Coombe sought indeminty before taking control of Portlaoise maternity unit

The board of the Coombe women’s hospital sought legal indemnity against being sued over problem births at Portlaoise hospital before agreeing to assume control of its maternity unit.

Members of the Coombe board repeatedly expressed concerns over the Health Service Executive’s proposal to take responsibility for services in Portlaoise, where five babies have died in controversial circumstances in recent years.

Their issues included concerns over funding, “reputational risk”, staffing arrangements and resources, according to the minutes of board meetings obtained under freedom of information legislation.

Asked by The Irish Times whether an indemnity had been provided, a spokeswoman for the Dublin Midlands Hospital Group, which includes the two hospitals, declined to say.

The Dublin hospital eventually agreed to sign a memorandum of agreement to take control of maternity services in Portlaoise, but the exact funding and staffing arrangements have not been made public.

HSE officials first proposed the measure at a board meeting in February 2014, shortly after an official report into the baby deaths at Portlaoise found that services there were not safe.

Due diligence

Coombe board members raised a series of concerns, including the underfunding of both the Coombe and the maternity unit in Portlaoise and the need for a due diligence exercise. They sought indemnity for “historic cases” in Portlaoise should the agreement go ahead. Then HSE director of acute hospitals Ian Carter told board members €

6 million would be available to manage the unit in Portlaoise.

The concerns of Coombe board members persisted even after the due diligence was carried out and a draft memorandum of understanding (MoU) was presented at a meeting last October.

Members said appropriate funding would need to be put in place to enable the Coombe to sign the MoU and infrastructural issues relating to maternity services in Portlaoise would have to be addressed.

Concerns were expressed about liability during the transition period during which Portlaoise’s maternity unit was brought up to appropriate safety standards, and about “financial and reputational risks” during this period.

The master of the Coombe, Dr Sharon Sheehan, advised the meeting of other concerns, including "not having the Hiqa report into maternity service at Midland Regional Hospital, Portlaoise, at this point in time and the requirement of the Coombe to have assurances from the HSE that any recommendations from the report would have to be fully funded".

The board decided to “rework” the draft MoU. Last January, it decided funding for the maternity unit in Portlaoise must be protected and guaranteed against cuts for three years.

The MoU was eventually signed in March, just days after a row blew up between the HSE and Hiqa over the latter’s draft report into Portlaoise.

The document says the two hospitals recognise that reports into Portlaoise such as that being prepared by Hiqa may have a “significant bearing” on the future delivery of services there.

It is not a legally enforceable agreement.

A spokeswoman for the Dublin Midlands Hospital Group declined to say whether an indemnity had been provided to the Coombe.