The HSE should urgently set up a dedicated perinatal autopsy suite at Cork University Hospital (CUH) for postmortems on deceased infants, a review has recommended in the wake of a controversy over the incineration of baby organs.
The review, set up for the South/Southwest Hospital Group, looked at how perinatal pathology services were carried out for all the group’s maternity hospitals including Cork University Maternity Hospital (CUMH), University Hospital Kerry, University Hospital Tipperary and University Hospital Waterford.
The review group, which included senior personnel from both CUH and CUMH, was set up with the aim of developing “a world class regional perinatal pathology unit at CUH, staffed by committed specialist staff that would provide a full perinatal pathology service to the hospital group”.
According to the report, the perinatal autopsy service currently available at CUH is provided in what is effectively a small corridor of the main mortuary facilities at CUH with no door that can be shut to close it off from those entering and leaving the main mortuary.
“The facility is grossly inadequate as it means only one autopsy can be conducted at a time. With increasing numbers of autopsies expected (when CUH becomes a regional perinatal pathology centre), this means that in some instances, autopsies may have to be delayed for a number of days.
“There is an urgent need for a dedicated, specifically designed perinatal autopsy suite that would accommodate the service in a respectful and dignified manner as advocated for in the National Standards for Bereavement Care Following Pregnancy Loss and Perinatal Death.
“These state that autopsy practice should be ‘viewed as parent-centred and that the baby and its parents are treated with respect at all times,’” said the report, noting that the current arrangement falls far short of what is required to ensure national standards are met.
“Babies are also accepted for autopsy by perinatal pathology staff on a corridor connecting the laboratories and the stores – this is insensitive and is not appropriate and has potential to be uncomfortable or upsetting for passing staff,” said the report.
The review also pointed out that there was a need for perinatal pathology staff to have full autonomy over their facilities to ensure that all protocols to perinatal pathology are complied with while the review also recommended extra laboratory capacity to cater for an increased workload.
Both CUH and CUMH have separate governance structures though they share a campus at Wilton in Cork. Autopsies on deceased infants, placental pathology and products of conception from early pregnancy loss from CUMH are carried out by pathologists attached to the Pathology Dept at CUH.
The specialist perinatal pathology service was established at CUH in 2011 with the appointment of a consultant pathologist with a 0.5 WTE (Whole Time Equivalent) and a second perinatal pathologist was appointed in 2019 bring the WTE equivalent for perinatal pathology to 1.5.
Under proposals, it is planned that CUH would become a regional centre for perinatal pathology with a staff of three pathologists, who would provide autopsy services for maternity hospitals in the midwest Hospital Group and the Saolta Hospital Group which covers Donegal, Mayo and Galway.
According to the review, there were some 7,040 births at CUMH and a further 1,115 at University Hospital Kerry, a further 782 in University Hospital Tipperary and a further 1,635 at University Hospital Waterford giving a total number of births in the group’s hospitals of 10,612 in 2020.
Figures for University Maternity Hospital Limerick, part of the midwest Hospital Group, show there were 4,139 births there in 2020 while maternity hospitals within the Saolta Group had 1,454 births in 2019, giving a total of 16,205 births across all three hospitals groups.
This amounts to 2.3 times the number of births at CUMH and would mean that if CUH was to become a regional centre for perinatal pathology services for all three hospitals groups, pathologists there would find themselves dealing with 2.3 times their current workload from CUMH.
The Perinatal Pathology Working Group for the South/Southwest Group was formed in 2020 after it emerged that the organs of some 18 babies who died at CUMH were sent to Belgium for incineration without the consent or knowledge of their parents.
Staff at CUMH learned of what had happened around April 21st 2020, when pathology staff at CUH discovered that organs removed at post-mortem from infants between January and March 2020 had been sent in April 2020, along with clinical hospital waste, for incineration in Antwerp.
Further checks were carried out and it was learned that an earlier consignment of organs, which had been removed from infants between May 2019 and December 2019, had been sent for incineration in Antwerp in December 2019 and that the two groups related to a total of 18 infants.
The controversy, which was highlighted by an RTÉ Investigates programme, led to an independent review by an external pathologist into what happened at CUH, but publication of the report has been delayed for over a year despite repeated calls from bereaved parents for it to be published.