The High Court quashed the Minister for Health’s decision to direct the Health Information and Quality Authority (HIQA) to investigate the National Maternity Hospital under section 9 of the Health Act 2007. Mr Justice Meenan found the decision unreasonable because the material relied on did not establish reasonable grounds to believe a serious risk to patients existed.
The judicial review concerned the Minister’s 3 November 2017 direction, made after the death of Mrs Malak Thawley during surgery at the hospital in May 2016. A coroner’s inquest recorded that she died from exsanguination caused by an abdominal aorta laceration during laparoscopic surgery and returned a verdict of medical misadventure. The hospital had admitted negligence and breach of duty in separate proceedings, which were settled in January 2018.
The judge reviewed the hospital’s internal report, an HSE review and the inquest evidence. The HSE panel had concluded that the internal report examined the case appropriately from a clinical perspective and that its recommendations, if implemented, would reduce the risk of a similar event. The judge found that the briefing notes advising the Minister did not properly reflect the reports’ findings and recommendations or the sworn inquest evidence.
The Minister’s stated concerns included surgery outside core hours, staffing levels and readiness for emergencies. In evidence, the Department’s Chief Medical Officer accepted that consultants were not routinely present on site at all times in the hospital or elsewhere, and said there was no issue with how the decision to operate had been made in Mrs Thawley’s case. The judge also rejected as unsupported concerns raised about blood, cross-matching, vascular instruments and ice.
The court found that the Minister had not told the hospital what serious risk he believed existed or the grounds for that belief, despite repeated requests. Nor had the hospital been advised to take steps to reduce the alleged risk. The judge said section 9 contemplated an investigation into an existing situation posing a serious risk, with the aim of eliminating that risk, rather than a general learning exercise. He considered it irrational to target the hospital over practices the Minister acknowledged also occurred elsewhere in the health service.
The court rejected the hospital’s separate arguments that the Minister had unlawfully fettered his discretion or owed it fair procedures before directing the investigation. It did not decide that further review was unnecessary. The judgment said the hospital and Minister agreed that a further review was needed and that lessons should be applied across the health service.