Statute of Limitations (Amendment) Bill 2013: Second Stage [Private Members] (Continued)

Tuesday, 16 April 2013

Dáil Éireann Debate
Vol. 799 No. 1

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  8 o’clock

Deputy Seamus Kirk: Information on Seamus Kirk Zoom on Seamus Kirk I thank Sinn Féin for the opportunity to contribute on the Bill, which Fianna Fáil supports. It took a long time for health services in this country and elsewhere across the world to evolve into the modern treatment facilities we have in many places today. In many areas of medicine the abandonment of inappropriate and outdated practices has taken time. The procedure of symphysiotomy is a very good illustration of the point. Between 1944 and 1992 it is calculated that 1,500 such operations were carried out in maternity units in this country. In many cases women suffered lifelong disability because of the procedure, often in silence.

Thankfully, the procedure is no longer practised in maternity hospitals. Since 2003 a health package has been available to approximately 100 women who suffered the ill effects of the procedure. In 2011, Dr. Una Walsh, senior research fellow in medical history at UCC, was appointed to review the practice of symphysiotomy in this country. The report was conducted in two stages. The first draft report contains information about the frequency with which symphysiotomy was carried out in this country. The second stage involved a consultation with patient groups, health professionals and, in particular, the women who had undergone symphysiotomy.

The key provision in the Bill is to set aside the Statute of Limitations to enable survivors to achieve redress through the courts. The stories of survivors are deeply upsetting and distressing. Survivors and their families feel a great injustice has been visited upon them and we agree. We must address the situation immediately. I appeal to the Minister for Health, Deputy James Reilly, and the Minister of State at the Department of Health, Deputy Kathleen Lynch, who are present, to take on board the points that have been made on the issue of which we have been aware for some time. Those who suffer, in many instances in silence, must have their cases addressed. The time is now. I urge the Minister to act.

An Leas-Cheann Comhairle: Information on Michael Kitt Zoom on Michael Kitt The next speaker is the Minister for Health, Deputy James Reilly. I understand he is sharing time with Deputies Heather Humphreys, Gerald Nash, Robert Dowds and Andrew Doyle. Is that agreed? Agreed.

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I welcome the opportunity to address the House on this important issue. I also welcome the women who are present in the Visitors Gallery, many of whom suffered as a consequence of the procedure. I can only imagine the level of distress that symphysiotomy has caused to the women who underwent the procedure and recognise the pain and ill health they have endured as a consequence. I reassure the House and the ladies present that I and the Government are committed to dealing with the issue sensitively so that it can be brought to an appropriate and fair conclusion for all the women affected. For those reasons I have agreed to accept the Bill, although I have been advised that it contains serious flaws and also that it might not achieve the objectives intended by Deputy Ó Caoláin. To oppose the Bill would send the wrong message. I want to send a strong message to the women involved that I intend to help them get closure on the matter in the fairest and fastest way possible.

Deputy Andrew Doyle: Information on Andrew Doyle Zoom on Andrew Doyle Hear, hear.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly At the outset I wish to explain what symphysiotomy is and to give some background and context about its use as a surgical procedure and, specifically, its use in this country. Symphysiotomy is a medical procedure that was primarily used before the advent of safe caesarean sections. It was introduced into Irish hospitals to help women who had difficulty giving birth due to narrow or obstructed birth passages. The procedure was carried out in this country from approximately 1920 until the early 1980s, long after it had been discontinued elsewhere. It was gradually replaced by caesarean section as the preferred method of delivery in childbirth, where required. A pubiotomy involved cutting the pubic bone rather than the joint of the symphysis pubis. It is difficult to understand why the practice persisted when caesarean section was so safe in the latter half of the 20th century. As a doctor I deeply regret that.

As Minister for Health, my first priority is to make sure that the health needs of those who have had a symphysiotomy are met quickly and effectively. I have discussed the matter with my ministerial colleagues, Deputies Kathleen Lynch and Alex White, and with the Cabinet. With that in mind we are committed to ensuring that the greatest possible supports and services are made available to women who continue to suffer effects of having undergone the procedure. The women concerned continue to receive attention and care through a number of services which have been put in place by the HSE. The services include the provision of medical cards to all who request them; the availability of independent clinical advice for former patients; the organisation of individual pathways of care and the arrangement of appropriate follow-up for women, including specialist triple assessment - medical, gynaecological and orthopaedic, counselling, physiotherapy, reflexology, home help, acupuncture, osteopathy and fast-tracked hospital appointments where that is appropriate; the refund of medical expenses related to symphysiotomy in respect of medication or private treatments; a support group facilitated by a counsellor which was set up in 2004 in Dundalk and Drogheda for women living in the north-east region; and the nomination of a national lead officer for symphysiotomy in the HSE. In addition, there are five designated regional liaison officers in place across the regions of the HSE. The provision of the necessary support services for women is monitored and overseen by the HSE, which is committed to being proactive in offering help to women who underwent a symphysiotomy and who may wish to avail of the services.

We must act on the basis of the best evidence and advice that is available on the issue, as in all aspects of the health services. To that end, the chief medical officer of my Department commissioned an independent research report into the practice of symphysiotomy in Ireland in 2011. The aim of the report is to provide an accurate picture of the extent of the use of symphysiotomy in this country, and an examination of the practice here relative to other countries. It will include an assessment of the circumstances in which the procedure was carried out, what protocols or guidance existed at the time for professional practice and details of when the practice changed and why.

The specific terms of reference the researcher has been given are to document the rates of symphysiotomy and maternal mortality in Ireland from 1940 to date, by reference to available data, including annual reports and other reports; assess symphysiotomy rates against maternal mortality rates over the period; critically appraise international reviews of symphysiotomy practice in this country and associated rates in a number of comparable countries; and to review any guidelines and protocols that applied in Ireland on symphysiotomy over the time period.

The researcher was asked to write a report based on the findings of the above analysis providing an accurate picture of the extent of use of symphysiotomy in Ireland, and an examination of the Irish experience relative to other countries. The academic researcher concerned was formally appointed in June 2011. The report was conducted in two stages. The first stage was an independent academic research process that analysed available documentary evidence. The first stage did not include interviews with individuals directly involved in symphysiotomies, namely, mothers, practitioners and midwives in particular. This approach was central to the production of an independent report, compiled without influence or input from vested interests.

The second stage of the research process was a consultation process on the draft academic research report. The consultation process directly involved patient groups, health professionals and, in particular, the women who have undergone a symphysiotomy. The second stage of the research took place during mid-2012. The consultation process was advertised to the public in the national newspapers and also through the co-operation of the symphysiotomy support groups in order to reach as many interested persons as possible, particularly the women themselves. A number of consultations were held at different locations throughout the country. The sessions were conducted solely by the researcher. It was also open to interested persons to make submissions in writing or by e-mail directly to the researcher. The second stage has just been completed by the researcher and the report has been sent for peer review, in line with best practice. It is expected that the report will be finalised and submitted to me in May, at which time I will examine it and consult further with the Government.

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