Correspondence to this newspaper about the case of Tadgh Costello, a boy with severe cerebral palsy due to an obstetric error at the time of his birth, has cast further light on the unacceptable delays experienced by patients when an adverse outcome occurs.
A moving letter from his parents outlined how it took the Health Service Executive (HSE) from 2006 to 2015 to admit liability in the case, notwithstanding a verbal acknowledgement some 6 weeks after his birth by the consultant obstetrician that a medical error had occurred. The director of the State Claims Agency (SCA) has confirmed that it required just over two years to legally process the case and confirm liability. Which leads to an important question: in an era of open disclosure of adverse outcomes, why were the Costello parents stonewalled for an additional 7 years?
The HSE and the SCA have initiated an open disclosure project in the health service: it includes expressing regret for what has happened, keeping the patient informed, and providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event. Based on the experience of the parents of Tadgh Costello, the project had not been implemented by frontline services at Kerry General Hospital.
However the honest, if isolated, response of the consultant obstetrician in this case must be acknowledged. In accepting there was a delay in proceeding to emergency Caesarean section, and communicating this to the parents at the earliest opportunity, the specialist followed the principles of duty of candour. These enshrine a series of responses aimed at minimising patient harm and reducing the chance of a similar incident happening again.
Duty of candour legislation was enacted in Britain in November 2014. It emphasises the duty of maintaining a relationship of trust with patients by placing their needs above the reputation of any organisation. There is clearly a need for similar legislation in the Republic as part of a promised review of our unnecessarily adversarial medical negligence system.