The Health Information and Quality Authority is due to publish its report into patient safety at the Midland Regional Hospital in Portlaoise tomorrow morning.

RTÉ's Prime Time programme understands that the report will be released at 10am, after a year of investigation into a number of deaths of babies at the Maternity Unit at the hospital since 2006.

Prime Time understands that, despite threats of legal action by the Health Service Executive and several public clashes over the matter, the report's substance has not changed and that its core findings are essentially the same despite the reported criticism.

It is thought the findings will be extremely critical of the failure of governance and leadership across the HSE at local, regional and national level over a number of years.

In 2006, 31 of the hospital's midwives wrote to the then Minister for Finance, Brian Cowen, alerting him to the crisis situation at the hospital, stating they had a real fear that a mother or baby would die in their care.

Before the deaths of five babies, a major alarm was sounded by the State Claims Agency, a body external to both the HSE and the hospital.

In a statement the State Claims Agency said it was aware of a pattern of under-reporting of adverse events at the Midland Regional Hospital in Portlaoise.

The State Claims Agency attempted to address issues at the hospital as well as meeting with senior management and the HSE, and requested that a review be conducted.

A spokesperson for the State Claims Agency told RTÉ last night that the HSE refused the request for an external review.

The HSE said it was carrying out its own audit.

The HSE statement said it engaged extensively with the State Claims Agency and it was decided at a later meeting that a full audit was not necessary.

But the State Claims Agency now says it did not accept that, and it had requested the HSE to provide the outcome of its own audit process but the HSE failed to do so.

The 200 page report

It contains in excess of 250 adverse findings.

HIQA was in contact with 83 families, some were referred by the Chief Medical Officer, some by the HSE, some by Patient Focus. 

A number of people contacted HIQA directly following the report from the RTE Investigations Unit.

HIQA met with and interviewed 16 families. 

The report covers the five deaths highlighted in the RTÉ Investigative Unit report.

The report states there were repeated failures and non compliance in National Healthcare Standards by both the hospital and the HSE.
Individual members of HSE management at various levels in the organisation, who while not named in the report, will be identifiable by the positions they held within the HSE.   

The agency contacted the HSE in 2006 because the agency was concerned at a pattern of under-reporting of adverse events

Through protracted communications with the HSE the SCA requested that a review of the maternity unit be undertaken either by the agency or in conjunction with the HSE.

The report will state that although the HSE conducted a risk assessment of the maternity services at the Portlaoise hospital, that SCA changes arising from the review were inadequate.

The State Claims Agency (SCA), operates the Clinical Indemnity Scheme (CIS), which provides clinical indemnity for public hospitals and clinical practicioners in relation to claims arising from personal injury.

All hospitals that participate in the CIS are obliged to provide detailed information to the agency on all incidents, including adverse events that take place.

The States Claim Agency in accordance with its statutory mandate undertook a series of actions to establish the reasons for the under-reporting and to improve risk management at the hospital.

States Claim Agency statement

In a statement to the RTÉ Investigations Unit the SCA said; 

*It visited the hospital and met staff who indicated there were problems with the reporting regime. 

*The agency engaged in a series of correspondence with the hospital over a protracted period, between 2006 and 2009 to seek details of adverse events that had not been reported appropriately.  

*The agency also requested to review a report, commissioned by the hospital of an individual adverse event that was identified by the agency as being of particular significance.

*As the agency was not satisfied with the responses received, it escalated its efforts to address issues at the hospital by meeting senior management at the hospital and the HSE.

*The agency requested that a review be conducted, either by the agency on its own or jointly with the hospital and the HSE.  

*The SCA told RTÉ that the HSE refused to accept the agencies offer of a review.

Health Service Executive statement

*The HSE said it was engaging extensively with the SCA in relation to all matters.  

*Meetings were held to discuss the risk assessment processes in place and it was determined that if a full audit of maternity services at MRHP was required, this would be carried out by an agreed person.  

*Significant documentation and correspondence was sent by the HSE to the SCA. All policies, procedures, processes and risk management practices were outlined and discussed.

*Records were maintained and meetings minuted.  

*Minutes were agreed by both parties. It was decided at a meeting in December 2007, by mutual agreement, that a full audit was not necessary. 

Reply from SCA to HSE claims

*A spokesperson for the SCA told RTÉ that he disputes the HSE claim that a full audit was not required.

*The spokeperson said the SCA would only have considered a full external audit to be unnecessary if the HSE internal review produced an outcome satisfactory to the State Claims Agency.

*The agency said that this did not happen.