Monday, 26 November 2012

On the records

Two recent cases in the Republic about Freedom of Information and the Abuse of power

A Stroke Too Far?

In the Republic, Minister of Health James Reilly is in trouble - and Freedom of Information has a major part to play.

In July this year, working with Minister of State for Primary Care (a junior ministry) Róisín Shortall, the Department of Health produced a list of 20 primary care sites for development, a list weighted in favour of particularly deprived areas of the country. On 16 July, it was announced that this list, approved by the Minister of Health, was to be published; by now there were 33 potential locations on the list. When the list was published, it had grown to 35. There were two significant additions: Swords and Balbriggan, neither particularly deprived - and both in the Minister's constituency.

After it was disclosed that these locations had been added to the list after it was passed to Reilly's department, Minister of State Shortall - a member of the Labour party, minority partners in the governing coalition - said she found this 'difficult to understand'. Despite support from Labour rank and file, she was not supported and she resigned both the ministry and the Labour whip.

The accusation was made that this was 'stroke politics' - the kind of devious backroom deal that had been typical of Irish politics in the past - especially when it turned out that the site for the proposed Balbriggan centre was owned by a property developer linked to Reilly and his Fine Gael party. The Minister, who had had the list in his possession for a week before publication, explained that the selection of the sites was a complex operation: 'a logistic, logarithmic progression. There is nothing simple about it'.

But emails released under the Freedom of Information Act showed that the two sites in question were added to the list in just two hours, shortly before the list was published.

The opposition has demanded his resignation. In a country that cared about such things, he would have resigned already. But as a close associate of the Taoiseach, Enda Kenny, and as deputy leader of the majority coalition partner, it's unlikely he will go.

'Stroke' politics may be alive and well in Ireland, but at least things which used to be carried out in private have now been exposed publicly. Let's hope the voters take this into account at the next election.

Off the record

Another medical-related story in the Republic: in the continuing saga of Savita Halappanavar's death, her husband has obtained copies of her medical records. A major part of the story was her repeated requests for a termination of her pregnancy, which was refused. But the records, eventually disclosed to her husband's lawyer, make not mention of this. They refer to her requests for a cup of tea and toast, and a blanket - but the termination requests do not appear to have been recorded.

This point led to a fascinating and troubling discussion on the MagicMum website. Commentators repeatedly described the medical records of their pregnancy and delivery as plain wrong: "There were lots of things missing off my notes", "Each time I was in hospital I would cry in agony during the night and request pain relief. Each morning was noted "patient slept well", "My notes were very different from the reality", "totally not true", "a work of fiction masquerading as medical notes", "My notes said I refused to push. I bloody did not."

One contributor pointed out that, in an understaffed wards, mistakes were inevitable: "When notes are being written , there are three things , what the patient thinks happened , what the staff member thinks happened and what actually happened . All of which are different ."

But others pointed out situations where facts seemed to be suppressed or distorted for a reason, especially when touching on the controversial subject of abortion:

"I've had an abortion previously and told the Coombe [Hospital] so. The midwife insisted on recording it as a 'confidential' pregnancy, saying that that was how they record them all, despite the fact that I told her 3 times I didn't mind it being recorded as an abortion."
"I went to two different hospitals over 5 pregnancies. The first of those 5 pregnancies resulted in a termination. That hospital put it down as an abortion on the following pregnancy. I changed hospital and on the next three pregnancies they recorded it as a miscarriage along with my other miscarriages. I told them at each booking in appointment that it was an abortion and they listed them all as miscarriages at 14, 13 and 10 weeks."

 Worryingly, while some contributors had been given easy access to their records, others found it difficult:

"I asked to see them once and the nurse told me I wasn't allowed see them. She went off to check with someone and came back to say I definitely wasn't allowed see them."
"I applied under data protection and was told that as I had a private consultant, the notes were not mine but his property."

"After my first was born, I wrote a complaint in my notes under the delivery records - when I requested my notes a year later, the page was photocopied and my complaint was cropped."

"I browed through and mixed with my notes were the notes of a totally different patient."
This is a really good example of the importance of Freedom of Information legislation available to ordinary people. One way of ensuring that accurate records are kept is to encourage people to check their own records. Falsifying information or playing down uncomfortable realities is an abuse of power - and one that can only be answered by ensuring that everyone has the right to tell their side of the story. It should not take a tragedy like that of Savita Halappanavar to get this message across.

Practice note: the access regime for personal data in the Republic is the opposite of that in Northern Ireland. In the south, personal data is provided for free by public authorities but other requests require a fee paid; in the north, FOI requests are free but Subject Access Requests for personal data require a charge (not always levied).

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