Draft extracts of a report into an external review of care given to newborn babies at Portiuncula University Hospital have been sharply criticised by the INMO (Irish Nurses and Midwives Organisation).

The representative organisation told senior management in the HSE and Saolta that it had “serious issues” with the review and its methodology.

It called for the review to be “stood down” immediately, and a new review commenced that complied with fair procedure and HSE policy.

INMO Assistant Director of Industrial Relations, Mary Fogarty, listed three major “failures” of the external review in a letter sent last week to Tony Canavan, Regional Executive Officer of HSE West and Northwest.

They included “failure to follow a systems analysis approach”; “failure to apply the principles of fair procedure and natural justice”; and “failure to appoint a multi-disciplinary team to undertake the review of a category one incident”.

In the letter – seen by The Connacht Tribune – INMO said the draft extracts of the review sent to its members were “inappropriately and unfairly apportioning blame”.

The reviewer, Ms Fogarty asserted, was “making erroneous findings of fact”.

Mr Canavan announced in late January that an external review was ordered into care given to nine babies in Ballinasloe.

The investigations centred on the deliveries of six babies last year, two still-born babies delivered in 2023, and one baby born in January.

Five of the newborns were referred for neonatal hypothermic treatment, also referred to as neonatal cooling, after being diagnosed with Hypoxic Ischaemic Encephalopathy (HIE) or brain injury. HIE is caused by a deficit of oxygen or blood supply to the brain before, during or after birth.

The INMO has taken issue with the external review in at least one of those cases, after extracts of a draft report were relayed to its members.

Ms Fogarty said the INMO believed there was “a failure to apply the principles of fair procedure and natural justice”.

She said the purpose of the review was to examine systems and processes in place to prevent risks and identify actions to reduce incidents occurring again.

“The actions of individuals will naturally be examined in the context of the overall system, the focus, however, of an incident review is to identify learning to inform safety improvement and should not be used as a mechanism to apportion individual blame. The draft extracts received are inappropriately and unfairly apportioning blame,” she said.

Ms Fogarty told Mr Canavan that there was “misrepresentation of the evidence” and the draft report was “drawing flawed conclusions”.

The review, she said, made “erroneous findings of fact” about “alleged failure to comply with escalation policies” without providing “clear evidence” or a “rationale”.

INMO said the HSE and reviewer, “failed to adhere to the HSE National Incident Management Framework”, a claim disputed by the HSE.

The matter under review involved clinical staff, including midwives, and it was “paramount” that the review team included a senior midwifery manager, Ms Fogarty said.

She said the absence of a senior midwifery manager on the review team was “stark”, was “a clear breach of the procedure” and leaves the review open to a “level of bias against the profession of midwifery”.

INMO also criticised the methodology, which failed to follow a “systems analysis approach”.

It said the Terms of Reference of review fail to set out the methodology, and there were “failures to separate out the chronology of events”.

“Negative commentary on aspects of care is documented in a collective manner inferring collective failures on the profession of midwifery,” she said

The Terms of Reference did not provide for interviewees to be accompanied at the review, which was a “fundamental breach of fair procedures”.

In response to queries from the Tribune, the HSE issued a statement this week, insisting the ongoing reviews were in line with its Incident Management Framework.

“External reviews are currently underway into the delivery of nine babies in Portiuncula University Hospital (PUH). Each of these reviews are independent and external to PUH. All reviews are being carried out in line with the HSE’s Incident Management Framework. Once completed, we will share the review finding with each family in the first instance and offer to meet with them,” the HSE said.

This was the third high-level external review carried out in the maternity unit in Ballinasloe. Between 2019 and 2023, eight deliveries with similar issues were reviewed but the findings were never published.

A review into the delivery and care of 18 babies published in 2018 found serious deficiencies in training and staffing issues contributed to the deaths of three babies.

About 800 pregnant women attending Portiuncula were written to in January explaining the latest review. Mr Canavan assured expectant mothers about the care they would receive in Portiuncula.

Pictured: Portiuncula Hospital: External reviews are underway into the delivery of nine babies.