An IVF mortality: Lessons to learn

A report on the circumstances surrounding the 2003 death of Irish IVF patient Jacqueline Rushton has been published. The report was commissioned by the Republic of Ireland's Health Service Executive (HSE), and written by Alison Murdoch of the Newcastle Fertility Centre and independent healthcare consultant Stuart Emslie. Rushton, a 32-year-old nurse, was treated at the Human Assisted Reproduction Ireland unit of Dublin's Rotunda Hospital. She was admitted to this same hospital on 8 December 2002, after she was found to be overreacting to her IVF treatment, and was subsequently transferred to Dublin's Mater Private Hospital. Despite initially appearing to make a recovery, she collapsed and was placed on a ventilator, which was switched off on 14 January 2003. The cause of Rushton's death was found to be acute respiratory distress syndrome, a rare complication of ovarian hyperstimulation syndrome - itself a complication associated with IVF, where fluid from the bloodstream leaks into the abdominal cavity and causes it to swell.

The report concludes that there were problems with the management of Rushton's care, compounded by a lack of senior supervision and inconsistent compliance with official guidelines for treating her condition. The report recommends regular care audits, in which it is incumbent upon hospitals to prove standards rather than merely claiming to have them, together with and a review of in-house protocol in all general hospitals and IVF clinics.

Rushton's family have declared themselves satisfied with the outcome of the report, and they have instructed their solicitors to drop legal proceedings against the health authorities. They have also expressed their hope that the report's recommendations will prevent another family from going through the same ordeal. The Irish Patient Association has said that the episode raises significant questions about patient care. Irish health minister Mary Harney has announced that immediate steps are being taken to implement these recommendations across HSE hospitals.

The statement, issued by the Master of the Rotunda Hospital Dr Michael Geary acknowleged "lessons have been learned". "In all medical treatments, one cannot always be guaranteed that the outcome will be positive and every effort is made along the way to comply with best practice in patient care and treatment," Dr Geary said. "We sincerely hope, with the new insights and learnings available to us, that a similar incident can be prevented from occurring again in the future," he concluded. "There is always an onus on any healthcare provider to review their processes and systems and this report underlines again this requirement. It is very important for us to learn from this tragic event."

OHSS is the only medical emergency that a Fertility physician faces in his/her career. This report is important because it highlights the possibility of death in the event OHSS is not managed properly. For bloggers interested in the subject, Rotunda is hosting an International Congress on PCOS at Goa in August 2008. There will be an entire video session dedicated to the management of OHSS. The link to follow will be www.sisab.net/pcos2008