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On 4th July, the Minister for Health, Dr James Reilly announced that an inquiry was to be set up into the events related to the case of 14 year old Maedhbh McGivern from Leitrim who lost an opportunity for a liver transplant on 2nd July due a failure in transportation facilities. The inquiry is being carried by the Health Information and Quality Authority (HIQA) but it was not until 12th July that HIQA published the terms of reference for the inquiry which are to:-

• Review the chronology of events in relation to the attempted transfer of Meadhbh McGivern, following confirmation of an available donor organ, up to and including the standing down of transportation.

• Review the governance, communications, management and systems and processes in place for the current operational arrangements, within and between the relevant agencies, for the emergency transportation of a person requiring transplant surgery.

• Make recommendations, where required, to ensure a person requiring care and transportation for transplant surgery receives integrated care which is coordinated effectively within and between the relevant agencies and service providers.

• Make recommendations that the Inquiry deems appropriate in relation to the implementation by the relevant and accountable agencies of any findings and recommendations that may emanate from this Inquiry.

In the meantime Minister Reilly expressed his deep concern and sympathy to the McGivern family over the traumatic events that have led to this lost opportunity.

The inquiry arose after 14 year old Meadhbh McGivern and her parents Joe and Assumpta received a call from King’s College Hospital in London at 19.20 on 2nd July to say a matching liver had been found. The Department of Health have said that it is not appropriate for it to go into the details of the matter until there is a full understanding of the sequence of events, which HIQA will seek to establish and in the absence of official confirmation we are constrained in making a complete account of the event. According to the Department of Health an air ambulance service is provided by the Air Corps through a service level agreement which provides inter alia for the transfer of patients requiring specialised emergency treatment in the UK. From the beginning of the year and to 5th, 41 air ambulance missions assisting liver transplant and other patients were carried out both nationally and internationally. The Irish Coast Guard has also facilitated the HSE with the transport of a transplant patient in the past few months, and has assisted the national ambulance services on approximately 15 other occasions. The HSE national ambulance service has a maritime and aviation operation manual, which is reviewed on an annual basis. This deals with all types of missions in respect of aero-medical transport of patients to the HSE from the Air Corps and the Irish Coast Guard.

From the available information the sequence of events were as follows. Within ten minutes of receiving the call from her home in Ballinamore, Co Leitrim, Meadhbh and her parents, were packed and ready to leave. However, they waited at home for two-and-a-half hours as three separate agencies - Our Lady's Hospital in Crumlin; Emergency Medical Support Services (EMSS), a logistics company contracted by the children's hospital to co-ordinate patient transfers, and HSE ambulance control - tried to arrange her transport. King's College Hospital also contacted EMSS, which at 19.45 informed HSE ambulance control about the mission. Ambulance control in turn contacted the Air Corps between 19.45 and 20.00. In this particular case the normal stand-by Air Corps helicopter was unavailable as it had been called to another emergency mission in Kerry. According to the Department of Transport, the Coast Guard received an 'exploratory call' from the HSE at 19.10 around the same time as the family and before the Air Corps were contacted asking if it might be able to help, but the Coast Guard told the HSE no aircraft was available at that time. The Department said the Coast Guard then got a second call from the HSE at 20.50 formally requesting assistance. The HSE however say it formally requested assistance from the Coast Guard just after 20.00.

Dun Laoghaire, Co. Dublin based EMSS said that at 19.31 it received a pager call from King's College Hospital in London about the case and subsequently advised HSE ambulance control at 19.46. It also called the patient's guardian after calling ambulance control. At 20.00, EMSS says it was advised by HSE ambulance control that no Irish Air Corps or Coastguard aircraft or helicopter were available for the transfer. It has been contracted by Our Lady's Children's Hospital in Crumlin to co-ordinate transport for transplant patients since 1999. It also provides nationwide medical transport services for other organisations. It is run by John Kelly (53), a risk management consultant, and Declan Traynor (38), an emergency medical technician. It has transported over 45 patients for Our Lady's Hospital in the past 12 years. Over the next hour (until 21.00) EMSS tried to get an Air Ambulance, urged King's College to source a private plane in the UK and put a call out for assistance from the RAF. The Air Corps reportedly offered the Gulfstream IV due back in Baldonnel from Monaco with the president at 20.30, but this offer was declined. Given that options being considered did not apparently require a fully equipped air ambulance, why the option of scheduled air services to London or the use of the CASA were not explored remain to be explained. Similarly, the as the Coastguard have six helicopters on standby at four locations with a response time of 15 minutes during daylight hours and 45 minutes at night.

Meanwhile Our Lady's Hospital in Crumlin, which was kept abreast of the difficulties, had also set about trying to source a private plane and had found one in the UK by 21:00. EMSS claimed the hospital was waiting on funding approval for the aircraft -- it reportedly would have cost more than €14,000 -- a claim the hospital has denied. Within half an hour, the Coast Guard control reported back that the Sligo helicopter looked positive. After a lengthy delay the McGiverns were told to go to Sligo Airport at 20.03. They arrived at 20.56 Sligo Airport in Strandhill to board the Sligo Coastguard helicopter. Only then, when EMSS rang King's College Hospital at 23.08 with an estimated time of arrival of 03.30 did the urgency become apparent. At 23.20 EMSS says it was told to stand down. At 11.23 Mr McGivern got a call to say that the family would not make it in time and the liver would be offered to another patient.

Finally in the aftermath of the fiasco, an event, organised for 7th July to allow parents of transplant recipients to thank the Air Corps for flying their children to their life-saving operations, was cancelled after it was deemed inappropriate. Among the 100 invited guests were 41 young children who are all either on the liver transplant list or who are transplant recipients. Members of the Air Corps and HSE were also scheduled to join the families for the event, which was planned to raise awareness of the importance of organ donation in Ireland. One of the organisers, Aoife O'Gorman, from Dalkey, Co Dublin said her group would consider rescheduling the event.