Serious privacy breaches uncovered following pregnancy terminations
The Medical Independent 30 April 2015
By Catherine Reilly Serious breaches of patient confidentiality have emerged in the process through which terminations of pregnancy are notified to the Minister for Health under abortion legislation, the Medical Independent (MI) has learned.
Some notification forms were not completed in compliance with the legislation, “with missing or incorrect information being supplied, and including serious breaches of patient confidentiality,” the Chief Medical Officer (CMO) Dr Tony Holohan informed the HSE Director General Mr Tony O’Brien in September 2014.
Under the legally-required notifications process, only Parts B (Information Relating to the Medical Procedure) and C (Information Relating to the Person Keeping Record) should be sent to the Minister for Health. Part A (Patient Details), which provides for the full name of the patient, their usual place of residence and date of birth, must be retained by the hospital.
MI asked the Department of Health and the HSE in how many instances Part A (Patient Details) was sent to the Minister and how many of these instances involved disclosure of the woman’s name. Neither would comment on these questions.
MI has also seen April 2014 correspondence from HSE Director of Quality and Patient Safety Dr Philip Crowley to HSE senior managers and clinicians “to clarify some issues that have arisen” relating to the notifications process. Dr Crowley referred specifically to Section 20(2) of the Act, which relates to notifications of procedures, where there is risk of loss of life from a physical illness in an emergency, carried out in a location other than the 25 hospitals listed under the legislation.
In this letter, Dr Crowley underlined and emboldened the legal requirement to notify the Minister of each termination “without disclosing the name of the woman”.
In his more recent response to the CMO’s letter of concern, dated 6 October 2014, Dr Crowley advised that “this matter is being treated very seriously by the HSE”.
He stated that he had written again to HSE National Directors, “directing them to ensure that all aspects of the Act are being complied with”.
The Minister is legally obliged to publish a report on the Act’s operation by 30 June, excluding identifying information on patients and doctors.
The legislation commenced on 1 January 2014 and guidance for health professionals was published the following September.
Training programme on abortion law not in place
The Medical Independent 5 March 2015
By Catherine Reilly
A training programme for psychiatrists and obstetricians on matters related to the abortion legislation is still not in place, despite having been promised by the HSE last summer, the Medical Independent (MI) has learned.
In June 2014, the HSE Director General (DG) Mr Tony O’Brien informed Chief Medical Officer Dr Tony Holohan that he had “engaged with” the College of Psychiatrists of Ireland and “it has been agreed” to devise a training programme. The College and the Institute of Obstetricians and Gynaecologists would jointly develop the programme, “supported by the HSE,” according to Mr O’Brien’s letter.
His assurance followed concerns expressed by the Committee developing the guidance document for health professionals. In March 2014, Committee Chair Dr Declan Bedford had written to the CMO, advising that the Committee wished the HSE to address “a number of outstanding issues” before the document was signed off.
One issue was “the need for training in relation to the clinical and operational requirements of the Act, in particular, specific training for psychiatrists on women’s health and obstetric issues”.
Spokesperson for the College of Psychiatrists of Ireland, Dr John Hillery, informed MI that a member of the College has been delegated to liaise with the Institute of Obstetricians and Gynaecologists on the development of the CPD programme, which is in its preliminary stages.
Dr Hillery could not yet indicate the precise length of the training, but said it would be “more intense” than a one-day course. Last week, the College received confirmation that the HSE would fund the course.
See my feature 'Opening new chapters in Ireland’s abortion saga' at http://www.medicalindependent.ie/60522/opening_new_chapters_in_irelands_abortion_saga
Warning was proposed on high-dose vitamins
The Medical Independent 22 January 2015
By Catherine Reilly
A public warning on “high-dose supplements” was considered by the Food Safety Authority of Ireland (FSAI) following concern over several high-dose vitamin D food supplements, the Medical Independent (MI) has established.
According to internal FSAI correspondence obtained by MI under Freedom of Information legislation, a high-ranking official expressed her view that the Authority “should issue a warning to the public regarding these high-dose supplements”. This would have to be “handled carefully” so as not to negatively affect the national policy on vitamin D infant supplementation, while the “high prevalence of low-to-deficient vitamin D intakes in Ireland” also had to be considered, wrote the official in December 2013.
An FSAI risk assessment of six high-dose vitamin D products, dated January 2014, expressed alarm that these products provided either 4,000IU or 5,000IU per day. These amounts were “multiples of the RDA [recommended dietary allowances]” and “10-fold the estimated average requirement for vitamin D”.
The EU RDA for nutritional labelling of food products sets vitamin D at 200IU daily, while the European Food Safety Authority (EFSA) has established a tolerable upper intake level (UL) at 4,000IU per day for adults and adolescents and 2,000 IU per day for children aged one-to-10. The ULs are the maximum level of total chronic daily intake of a nutrient (from all sources) judged to be unlikely to pose a health risk.
According to the FSAI website, “continuous high intakes” of vitamin D can cause kidney damage and bone deformity.
An FSAI spokesperson told MI that, in the time available to respond, it was not possible to review all incident files to determine any actions taken in respect of vitamin D products meeting or exceeding the EFSA ULs on the Irish market during 2013 to date. A public warning had not been deemed as warranted following further in-house consideration, the spokesperson said.
Currently, there are no “agreed upper safe limits at European level”, which is “a disadvantage for consumer protection”, she pointed out.
The FSAI has commissioned its Scientific Committee to examine how maximum safe levels of vitamins and minerals can be established and the report is expected this year.
See my feature, 'The vitamin D dilemma' at http://www.medicalindependent.ie/58230/the_vitamin_d_dilemma
State Claims Agency surveys maternity services on oxytocin
The Medical Independent 18 December 2014
By Catherine Reilly
The State Claims Agency (SCA) has surveyed public maternity units on the use of oxytocin, having noted the drug as “frequently” a causative or contributory factor in obstetric claims, the Medical Independent (MI) has established.
According to the SCA, clinical negligence claims for harm caused in maternity services account for 20-25 per cent of all claims and 55-60 per cent of costs paid. A spokesperson told MI: “An analysis of obstetric claims frequently reveals that oxytocin (trade name, Syntocinon) is a causative and/or a contributory factor.
“The purpose of the survey was to ascertain the nature and extent of specific, contemporary, evidence-informed clinical guidance for the use of oxytocin to induce and/or augment/accelerate labour in each of the 19 maternity services in Ireland.”
The survey was undertaken by an SCA Clinical Risk Adviser as a professional project as part-requirement for a Graduate Diploma in Healthcare (Risk Management and Quality). The findings will be published “in due course”.
Information was requested on: guidance available; if specific consent was sought prior to commencing; and if the guidance incorporated specific details including the type of assessment of the woman and foetus prior to commencing oxytocin and during its use.
Questions also sought to establish who prescribed oxytocin and if the guidance included explicit exclusion/contraindications criteria; when oxytocin is discontinued; who determines when the administration is discontinued; recognition and management of uterine hyper-stimulation; and where the details are documented in the maternal healthcare record. The survey also asked if the use of oxytocin is audited and if so, who is the lead, the frequency of audit and if the results inform/change practice.
On the issue of dosage, the survey questioned whether available guidance specified the dosage (starting and maximum) and the titration.
A spokesperson for the HSE, which jointly operates the National Clinical Programme for Obstetrics and Gynaecology with the RCPI, told MI: “At present, we are not aware of any national or international guidelines to guide practice on oxytocin augmentation in labour. The programme supports the development and use of local guidelines at each maternity unit, but the programme hopes to build a national consensus on a standardised guideline over the next year.”
GPs being pressurised on infant circumcision
The Medical Independent 23 October 2014
By Catherine Reilly
Some families are pleading with GPs to indicate pathological phimosis in an attempt to access circumcision for cultural reasons, according to a Specialist Registrar in Urology.
Dr Fardod O’Kelly told the Medical Independent (MI) that public hospitals generally only have provision for circumcision for pathological phimosis, for which there are “huge” backlogs for adults and children.
The HSE intercultural strategy acknowledged that early circumcision of infant males is an expected cultural or religious duty in some ethnic minority groups. However, due to lack of provision, some families are pressuring their GPs to indicate medical need.
“Some families would try to go privately to get [cultural circumcision] done because there are some surgeons that might have more space on their lists in the private sector,” Dr O’Kelly told MI. “Other families are trying to get primary care physicians to actually suggest there is a problem with the foreskin — that it is pathological — to get seen in the first place.”
Some had been successful in having their GP make a referral to an OPD to put forward their case. Dr O’Kelly said he did not envy the predicament of GPs on this issue, particularly given “they are under so much pressure themselves”.
He said there was also a danger that some families may turn to unlicensed individuals, as occurred in 2003, when a young baby of African background died following a ‘home cultural circumcision’ in Waterford.
More widely, provision of paediatric circumcision in Ireland is challenged by a trend towards its non-performance by younger consultant general surgeons, with it increasingly viewed as a urological responsibility, according to a paper Dr O’Kelly co-wrote in the Irish Journal of Medical Sciences (IJMS).
Dr O’Kelly said surgical sub-specialisation and gradual lack of exposure to paediatric surgery had meant that many newer general surgeons were no longer in a position to undertake the procedure, with the burden of cases left to urologists and paediatric surgeons, especially outside Dublin.
Significant manpower issues would be exacerbated by retirements of older, more classically-trained general surgeons, noted the IJMS paper.
Dr O’Kelly told MI that, ideally, paediatric circumcision could be performed on specific lists, under sterile conditions, by appropriately-trained surgeons and this did not necessarily have to occur in an acute hospital.
NAS authorised untrained staff to operate its vehicles
The Medical Independent 9 October 2014
By Catherine Reilly
The HSE National Ambulance Service (NAS) authorised non-trained personnel to crew intermediate care vehicles (ICVs) and assist in patient care, but retracted this memo following intervention by the regulator of emergency medical services, the Medical Independent (MI) understands.
Mr Barry O’Sullivan, Deputy Director and Registrar of the Pre-Hospital Emergency Care Council (PHECC), confirmed to MI that such a policy would be “contrary” to NAS obligations with the Council on professional standards.
According to the PHECC’s Inter-Facility Patient Transfer Standard, the minimum crewing level of an ICV is two Emergency Medical Technicians (EMTs). The ICVs are mainly intended to support routine patient transfers, thereby freeing-up emergency ambulances. However, ICVs may be tasked to higher-acuity calls as first response or as support for emergency services.
The situation arose, MI understands, after the NAS redeployed staff who had been working at the control centre in the North East following its closure under centralisation plans. However, some redeployed staff had not qualified as EMTs.
The matter of authorisation of untrained staff to assist in patient care had been discussed at the March meeting of PHEEC’s Quality and Safety Committee meeting. In May, a Council meeting heard that the NAS had been requested to cease this practice immediately. The response from the NAS, citing contractual obligations and minimisation of potential risk, was tabled. It was agreed that a response be requested from the NAS Director before escalation.
The July meeting heard that the NAS Director “assured Council” that the Inter Facility Patient Transfer Standard is “complied with at all times”.
Doctor who was sanctioned by Council FTP changed his name
The Medical Independent 4 December 2014
By Catherine Reilly
The Medical Council has permitted a doctor whom its Fitness to Practise Committee found guilty of professional misconduct to change his name on the register of medical practitioners, the Medical Independent (MI) has uncovered.
The Council told MI it is not party to the legal change of name process and therefore has “no basis” to object.
“By law, a person can change their name. The Council and indeed the media are not party to this legal process and therefore have no basis to object. Once a doctor has legally changed their name, there is a process in place to ensure this is reflected on the Medical Register,” said a Council spokesperson.
The doctor in question is “not currently in practice” and no other doctors have changed their name “while being monitored by the Council,” the spokesperson added.
Following a name change, the same registration number is retained. This must “always be used by a doctor to represent themselves as a medical practitioner,” said the spokesperson.
The conditions attached to this doctor’s registration are outlined on his online registration. This is searchable by both name and registration number. However, there is no reference to his previous name.
The doctor, whom MI is not naming, has “health-related conditions” attached to his registration. The conditions also state that he must notify the Council promptly of any post that he accepts; allow the regulator to exchange information with any employer; and inform the Council if he applies for employment outside Ireland.
He must inform any organisation or person employing or contracting him to undertake medical work that his registration is subject to conditions. He must also inform any locum agency or out-of-hours service that he is registered with, or applies to be registered with (at the time of application), and any prospective employer (at the time of application).
Following the doctor’s legal name-change, his registration was updated earlier this year.
People who legally change their name can enrol a Deed Poll at the Central Office of the High Court and this document is open to public inspection.