Cinneadh
Dr. Z and The Health Service Executive/Cavan and Monaghan Hospital
Ó Oifig an Choimisinéara Faisnéise
Cásuimhir: OIC-144860-S6X4X7
Foilsithe
Teanga: Níl leagan Gaeilge den mhír seo ar fáil.
Ó Oifig an Choimisinéara Faisnéise
Cásuimhir: OIC-144860-S6X4X7
Foilsithe
Teanga: Níl leagan Gaeilge den mhír seo ar fáil.
Whether the hospital’s deemed refusal of the applicant’s request for access to various records relating to augmentation during birth and labour was justified under the FOI Act
2 April 2025
The applicant in this case is represented by a solicitor in this matter and therefore all references to the applicant in this decision should be taken to include correspondence with her solicitor where appropriate. On 4 May 2023, she made the following FOI request to each of the 19 maternity units in the State:
“We request the following data for the month of October 2022. For each of the questions below, please provide a breakdown into nulliparas and multiparas.
1. Please provide us with the total number of births in October 2022 and a breakdown of full term (from 37 weeks) spontaneous onsets of labour (SoL) vs. induced labours (IOL).
2. Of those with SoL, how many labours were augmented during labour including amniotomy/artificial rupture of membranes (ARM) and augmentation with syntocinon?
3. Of those with SoL who were augmented, please provide a breakdown of type of delivery: how many had a spontaneous vaginal delivery, how many had an instrumental birth (suction cup or forceps) and how many had a c-section?
4. Please provide us with the hospital protocols/policies/standard operating procedures relating to augmentation of labour, and/or management of prolonged labour and/or management of ‘failure to progress’, including references to the national or international clinical guidelines that they are based on.
5. Please provide us with any clinical audit reports relating to augmentation and/or management of prolonged labour and/or management of ‘failure to progress’ that have been conducted in your hospital.”
The applicant’s request was forwarded to the HSE National Lead Office (NLO) for review and management. It appears that this was done in order to establish if the records sought were held nationally. I also understand that a number of the hospitals, including the hospital in this case, informed the applicant that her request was being dealt with at a corporate national level by the National Women and Infants Health Programme (NWIHP).
On 20 June 2023, the NWIHP issued a decision (HSE reference C285/23) wherein it stated that it was part-granting the applicant’s request set out above. While the letter did not specify this, I understand that it was intended to be a response to her request on behalf of all 19 individual maternity units. The NWIHP provided some limited information relating to parts 1, 2 and 3 of the request, including details of the total number of births in October 2022 and those which had involved a procedure for augmentation. It also provided information and links to some guidelines which it considered to be relevant. The NWIHP refused access to additional relevant records under section 15(1)(a) of the FOI Act, on the basis that further records did not exist or could not be found.
I understand that the applicant made an internal review request to the hospital in June 2023 on the basis of a deemed refusal, but that she was informed that NWIHP was dealing with the request and that she could seek an internal review of its decision. As she received no further records or substantive response, the applicant made an internal review request to the HSE National Lead Office (NLO) and to the individual maternity units on 19 September 2023.
As she had received no further substantive response, on 29 November 2023, the applicant applied to this Office for a review of the HSE’s decision on behalf of 18 of the maternity units. A small number of hospitals had issued decisions and internal review decisions on her request directly, all of which she sought to have reviewed, except the internal review decision made by one hospital, which had provided the majority of the information sought. On foot of correspondence from this Office, the HSE NLO issued an effective position letter on 16 January 2024.
The NLO affirmed the NWIHP’s original decision, apparently on behalf of all 19 maternity units, although again, this was not stated. It said that the HSE’s Hospital In-Patient Enquiry (HIPE) data did not contain information relating to spontaneous onset of labour and that the NWIHP did not hold information in relation to local hospital protocols, policies or standard operating procedures. Essentially, it said that that the NWIHP and HSE Acute Operations made “all reasonable efforts to locate relevant information and respond comprehensively” to her request. It further stated that the NWIHP, as a national office, did “not govern or maintain local hospital information”.
Following receipt of the HSE’s effective position letter, the applicant informed this Office that she was not satisfied with the HSE’s decisions or the hospital’s deemed refusals.
I have now completed my review in accordance with section 22(2) of the FOI Act. In carrying out my review, I have had regard to the submissions made by the applicant and by the hospital. I have also had regard to correspondence between this Office and the HSE in relation to the matters set out above. I have decided to conclude this review by way of a formal, binding decision.
This review is solely concerned with whether the hospital was justified in its deemed refusal of the applicant’s request for records relating to augmentation during labour and delivery on the basis of section 15(1)(a) of the FOI Act.
The applicant is an academic researcher, who made her request as part of a series of five requests made by her research team. As set out in my decision in OIC Case No. OIC-144860-S6X4X7, the way in which the applicant and her team’s various requests were handled by the HSE has not been up the standards expected. As noted above, the HSE purported to issue a centralised composite decision and an effective position in relation to the matters concerned. However, none of these letters stated that the requests had been transferred to another part of the HSE or on behalf of which maternity units the decisions were intended to issue. Furthermore, it appears that the HSE then effectively informed the applicant that it did not hold the records sought at a national or corporate level and relied on section 15(1)(a) of the FOI Act. This has frustrated the applicant’s attempts to access the records sought. I would expect the HSE to have regard to the precise nature of the records sought when deciding whether to deal with such requests at a national level in future.
As set out in my decision in OIC Case No. OIC-144713-G5T5Q1, the applicant’s request above is No. 2 in a series of five requests. The applicant is of the view that the HSE’s and the hospital’s decisions on all five requests should form part of this Office’s review of each decision or deemed refusal to release the records sought. I have addressed her submissions on this matter in OIC Case No. 144713.
While I shall not go into the details in this decision, I am satisfied that the applicant was put on notice that only the decisions or deemed refusals in relation to FOI Request No. 2, concerning augmentation, would be reviewed by this Office. I am also satisfied that she was given an opportunity to comment or to provide further evidence but that she has not provided any persuasive argument or evidence in support of her position. It is, of course, open to the applicant to make new requests to the relevant units seeking the additional records concerned.
Section 15(1)(a) of the FOI Act provides for the refusal of a request where the records sought do not exist or cannot be found after all reasonable steps to ascertain their whereabouts have been taken. Our role in a case such as this is to review the decision of the FOI body and to decide whether that decision was justified. This means that I must have regard to the evidence available to the decision maker and the reasoning used by the decision maker in arriving at their decision and also must assess the adequacy of the searches conducted by the FOI body in looking for relevant records. The evidence in “search” cases generally consists of the steps actually taken to search for the records along with miscellaneous and other information about the record management practices of the FOI body, insofar as those practices relate to the records in question.
As set out above, the applicant made her original request to the hospital directly. This request was effectively transferred to the NWIHP, which issued its decision on 20 June 2023. As also set out above, the NWIHP refused most of her request on the basis of section 15(1)(a) of the FOI Act. The NLO subsequently affirmed this decision in its effective position letter on 16 January 2024.
In her application for review to this Office, the applicant maintained her position that the records sought were held locally, i.e. by the hospitals to which her requests were made.
During the course of this review, the HSE informed this Office that it did not hold any additional information relating to the applicant’s requests centrally, and that instead the information was held by the individual maternity units. In its submissions to this Office, the hospital in this case confirmed that it was not asked to search for records or to provide any information to the NWIHP or the NLO for the purposes of processing the applicant’s request.
Unusually, in this case, the applicant and the FOI body are in agreement about the relevant issue – i.e. that the records sought are held locally by the individual maternity units, in this case by the hospital, rather than centrally by the HSE. However, neither the original decision maker nor the internal reviewer asked the hospital to carry out searches for relevant records.
As set out in my decision in OIC Case No. OIC-144860-S6X4X7, the HSE’s published Maternity Safety Statement guidance book, which relates to the collation and publication of maternity-related statistics, provides that this data should be sourced directly from each maternity unit, rather than from national-level datasets such as HIPE. From an examination of this guidance, it seems to me that it should have been clear to the HSE that the records sought by the applicant in this case, i.e. records relating to specific clinical matters in a maternity unit, were held at a local rather than at a national level. Accordingly, it is unclear to me why matters proceeded as it did in this case.
In any event, the hospital in this case has confirmed that it took no steps to locate records relating to the applicant’s request. Accordingly, I simply cannot find that section 15(1)(a) of the FOI Act applies. In the circumstances, it seems to me that the only logical course of action available to me is to annul the hospital’s deemed refusal of the applicant’s request and remit the matter to the hospital. The effect of this is that the hospital must consider the applicant’s request afresh and make a new, first instance decision in accordance with the provisions of the FOI Act. The applicant will have a right to an internal review and a review by this Office if she is not satisfied with the hospital’s fresh decision. I would encourage the hospital to engage with the applicant with a view to identifying the specific records sought while processing this request.
Having carried out a review under section 22(2) of the FOI Act, I hereby annul the hospital’s deemed refusal of the applicant’s request and I direct it to process the applicant’s request afresh in line with the provisions of the FOI Act.
Section 24 of the FOI Act sets out detailed provisions for an appeal to the High Court by a party to a review, or any other person affected by the decision. In summary, such an appeal, normally on a point of law, must be initiated not later than four weeks after notice of the decision was given to the person bringing the appeal.
Sandra Murdiff
Investigator