Women giving birth in a Cork hospital may have to do so without an epidural due to insurance restrictions introduced recently.
At the Erinville Hospital in Cork, the local anaesthetic used to ease the pain of childbirth is currently available for public patients only three days a week. But, according to Dr John Keogh, consultant anaesthetist at the hospital, even this may have to be withdrawn because of advice from the hospital's insurers that trainee doctors should not be allowed to supervise the anaesthetic. Almost 3,000 babies are born in the Erinville each year.
Dr Keogh said there was not enough consultant anaesthetist cover in the hospital. He explained that as a consultant with the Cork University Hospital group, he had commitments in other hospitals on different days. "Sometimes I may get a call telling me that a woman, who is a public patient, is in terrible distress and asking me to get to the Erinville. Of course I try my best but very often I am busy in another hospital."
He also expressed concern that at weekends just one registrar, a trainee doctor, works between the Erinville and the second maternity hospital, St Finbarr's, which is located at the other side of the city. "The situation is appalling really," said Dr Keogh. "Normally a second doctor can be found if there is an emergency in each hospital at weekends. But the doctor can often be caught in traffic in the middle of the city. It has come very close on a number of occasions. We have been making the case for a long time for extra doctors but it has fallen on deaf ears."
Dr Keogh said that up to two weeks ago a consultant anaesthetist would put in the epidural, ensure it was working, and then delegate the "topping up" to a more junior member of staff.
"But the insurers said it was not very safe and that they were withdrawing cover for the obstetric staff to top it up. Our option at this stage is either to withdraw the service or find a new way."
Since then, epidurals have been administered as a drip, which Dr Keogh described as a "recognised way of managing epidurals". However, he said, it was not a full-strength anaesthetic. "That's fine for a lot of labours but towards the end of labour it needs to be topped up, because the patient is suffering pain and there are not people around to do that, which has its own medico-legal implications. It looks like we should not do this kind of thing. I'm in two minds as to whether we should continue it or not." At present epidurals are available on Monday, Thursday and Friday. The limited service was increased from two to three days in recent years.
In a statement, the Southern Health Board said it had been advised, as a result of a recent court case in another area, to review procedures and is "currently having discussion with medical staff and will explore options available to us".
The board recognised that difficulties had arisen in Cork because of the fragmentation of services at the Erinville and St Finbarr's. There are plans to amalgamate maternity services on the Cork University Hospital site with a 110-bed unit.
The statement said any practices agreed would be in keeping with "best practice" and the advice of insurers. The board applied some time ago to the Department of Health for approval to employ five additional anaesthetic registrars "which would enable the provision of an enhanced consultant-led service", it said.