be no religious involvement in medical and ethical oversight. That is critically important to ensure that all medical services are available to women.”

 

 

http://www.irishexaminer.com/breakingnews/ireland/questions-remain-over-new-national-maternity-hospital-791703.html

Lessons from the death of Savita Halappanavar that bear on the decision made by Minister Harris to move the National Maternity Hospital to the St. Vincent’s University Hospital campus

The HIQUA report (http://ow.ly/CwTv30c5MNm) into Savita Halappanavar’s death from sepsis while in labour at University Hospital Galway should be read by our politicians during the one month abeyance in the planning for the move of the NMH to SVUH campus decreed by Minister Harris.

“The Authority’s investigation also found that there is wide variation in the local clinical and corporate governance arrangements in place across the 19 public maternity hospitals/units nationally. This means that it is impossible at this time to properly assess the performance and quality of the maternity service nationally.

There has been no national review, or national population-based needs assessment, undertaken to date to identify the appropriate allocation of resources including multidisciplinary workforce arrangements, or the models of care required to ensure that all pregnant women have appropriate choices and access to the right level of care and support at the right time in Ireland”.

How do we know that co-location with SVUH is the best tertiary hospital choice when faced with this reality?

HIQUA specifically demanded this policy response from Minister Harris’ Department of Health:

“The Authority has also included a specific recommendation for the Department of Health to develop a ‘Code of Conduct’ for employers. This includes a code for managers that will clearly set out the behaviours and responsibilities expected in relation to achieving an optimum safety culture, governance and performance of an organisation. It should also include the duties and responsibilities in relation to the professional regulation of staff and the referral of healthcare professionals, where appropriate, to their professional regulators”.

How will the chilling religious ethic effect that will be present at SVUH be squared with this?

Some key issues in reproductive medicine, novel therapies and research at the new National Maternity Hospital campus location

The planned move of the National Maternity Hospital (NMH) to the St. Vincent’s University Hospital (SVUH) campus

Some key issues in reproductive medicine, novel therapies and research at the new campus location

  1. Who is in charge of a patient who is transferred from the NMH to SVUH
  2. Is that patient to be treated under the Code of Medical Ethics of SVUH or of the NMH
  3. What are to be the codes of medical ethics of both SVUH and the NMH? Remember that both the SVUH and NMH at present are Roman Catholic hospitals. The term ‘National’ used to describe the NMH is a misnomer given its religious governance.

The structure and composition of their respective boards of governance are set out here:

NMH

http://www.nmh.ie/about-us/corporate.201.html

The RC Archbishop is ex-officio chairman of the Board. Dr. Diarmuid Martin is the present incumbent. Three local parish priests also serve ex-officio.

SVUH http://www.stvincents.ie/About_Us/Governance_and_Management_Structure.html

The governors of SVUH are responsible to the shareholders, the Religious Sisters of Charity, who are the owners of the hospital and its entire campus, including the Elm Park Golf Club, which leases its course from the Order.

We raise here a number of specific concerns to be considered, simply as examples of the ethical complexity of the consequences of the NMH moving to the SVUH campus.

The main question is whether the NMH and SVUH will guarantee that all procedures and therapies legal in Ireland will be available in both NMH and SVUH, if clinically required and following best international practices? It is vitally important that SVUH changes to become like the NMH and not the other way round.

The NMH gradually moved away from strict Catholic ethics under the courageous leadership of Dr. Peter Boylan, and others, but we must be concerned that it might revert to more conservative ethics under the influence of SVUH.

Consider this problem. If a procedure is requested by a patient or next of kin (in an emergency) or a nurse or doctor attending the case, and if it is known that a responsible consultant acting in the best medical interests of the mother might approve the procedure, but the consultant in charge of the patient could not carry out such a procedure because it would be contrary to his or her ethics, will SVUH (and NMH) guarantee that that doctor is required to withdraw from supervising the case?

One can imagine a very sick mother; still carrying her baby, being moved across to SVUH with decisions to be taken about caring for her that might definitely or possibly lead to the death of the baby. The mother’s life may not be immediately at risk but most doctors might decide that the risk of not intervening is too great – this is a matter of judgement.  The ethics of SVUH (like those in Galway with the late Savita Halappanavar) may well delay taking such tough decisions and even prevent them. The fear is that SVUH under its present medical ethics code will tend to err in favour of the baby and rather than the mother.

At the moment we understand that SVUH does not offer or perform “elective sterilisation” – that is sterilisation of a man or a woman, requested just for contraception.  Nor does SVUH officially give advice on modern contraception in general. So at the moment SVUH does not offer all procedures or therapies that are legal in Ireland and considered to be part of normal medical care in hospitals that are not required to abide by Catholic medical ethics.

Consider a case of a woman who has just had a child with a severe genetic disorder. She wants to have a tubal ligation to avoid conceiving a similar child.  She does not need to go to NMH. Will SVUH admit her and perform the procedure? The same question can be posed for the case of a man who carries a defective gene who wishes to avoid conceiving a child.

Now think of IVF, today only performed in the Rotunda and the NMH (apart from private clinics). At present the NMH has the only not-for-profit IVF clinic in the state. IVF is absolutely prohibited by Catholic medical ethics. So it is impossible to imagine that SVUH could approve the setting up of an IVF clinic on its campus. Yet it would be an excellent idea for the NMH, as the largest maternity hospital, to set up its IVF clinic at the new location. There has been silence on this key issue.

Even if the NMH was allowed to set up such a clinic would SVUH allow the use of its laboratories and equipment and health care and technical staff to facilitate an IVF clinic?

The ethical challenges can be very profound.  Consider the use of the laboratories and staff of SVUH to facilitate modern methods for avoiding the birth of severely genetically defective children. The procedure is as follows:

  1. Embryos are conceived in the test tube by allowing the father’s sperm to fertilise the mother’s eggs;
  2. Each embryo is allowed to grow into a few cells;
  3. A few cells are taken from each embryo and tested for the genetic defect;
  4. Embryos without the defect are either implanted or stored for implantation later;
  5. Embryos with defects are allowed to die. So you can see that we should expect that SVUH would block the setting up of an IVF clinic at the NMH.

One other variation would be the use of surrogate-sperm donors in IVF (when the mother’s partner is infertile)

Another would be the use of surrogate-egg nucleus donors in IVF (when the mother’s own nuclear genes carry a genetic defect, or might even be a cause of infertility)

Yet another would be the use of a surrogate-mitochondrial donor in IVF (when mother’s own egg carries defective mitochondrial genes).

The general point is that SVUH should, by its own rules, inhibit and do its best to block the introduction of any ethically unacceptable advances in reproductive medicine at the NMH that might involve SVUH as an associate through its personnel (consultants, nurses, medical laboratory technologists, etc. with positions in both hospitals), labs, paramedical services etc.

In other words the NMH would not be completely free to take advantage of advances in reproductive medicine because of the deadening effect of the SVUH overarching governance of the medical and nursing personnel working on the campus. This is known in law as a ‘chilling’ effect.

Nor would it be easy for the NMH staff to have access to significant research laboratories and their support services provided at SVUH – such laboratories are essential if staff at NMH are to be able to keep up with discoveries abroad, and indeed to contribute to them. It is a weakness of the Irish maternity hospitals that none of them has significant research facilities – the new NMH on the SVUH campus should be able to use the SVUH research labs. Some of the research undertaken at SVUH is in close collaboration with UCD biomedical scientists. But we must assume that there will be religious ethical restrictions on the kind of research going on in these labs?

Ends

@Dick_Spicer @NormanSpicer86

@HolyMess1 #HolyMess1

26 May 2017