Hiqa raised concerns over maternal bleeds at Portlaoise Hospital
Patient safety inspectors raised concerns about the rate of haemorrhage after birth and also the quality of ultrasound scans in Portlaoise Hospital as late as last December.
Hiqa wrote to senior management in Portlaoise on December 16, as it finalised its investigation into safety standards at the hospital, where five babies died.
It identified a potential area of concern in the rate of post partum haemorrhage (blood loss in the first 24 hours after giving birth), according to correspondence seen by the Irish Independent.
Hiqa asked that as a priority it reviewed the current rate of post partum haemorrhage, validate data and also examine the clinical arrangements in place to reduce the risks relating to this kind of haemorrhage. This would include the supervision of junior doctors in the maternity unit and multidisciplinary working arrangements.
It asked for reassurance no later than January 12.
A separate letter from Hiqa to Portlaoise the following day said that in June 2014, it found concerns with obstetric ultrasound scan services in the hospital, which investigates the foetus.
At that stage, the investigation team was not satisfied about the safety of the service.
When they checked again with management in October, the investigators were told measures were under way, including more training and recruitment of staff.
In response to the post partum haemorrhage concerns, the hospitals gave a detailed reply, saying its data supports the view that its maternity services had the appropriate processes in place to manage the prevention and treatment of haemorrhage in an appropriate and effective manner.
In response to the use of ultrasound scans, the hospital said that junior doctors at senior house officer level no longer perform this screening .
Junior doctors at registrar level scan with senior consultant support.
The service is overseen by a consultant obstetrician who agreed to oversee it, said the hospital response.
Separate documents reveal how Hiqa received 15 pieces of information in relation to various aspects of patient care at Portlaoise between 2008 and the end of 2011, when it was asked to do an investigation into the hospital. It said that "as a result of the concerns highlighted in the information, Hiqa engaged with the hospital locally and with the HSE nationally".
During 2012, further information was received and based on potential risks it carried out a hygiene inspection, finding it has inadequate clinical governance in place, which posed a risk to patient safety.
These risks were escalated to the hospital and the HSE nationally over a period of eight months. It raised the issues again later with the National Director of Acute Hospitals in the HSE.
This was before the 'Prime Time' investigates programme on Portlaoise in January 30, 2014, which highlighted the deaths of babies in similar circumstances over a number of years.
The highly critical Hiqa investigation report was published last month.