The use of the medication Oyxtocin (brand name Syntocinon) to augment labour is fraught with risks. It is well-documented that inappropriate use can cause death or disability. In Ireland, it is listed as a high 1 of 10 high alert medications. Thus it should seem obvious that an approved Guideline be available for use across all maternity hospitals. However the shocking truth is that, in Ireland, there is currently no National Guidance for the Use of Oxytocin to Induce or Augment/Accelerate Labour.
Lack of National Guidelines
The State Claims Agency (SCA) recently published details of their research into the extent of Guidelines and procedures regarding the use of Oxytocin across the nineteen maternity services in Ireland. The research was prompted by rising numbers and costs of medical negligence claims. These numbers are unacceptable and the costs are unsustainable, therefore presumably (and logically) the SCA sought to examine the source of the most costly class of claims. The research found a lack of Guidelines in some centres and significant deficiencies in many of the local Guidelines where they did exist. Variations in practice were found across all centres. One centre didn’t even have the courtesy to reply to the research.
Clinical Guidelines are no substitute for professional knowledge and experience but healthcare professionals are well aware of the countless benefits of Guidelines. Written National Guidelines minimise variation and ensure clarity and consistency in practice. Guidelines can be reviewed, audited and updated as necessary. They are developed from rigorously researched evidence and incorporate input from all key stakeholders and International best practice. They allow us to learn from and pre-empt previous mistakes.
Overall written National Guidelines regarding Oxytocin wold help to ensure that a mother and her baby receive the same safe, high quality care whether they are admitted to, for example, the National Maternity Hospital in Dublin or to the General Hospital Portlaoise.
Medical Negligence Litigation
Medical negligence cases in respect of a child suing the HSE for catastrophic injuries caused as a result of negligence at birth, are all too familiar. The SCA report that claims against the 19 public maternity services for medical negligence account for up to 25% of claims. In turn, these claims account for 60% of costs paid. Oxytocin is understood to be a causative or contributory factor in many of these claims.
On a human level it is clear we need to minimise these tragic catastrophic injuries to babies. At a crude, economic level the State cannot afford the cost. A National Guideline for the use of Oxytocin will help to achieve this aim.
Benefit of Medical Negligence Litigation
For many victims (and their families) vindication, an apology and compensation are quite justified reasons for bringing a case. Often, victims also wish to highlight the error in the hope that it will never happen again. This is an important benefit of medical negligence litigation. Medical negligence cases highlight incidences of negligence and areas of potential risk; often clinical circumstances where Guidelines are lacking, not least Oxytocin. By litigating an incident, the error or potential risk is highlighted. The individual practitioner involved (eg doctor or midwife), the risk management department of the hospital where the incident occurred and the HSE, all become aware of the risk and are forced to re-examine their practice. Regrettably, experience shows that without the threat of litigation, many errors would not be investigated.
In summary, too many medical negligence cases arise due to inappropriate use of Oxytocin in our labour wards. Families of children born with catastrophic injuries due to the inappropriate use of Oxytocin have been calling for change in practice for many years. Individual doctors, midwifes and indeed politicians recognise the need for Guidelines. Cold hard percentages and costs to the state reported in the SCA research speak volumes. Hopefully the influence of the SCA will finally result in the completion and implementation of a National Guideline.
Without medical negligence litigation, the SCA would not exist and society would not have the benefit of their valuable, if somewhat shocking research. Everybody wants safe, high quality maternity services in Ireland. The reality is that by highlighting bad practice, medical negligence, is an important mechanism for prompting research, review of bad practice and forcing change.
Contact us at Cantillons Solicitors at +353 (0)21 -4275673 or [email protected] if you would like more information.
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