A proposed inquiry into patient health and welfare at the National Maternity Hospital raises massive operational and safety issues not just for Holles Street but for maternity services throughout the country, the High Court has been told.

The hospital is challenging the Minister for Health's decision to order HIQA to carry out an investigation into issues, including the carrying out of surgery 'outside core hours'.

The inquiry was ordered following the death of a woman during surgery for an ectopic pregnancy two years ago. 34-year-old Malak Thawley died when her aorta was accidentally torn by a doctor during the surgery.

Malak Thawley died during surgery for an ectopic pregnancy two years ago

In a sworn document submitted to the court, the master of the hospital, Dr Rhona Mahony, said the reasons advanced for the minister commencing such an investigation, did not make sense and ignored the unique features of maternity medicine.

The hospital says there is no justification for this inquiry, particularly when there have been three other reports into Mrs Thawley's death: by the hospital itself, the HSE and the coroner. 

It says the minister was wrongly influenced by representations made by Mrs Thawley's widower, Alan, and his legal representatives.

Senior Counsel Paul Gallagher said the hospital had no objection to a fourth investigation and has proposed an inquiry by an independent expert body such as the Royal College of Obstetrics and Gynaecology in the UK.

But he said the type of inquiry proposed by the minister would have a negative effect on the hospital and on its ability to provide services to women and children.

He said there was no justification or evidence for the Minister's belief that there was a risk to patient health or welfare in the hospital.

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In her affidavit, Dr Mahony said that because of the nature of childbirth, it was irrational for the minister to imply that the provision of services at the hospital outside core hours was unsafe. She said 30% of deliveries take place between midnight and 8am and emergency surgery is performed whenever it is required.

She said the surgeon who carried out the procedure on Mrs Thawley had performed 92 similar procedures and five independent consultants had assessed him as being qualified to carry it out independently. She said a consultant obstetrician was in the theatre within 10 minutes of being called.

Dr Mahony said if seniority of staff was a reason for the minister's view that there was a serious risk to the health or welfare of patients, then this risk existed in all maternity hospitals in the State.

Dr Mahony said it was possible that registrars would be reluctant to take responsibility in emergency situations out of hours. This she said raised massive operational and safety issues as there were insufficient consultants to perform all procedures in the hospital in any 24 hour period. This was a risk for all maternity services in the country, operating with similar arrangements.

She said clinicians might avoid high risk procedures at certain times, based on the minister's belief that childbirth had core hours.

Dr Mahony said public confidence would be undermined and patients could be deterred from appropriate attendance at the hospital. And she said the type of investigation proposed could be raised in any legal action involving the hospital.

The court heard HIQA itself told the minister in November last year that an investigation such as this could lead to an undermining of public confidence in national maternity services.

Mr Gallagher said these concerns were not taken into account by the minister. He also said the hospital had tried to avoid legal action but the minister had refused to meet with the hospital or engage with it.

The court was told recommendations made by three previous reports have been implemented to ensure such a tragedy does not happen again.

The minister denies the hospital's claims and is opposing the action. It will continue tomorrow.