The State’s chief medical officer has denied a plan to co-locate the National Maternity Hospital (NMH) with St Vincent’s in Dublin has been put on hold because of the Holles Street hospital’s High Court challenge to the setting up of an inquiry into patient safety.

Dr Tony Holohan said however that the Minister for Health had to consider what the governance arrangements of a new co-located service would be in light of his ongoing “genuine concerns” about the NMH’s attitude to patient safety.

It was also in light of engagements so far with the NMH over the setting up of a statutory inquiry by the Health Information and Quality Authority ( HIQA) “which have not given us confidence”, he said.

The inquiry was set up in the wake of the death of Malak Thawley during surgery for an ectopic pregnancy at the NMH in 2016.

Dr Holohan told the fourth day of the NMH’s case challenging an inquiry arising out of the death of Malak Thawley that the raising of governance concerns at the hospital did not arise out of anger or annoyance at the taking of the legal action.

He also denied, under cross examination, that he only began to justify his claim of the need for another inquiry because of the NMH taking this case and that was then used to put the co-location of maternity services to St Vincents’ grounds on hold.

He agreed engagement with the NMH over the co-location ceased after the hospital launched its case in January and no Department of Health representative attended meetings on the issue since last February.

He said a letter from his department earlier this month expressing unhappiness with the case in the context of the co-location plans was not a threat. It was expression of concern over governance issues in the light of the hospital’s attitude to patient safety and the experience of engagement between the department and the NMH.

Earlier, he repeatedly insisted the purpose of a further investigation was to find answers to questions which had not been answered by the HSE review of the NMH’s own investigation following Ms Thawley’s death. It was also being done to assuage outstanding concerns of the minister and others.

Mrs Thawley’s death was a “never event with unexplained circumstances” and the aim of an inquiry was to find out about what exactly happened from the time she entered the hospital to when she underwent surgery.

Unexplained circumstances

He refused a number of requests from the NMH’s senior counsel Paul Gallagher to withdraw his “unexplained circumstances” claims because, counsel said, they had all been explained in previous reports. He insisted there were and remained unexplained circumstances which needed answering.

He said one of the main objectives of an inquiry would be to look at situations, where there is not a full complement of staff in a hospital, whether there is a procedure and checklist for actions which help increase patient safety. These can be monitored rather than have an arrangement whereby phone calls take place between staff which makes for very little auditing to ensure best practice.

The question arose as to whether they were in existence in the NMH during the Thawley case, whether they were followed and whether there was room for improvement, he said.

Dr Holohan said an early warning score system, such as had been adopted after the death of Savita Halappanavar in Galway in 2012, had saved hundreds of lives.

It brought formality to vital sign measurements by nursing and medical staff which meant it was not just left to the judgment of individual doctors or nurses and was “much more superior to the total judgments” of staff.

Dr Holohan also told the court the proposed HIQA investigation would cost €328,000. However, it could be done in one year rather than the three it was expected to take because it would only examine the NMH rather than the wider maternity services, he said.

In its judicial review action, the NMH says a statutory HIQA inquiry will be highly disruptive, demotivate staff and undermine public confidence in all maternity services. The Minister denies the claims.

The case resumes before Mr Justice Charles Meenan on Tuesday.