AIMSI Statement: Scan Misdiagnoses

national | consumer issues | press release Thursday June 10, 2010 11:48 by AIMS Ireland - Association for Improvements in the Maternity Services Ireland info at aimsireland dot com

AIMSI Statement regarding scan misdiagnoses

The Association for Improvements in the Maternity Services Ireland would like to offer its support to women affected by the ongoing scan misdiagnoses controversy. AIMSI offers support and information to women in their contact with the maternity services, and also assists women in registering complaints. Women can access AIMSI support services at: [email protected] OR [email protected].

Women may also seek support through dedicated helplines which have been established in Our Lady of Lourdes Hospital Drogheda , tel 1800-200-529 and in University College Hospital Galway, tel 1800 252 016. There is also a general HSE information line: 1850-241 850.

In response to the scan misdiagnoses reported, AIMSI would like to make the following statement:

The Association for Improvements in the Maternity Services Ireland (AIMSI) is extremely concerned by the recent revelations that several women accessing maternity care services have been given misdiagnoses regarding the status of their pregnancies following the incorrect reading of scans.

The widespread fragmentation of maternity care services, which includes huge variability in the type and standard of care available to women, a lack of continuity of care, poor communication between healthcare professionals and women in their care, an over-reliance on technological equipment, as well as underfunded, overcrowded, understaffed centralized care units, is characteristic of the type of model that dominates the Irish maternity care system. Such a service does not create a space for the voices of women to be either heard or listened to, and allows for an unacceptable margin for error. This has resulted in the undermining of women’s trust in their caregivers, and has forced many to seek reassurance through seeking advice independently or self-referral to other maternity units.

AIMSI is deeply concerned that a feature of the recent scandal has been the highlighting of the role of women in ensuring they have received adequate care. Women are entitled to free, impartial, reliable, evidence-based maternity care which reflects international best practice. It ought not to be the responsibility of individual women to ensure that they receive such care, but the responsibility of health professionals, the HSE, and ultimately the Minister for Health. However, since the HSE is not fulfilling its duty to the maternity population, and continues to fail women by providing care that is often inadequate and substandard, AIMSI urges women to act on any doubts they may have, and inform themselves to the best of their abilities.
Furthermore, AIMSI asks health professionals in the maternity care services to listen to women’s concerns, and to facilitate enquiries for further information and support.

AIMSI continues to be contacted by women in light of this scandal and is aware of many instances of questionable antenatal scan diagnoses other than those highlighted in recent days in relation to fetal viability and early miscarriage diagnosis. We are also aware of cases in which dating errors have led to the premature births of babies. AIMSI urges any woman who has experienced questionable diagnoses (fetal normalities, placenta previa, incorrect gestational dates) to come forward and to contact their hospital and/or HSE helpline in order for a full review to be carried out on ALL instances of misdiagnosis.

In addition, this scandal illustrates how the increased medicalisation of birth in Ireland has led to an over-reliance on technological equipment such as ultrasound without proper regard for its limitations or acknowledgement of potential inaccuracies. Trust in technology alone at the cost of skills-based means of assessing pregnancy is a retrograde step in a system which must recognise the needs of women and support a social model of care. The fact that many of the scan misdiagnoses occurred during routine checks, without women having reported any signs or symptoms of miscarriage must call into question the appropriateness of interventionist techniques which have become a normalised part of Irish antenatal care. Further, several comments have been made by women expressing their dissatisfaction regarding the manner in which they were told their baby had died: A recent Irish study has shown that the way in which adverse diagnoses is communicated is extremely important to parents, given their vulnerability at this time.

AIMSI also wishes to express its concern with regard to reports which have also emerged relating to the management of miscarriage in maternity settings. The practice of prescribing abortifacient drugs or surgical D&C operation without waiting for verification of scan results through cross checking or consultation, or allowing nature to take its course must be examined as part of a broader review of practices and procedures within maternity care in Ireland. The use of the drug Cytotec is of particular concern given previously documented dangers associated with its use, including incidences of ruptured uteruses during VBAC deliveries.

AIMSI understands that the HSE has undertaken to ‘review cases over the past five years to determine the number patients who were recommended drug or surgical treatment when the diagnosis of miscarriage was been made in error, and where subsequent information demonstrated that the pregnancy was viable’. AIMSI believes that, given the catalogue of controversies which have come to light involving the HSE, it is not appropriate for the HSE to continue to conduct internal reviews of its own practices. In the interests of accountability and transparency AIMSI calls for the immediate involvement of HIQA as an independent autonomous authority to investigate this serious matter. The inadequacies of the telephone response units set up by the HSE over the past number of days, provides further evidence of the need for the involvement of an independent body.

Since October 2008, AIMSI has been lobbying for the creation and implementation of [b]National Guidelines for Clinical Practice in Maternity Care [/b]to include the publication of annual clinical reports and standardised maternity related statistics per unit/service and per individual lead clinician or practitioner therein (e.g. obstetric consultant, midwife, SECM). (Full details available here http://www.aimsireland.com/news/?topic=lobbying#_lobItem4)

In response to a recently updated campaign, AIMSI has become aware, via sources outside of the HSE, that plans are underway to create National standards under a recently established “clinical programme for obstetric care”. For the reasons stated above, AIMSI is extremely concerned that the creation of such Standards may be hastily implemented in reaction to this latest scandal without due input from service users. Given the HSE’s history in addressing cases in which patients have been systematically let down by their services, AIMSI has no confidence that any internal audit of services would not adopt and support the same type of misplaced professional loyalty and superficial reform, the likes of which were exposed in the Neary case, and in the Symphysiotomy scandal. AIMSI is adamant that patient groups representing women as maternity service users must be consulted with regard to the creation and implementation of these National Standards in order to reflect women’s real needs and concerns. Further, we strongly stress the need for an autonomous independent body to regularly audit clinical practices and for National Standards and to publish fully transparent results on an ongoing basis.