Tag Archives: Paul Cullen

Coombe Hospital

Last week in the Dáil.

Solidarity-People Before Profit TDs Ruth Coppinger and Bríd Smith spoke about a pregnant woman, from Clondalkin, Dublin, whom they claimed had been refused a termination at the Coombe Women & Infants University Hospital in Dublin, despite two consultants certifying that she needed a termination for a fatal foetal abnormality.

Ms Coppinger said the board of the hospital overruled the two consultants’ direction and asked her to wait four weeks to see if she has a spontaneous miscarriage.

After the Dáil debate, the Coombe Hospital denied its board over ruled the decision of the two consultants.

The woman later spoke to Kitty Holland, of The Irish Times, and said she planned to travel to the UK for a termination.

Ms Holland later reported that the couple were told by the Coombe, in a letter, that their unborn baby had a “complex foetal anomaly” and that the hospital did not believe “there is present a condition affecting the foetus that is likely to lead to the death of the foetus either before or within 28 days of birth, as per the Health (Regulation of Termination of Pregnancy) Act 2018”.

Ms Holland reported on Saturday:

“The couple reject that they were told their foetus had a “complex anomaly”, saying they were told clearly a week before the letter was issued that the anomaly was fatal.”

Further to this…

This morning.

Paul Cullen, in The Irish Times, reports:

Decisions on whether or not to provide terminations in cases of foetal anomaly should be reached by multidisciplinary teams of doctors on a consensus basis, newly prepared guidelines indicate.

The multidisciplinary team (MDT) should be a formally-constituted committee of the hospital whose decisions are documented in clinical notes, according to the guidelines from the Institute of Obstetricians and Gynaecologists.

One such MDT was constituted at the Coombe hospital in Dublin earlier this month to consider the case of a patient whose foetus had been diagnosed with a foetal anomaly. The case was raised by two Opposition TDs in the Dáil last week after the woman’s request for a termination was refused.

In the Coombe case, treating doctors found that despite the presence of a “complex foetal anomaly” they did not believe the condition affecting the foetus was likely to lead to its death either before, or within 28 days of, birth – as required by legislation on terminations in cases of fatal foetal anomaly.

The MDT recommended a re-evaluation of the clinical condition of the foetus after four weeks.

Foetal anomaly cases require ‘teams of doctors’ (Paul Cullen, The Irish Times)

Previously:  “Her Words To Me Were: ‘This Is Not What I Voted For’”

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From top: Irish Times Health Correspondent Paul Cullen; Independents 4 Change TD Clare Daly and health correspondent at The Irish Times Paul Cullen

You may recall the publication last week of Judge Maureen Harding Clark’s report on the symphysiotomy redress scheme.

And some of the subsequent criticism of both and the report and the media coverage of the report.

Senior lecturer at Birmingham Law School, Mairéad Enright wrote:

[Judge Clark’s report] is not the independent report survivors of symphysiotomy are entitled to under human rights law. The media have read it as diminishing SOS’s claim that the non-emergency substitution of symphysiotomy for Caesarean section without consent, as practiced in Ireland, violated many women’s human rights. However, this coverage has been insufficiently critical of this report.

“…It is a mistake to think of the story of symphysiotomy as one about ‘bad doctors’. It is a story about bad systems of knowledge, and bad cultures, which corner women, induce compliance, deny their autonomy and thereby wound them. Those cases are extraordinarily difficult to litigate because the assumptions which drive the old system persist in judicial reasoning and are exacerbated by an adversarial framing.”

“Outside the courtroom, we can find the same problems. What is striking about this report is that it uses constructs from those systems and cultures – valorising reproduction however painful, stoking a suspicion of women who claim their human rights, privileging medical literature over first person testimony – to silence protest. It deserves closer, and more critical reading and discussion.”

Further to this.

Yesterday, Independent 4 Change TD Clare Daly and Anti Austerity Alliance TD Ruth Coppinger raised Judge Harding Clark’s report and the media coverage – with Ms Coppinger naming Irish Times journalist Paul Cullen.

Clare Daly: The Harding Clark report into the symphysiotomy redress scheme has been described as deeply skewed, profoundly unfair, subjective and selective, intellectually dishonest, morally bankrupt, replete with false allegations, omissions, distortions, misrepresentations and contradictions, and biased throughout. Those who said that are being soft on Judge Harding Clark whose report cannot go unchallenged or uncorrected. She goes way beyond the terms of reference of her assessor report to the Minister for Health when all she was asked to do was deal with the activities and expenditure of the scheme. Instead, she deviated into personal and unsubstantiated commentary, which is highly inappropriate in the context of outstanding litigation. Her report is riddled with false allegations, such as alleging that leading campaigners against symphysiotomy had alleged they had the procedure when they had not. That is completely and utterly untrue.”

“The only interpretation one can draw from this report is that it is a defence of the uniquely Irish practice of non-emergency symphysiotomy. It serves to diminish survivors’ claims and is a further violation of those women’s human rights. Symphysiotomy as practised in Ireland is a human rights abuse and that is the case regardless of this report. There can be no denying that the State has been culpable in this but rather than address these matters honestly, the report has served to diminish the suffering caused and undermined the experiences of the women. There is a continued suggestion that the women were lying. Nobody who met these women could ever believe that.”

“Of course, Judge Harding Clark met hardly any of them. It was a paper review with no right to appeal any of her decisions. It was her opinion and her opinion only. It is hugely traumatic for the women involved that this horrific report has been published. I believe the Minister needs to intervene to have it withdrawn. It is hostile in its tone and it smears and discredits survivors rather than dealing with a bad and deliberate policy and a poorly-administered scheme. It needs to be withdrawn and we need clarification on this matter.”

Ruth Coppinger: “I, too, have been absolutely appalled by the media coverage and the commentary of certain people in the media in the last week in response to this report. I agree that the methods of assessment were defective. I agree with Deputy Daly on the policy of Judge Harding Clark of taking oral evidence and meeting only a handful of the women involved. If she had met more, she would have seen for herself some of the injuries and limping, etc., that these women endure. Using contemporaneous radiology in one particular case, the judge stated that a 2004 X-ray did not show injuries to the women and that therefore the injury had happened afterwards. The judge went way beyond her brief, showed her own bias and showed contempt for these women. I believe it is absolutely vital that this Dáil and the Government agrees to set aside time to have a proper analysis of this report.”

There are a couple of myths that the report tries to knock down. The first is that symphysiotomy was a normal procedure practised in many countries, as argued by Paul Cullen, for example, in The Irish Times. In 1944, there were four of these operations in the national maternity hospital. In 1948, there were 43. That was because of the arrival of Dr. Alex Spain, an arch-Catholic, as head of the hospital, who refused caesarean sections and said that their result would be contraception, the mutilating operating of sterilisation and marital difficulty. It is utterly wrong to say that. They also argue that symphysiotomy was not dangerous. Clearly, it was. It was not a benign procedure. It was not used in other countries as a first resort; it was used as a last resort. This is the third whitewash report there has been. It is a disgraceful indictment of the system that it does this to women who were brutalised in Catholic Ireland of the past.”

Later

Daly: “I have to say that there has been a certain rewriting of history again. We know that the majority of survivors never accepted this redress scheme to begin with. The Minister of State is dodging the key elephant in the room, which is that this report goes one step even further from that. It is riddled with factual inaccuracies, unverifiable anecdotes and is severely damaging. It is well known that people experience trauma and upset as victims of abuse if their stories are not believed. The report is done in a manner which disbelieves the testimony of the women involved. It makes outrageous claims. We know that not one woman anywhere submitted that she had consented to or was aware of that procedure, yet the judge said that she found it very difficult to believe that is the case. There is no evidence to support her view in that situation. This is the same judge who, when awarding payments previously, told the women they were getting the money to redress their “unhappy experience”. This was deliberate butchery that was carried out on people for ideological reasons.”

“What the report shows is a deliberate undermining of the human rights campaigners and groups whose work actually led to the setting up of this scheme to begin with, bad and all as it is. I remind the Minister of State that it took a former Minister to go to court to get the Guerin report withdrawn. We know the McAleese report into the Magdalen laundries was hugely criticised and controversial. The point that is being made here is that this document cannot stand. In and of itself, it abuses the women involved. It has to be withdrawn and considered further by this House.”

Coppinger: “There has been an attempt by the Catholic right to seize on this highly flawed report to argue against the whole question of Catholic control of maternity hospitals. There is no question that this was done and motivated by a Catholic medical theology. It is also argued very patronisingly that these women did not know the difference between a caesarean section, a symphysiotomy or anything else that was happening to them.I know women were kept in ignorance but I think most women would know if they had their pelvic bones broken.”

“The scheme relied on written and radiological evidence which was extremely unfair because proving a symphysiotomy happened over 50 years ago is incredibly difficult if medical records do not exist. In that sense, the scheme militated against the older women and some younger women were able to pursue their claims successfully. The fact there were 185 unsuccessful applications does not mean that 185 symphysiotomies were not carried out. As I said, it was difficult to prove. People were also only given 20 days to apply to the scheme which is highly restrictive in the context of gathering up information.”

“There is no way that this Dáil could or should stand over this report. A debate must take place in this Chamber to question the rationale of Judge Harding Clark.”

Transcript: Oireachtas.ie

Notes on Judge Harding-Clark’s report on the symphysiotomy payment scheme (Mairead Enright, Human Rights in Ireland)

Pic: Paul Cullen