Saturday, February 28, 2015

A dispute born of HSE unaccountability

                                                               PHILOMENA CANNING

PHILOMENA CANNING has been allowed to return to work. Three weeks ago, the last time this column visited the State’s attack on Ms Canning, that phrase was hardly imaginable

The Health Service Executive had tied itself in knots, giving the serious impression that it was trying to hang Ms Canning any which way it could. Form suggested it would muddle on, behind closed doors, until finally somebody would shell out a chunk of public money in lieu of accountability.

Then, last Wednesday, apparently out of the blue, the HSE’s solicitors, Arthur Cox, wrote to Ms Canning’s that she could return to work, as “the temporary suspension is no longer in the public interest”. The burning question is whether it was ever in the public interest, or whether there was an agenda against an independent-minded woman who refuses to tug the forelock to those who regard themselves as her betters.

Canning’s case is the latest example of how the State deals with dissonant voices that threaten the status quo, or that raise uncomfortable questions. Its import goes far beyond what appears to be the hounding of an innocent woman.

Quick recap. Philomena Canning is the leading home-birth midwife in the State, having practiced for more than 30 years. Her clients refer to her work in superlatives. One woman to whom I spoke alternated between outrage at the treatment of Ms Canning and wonderment at how the midwife had delivered her baby.

The admiration isn’t universal. Homebirths are frowned on by the medical establishment here, but in other jurisdictions they are a growing phenomenon. For cultural reasons — not to mention vested interests — home-births remains the choice of a small minority here.

Canning is a passionate advocate for home-births, and has never been backwards in representing women who feel ill-served by the State’s approach to the practice. As a result, she has never been well got in the mother-ship of the HSE.

She is also an advocate for a public health system, and so wanted to open birth centres in conjunction with the HSE. These centres would provide for birth in a home-like setting, and are highly popular in other countries. No thanks, came the reply.

So she set about it herself, acquiring premises and funding, intent on doing it privately under the HSE’s home-birth scheme. Then, last August, just as the project was reaching fruition, she got word that her indemnity insurance was being withdrawn, pending an inquiry.

The inquiry involved two births, delivered by Canning, in which there were routine, minor complications. In both cases, the mothers were effusive about the care they had received and have supported Canning since. Somebody in the HSE determined that the cases required investigation. Canning sought a High Court injunction to prevent her suspension, but she was unsuccessful. She appealed the ruling. That appeal was due to be heard yesterday. Then, last Wednesday, she got word that all bets were off.

What changed? In preparation for the appeal, Canning had commissioned independent reports on her case from maternity-care authorities in the UK. Two reports endorsed her position, one in a tone that barely concealed outrage at her treatment.

The HSE commissioned its own report, which, guess what, also came out in favour of Canning. How often does an ‘independent’ report prepared for court tell its client the polar opposite of what it was commissioned to find.

Quite obviously, the HSE saw the writing on the wall. There was no chance of winning in the appeal court. Instead, it was possible that one of the judges might issue a withering response to the agency’s case. That would raise further questions about the so-called inquiries into Canning.

All was not lost, however. On Tuesday, the day before the HSE caved in, Canning received a long-awaited response to her proposal of last August on the birth centres.

“My dream, for many years, was to open Ireland’s first such centres to the public, and I had two centres on the verge of opening, back in September, when I was unlawfully suspended,” Canning said yesterday in a statement.
“Stand-alone birth centres in the community, a model widely adopted in the UK, are not alone more economically advantageous over hospital births, they also provide the best outcomes in low-risk births.”
And the long-awaited response? “The answer, in short, was no. For reasons not specified, it was made clear the HSE does not acknowledge this under their (home birth) scheme,” she said.

So, at least the turbulent midwife has been put back in her box. She is allowed to resume practice, but she can forget any notions of developing home-births in line with the status they are accorded in ‘first world’ countries.

In its statement on Canning’s reinstatement, the HSE noted that its two inquiries, which precipitated the suspension, were continuing. (The Dail was told, late last year, that the second inquiry was set up to expedite the first, but, despite its raison d’etre, it was not possible to give a timeline for this second inquiry).
This is now little more than a box-ticking exercise, particularly in light of the three reports that were commissioned by Canning and the HSE. Her own legal action against the agency for suspending her, and the fallout thereof, is continuing.

Serious questions, vital to both public health and how power is exercised in a democracy, remain to be answered. A woman was put out of her job, her career jepordised, and 29 clients, who had retained her services for a major life event, were left high and dry. This was done because she allegedly presented some form of threat to public health. The evidence for such an allegation is highly suspect, to put it at its mildest.
Was the public interest the real imperative, or was some other agenda at work? As stated here previously, form would suggest that the ultimate outcome will be that the HSE will settle with Canning, including a premium to ensure confidentiality on the matter, and there it will be buried. Form also suggests that very serious pressure will be placed on Canning to accept such a settlement, if she intends to continue practicing in this country.

This is simply not acceptable in today’s world.

A woman whose contribution to this society far outweighs anything offered by mandarins in the HSE. She has had her life turned upside down.

Her personal travails are worthy of great consideration, but the implications of how she has been treated go far beyond that. The only course that could restore any confidence in the system is an inquiry into how and why the HSE initiated its inquiry into Canning. There are, unfortunately, two chances of that ever happening.

Midwife’s case is the latest example of how the State deals with dissonant voices

Michael Clifford

No comments:

Post a Comment