Establishment of an ex-gratia scheme for women who underwent the procedure of symphysiotomy
The Government today (Tuesday 1st July 2014) announced the establishment of an ex-gratia scheme for women who underwent the procedure of symphysiotomy.
This Government recognises the pain and suffering that many of the women who underwent this procedure suffered. It hopes that the ex-gratia scheme, which will allow women to accept an award of between €50,000 and €150,000, thereby relieving them of the burden of pursuing their case through the courts, will help to draw a line under the issue for those affected.
To date, in a very small number of cases, insurers of the hospitals and the obstetricians who carried out the procedures have been found liable by the courts. However, Government recognises that the women affected are of advanced years, that such court cases can take a long time to come to a conclusion, and that not all women will want to pursue what can be a difficult case through the courts.
The Government profoundly regrets the serious and damaging effects symphysiotomy has had on many of the women and their families and hopes that today’s announcement of an ex-gratia scheme, together with a commitment to continue providing health and social care supports, including access to a Medical Card, will finally help to bring closure for them.
By today’s standards symphysiotomy would not be indicated. Evidence shows that for some women, the procedure resulted in chronic pain and limited mobility, incontinence, neck and back problems and also psychological problems.
In the case of symphysiotomy carried out after the baby had been delivered by caesarean section, Government supports the Supreme Court’s position that the procedure was indefensible and wrong. This Government strongly condemns this practice, which was not in keeping with best practice at any time.
This Government has acknowledged the pain and suffering which the procedure caused to many of the women who underwent symphysiotomy, and does so again today. Some women have been left with medical problems, as well as psychological problems in relating to their partners and reestablishing normal sexual relations following the procedure.
For many women, today’s decision comes after a very long wait; previous administrations chose not to act to bring closure to the women and their families. However, this Government has recognised the importance of this issue, and today’s decision represents an honest intention to try and bring a resolution to this matter.
It has been important to ensure that the decision of Government is considered fair to women who endured a symphysiotomy. The Government wishes to thank Professor Oonagh Walsh and Judge Yvonne Murphy, whose reports were crucial to reaching today’s decision, and which will be published today. Government also wishes to thank the women and family members who participated in the process and shared their experience with Prof Walsh and Judge Murphy, so that we would be fully informed about all relevant issues.
Government hopes that the establishment of an ex-gratia scheme and the commitment to ensuring that the HSE continues to provide access to health and social care services (including Medical Cards), will finally help these women, and their families, to find the closure they so badly want.
Notes for Editors
Background to symphysiotomy
Symphysiotomy was a statistically exceptional intervention in Irish obstetrics. At the height of its use in Dublin, from the mid-1940s to the mid-1950s when it went into decline, it accounted for 0.34% of the total deliveries at the National Maternity Hospital and 0.4% at the Coombe Hospital. It was carried out on around 1,500 women, about 350 of whom are still alive.
Symphysiotomies were not carried out secretly in Irish maternity hospitals and the practice continued in a number of them until the mid-1960s, when use of the procedure had ceased in other countries by 1950. In one hospital, Our Lady of Lourdes in Drogheda, the practice continued until the mid-1980s, placing this hospital firmly outside of normal practice.
One of the principal reasons for symphysiotomy was the dangers associated with caesarean section, which were very real in the 1950s and 1960s. Professor Oonagh Walsh noted in her report that although the caesarean section operation had a high rate of success, it also had a far greater maternal mortality rate than symphysiotomy. She also referred to 10 studies between 1908 and 1995, where it was found that maternal mortality was 4 times higher with caesarean section in the first half of the twentieth century and 6 times higher in the second half of the century.
The Supreme Court has found that there was no justification whatever, in any circumstances, for the performance of symphysiotomy ‘on the way out’ – that is, after the baby had already been delivered by caesarean section. There are around 10 women who are still living who underwent this particular procedure.
The reports on this issue from Professor Oonagh Walsh and Judge Yvonne Murphy state that in a number of cases, the procedure was carried out without the woman’s knowledge or consent.
Operation of the ex-gratia scheme
The State Claims Agency has agreed to administer the scheme and it has estimated that it will take around 8 working weeks to put in place the operational details for the scheme. Account must be taken of the fact that the women are old and should not be put under undue stress. The State Claims Agency must agree on:
- the most appropriate way of assessing that a woman had a surgical symphysiotomy;
- the level of medical and other problems that have arisen as a result of the procedure;
- whether the procedure was “on the way out”.
View the Independent Review of Issues relating to Symphysiotomy by Judge Yvonne Murphy here
View the Report on Symphysiotomy in Ireland 1944-1984 – Professor Oonagh Walsh here
Listen to the Press Conference