Consultant 'removed from post-mortem work'

A consultant pathologist at Dublin's Rotunda Hospital was removed from doing post-mortem work at the hospital in late 2007 following an audit at the hospital, it has emerged.

However, the consultant concerned,  Dr John Gillan, in a statement, has said "there is nothing to hide" in relation to concerns about post-mortem and organ retention practices raised in a subsequent review carried out.

This review at the Rotunda found serious failings in its post-mortem and organ retention practice between 2000 and 2007, despite the fact that most other hospitals at the time had improved their practices in the wake of the organ retention controversy some years before.

The audit team which was undertaking a national review of post-mortem practice on foot of the 2006 Madden organ retention report, refused to validate the hospital in December 2007 having expressed serious concern about its post-mortem procedures, including the fact that it still retained many organs without consent and kept poor records.

(Read more about the national review here)

The subsequent specific probe of the Rotunda's post-mortem practice, carried out by St James's Hospital CEO Ian Carter in 2008, confirmed these failings.

Its report, published yesterday along with the national audit results, identifies 116 confirmed cases where organs were retained without proper consent.

The Carter report says that in 24 instances consent was only secured for an autopsy and not for retention. In 92 instances, organs were retained for more than one year in a manner that was not compliant with consent policies at the time.

"It is likely that families are unaware that these organs have been retained."

However, Rotunda Master Dr Sam Coulter-Smith, in a statement yesterday, said "there are now 138 post mortems carried out between 2000 and 2007 that are affected" (by retention issues).

He apologised to the families affected and said the hospital was communicating with them. It would arrange meetings with families with specialist members of staff and counselling if necessary.

The Rotunda inquiry line is 1800 303 265.

Mr Carter, at a press briefing yesterday, said his review had found problems in relation to a substantial number of organ retentions not in compliance with consent policy;  a significant number of organs not transferred to blocks or slides; the level of superficial (ie, not internal) post-mortems undertaken without proper consent, poor record-keeping and data management and defects in the consent process.

He said issues relating to retention of unblocked organs and incomplete records relate mainly to a "Consultant A." mentioned in the report.

This is one of two consultants referred to in the report but are not named. In "Consultant A's" case, 31% of their post-mortems during this period resulted in temporary, non-consented organ retention.

The Rotunda's retention rate was found to be at least two to four times higher than that of two other maternity hospitals.

The report points out that no one individual at the hospital appeared to hold ownership for the totality of the autopsy process.

The report refers to heavy workload and staffing issues as factors in the deficits in organ retention at the hospital.

One of the factors quoted here was the amount of time Consultant A had to spend organising an international meeting and preparing for continuous professional assessment scheme accreditation.

The Carter report states that in December 2007 Consultant A was freed up from all clinical work to address issues whch had arisen in the national audit.

"Subsequently, concerns were raised with the management executive by the independent auditors and the work was ceased with immediate effect."

Dr Paul Kavanagh of the HSE's National Hospitals Office, at the press briefing, confirmed that the consultant concerned has was removed from post-mortem work in December 2007.

He said failings that led to the very significant issues at the Rotunda were multiple and were at multiple levels within the organisation.

He said certainly there were issues in relation to individual professional practice and the HSE had made it clear to the hospital that it had an obligation in relation to management of these concerns.

Dr Kavanagh said the Rotunda had confirmed, however, to the HSE that a consultant was removed from post-mortem services when the issues  concerned were identified in the two reviews carried out.

Dr Gillan, who has identified himself as Consultant A, said that while the Rotunda retained organs longer than many hospitals, no other hospital had a higher detection rate into the cause of infant death.

He also referred to resourcing and staffing issues, and said he had to work alone for prolonged periods.

Dr Gillan said the delays with organ retention were "deeply regrettable:" but the full explanations of the cause of death were of interest to parents who might have hoped to have other children.

He said the hospital had a choice between quiuck examinations or thorough examinations to determine the cause of death.

The Rotunda was subsequently validated under the audit process in the spring of this year. However, it is to be audited six-monthly for the next two years to ensure consent compliance and conformity with national standards.

The National Audit was carried out by UK expert Michaela Willis.

[Posted: Fri 24/07/2009]