We need to go straight to the source of the problem and speak out against injustices in healthcare
17 April 2007
The 't's have been crossed and the 'i's dotted on the Medical Practitioners' Bill 2007. From listening to the debates in the Dáil and the Seanad one can sense that the scandal regarding Caesarean hysterectomies at Our Lady of Lourdes Hospital in Drogheda had a profound effect on the drafting and passage of the legislation.
The issue of a lay majority on the Council caused so much consternation amongst the medical profession that a group of doctors got together to oppose it. This is how democracy progresses, but one of the tactics the group employed was counterproductive. Advice appears to have been given to members of the public to write to deputies and senators telling us that if a lay majority was forced on the medical profession by the Minister for Health that abortion and embryo research would follow fast. These would be promoted by this dangerous lay majority, led by the five political appointees that the Minister for Health would put on the Council. Some said that their voting intentions in the next election would be coloured by the recipient's response.
Now, it is right to look carefully at appointments to State boards. Many are laudable, but it is odd that in the dying days of a Government, no matter of what hue, it appears essential to fill every vacancy on every board in sight - over 400 such appointments may take place or, should I say, are expected, before this Government leaves office. But let me give readers assurance that the legislation in the Medical Practitioners' Bill specifically disallows the Minister for Health from interfering with medical ethics or criteria regarding a doctor's performance, so one would imagine that the five appointees of the Minister will be very carefully watched for surrogate actions by the other twenty on the Council. All this is predicated by the fact that it is most unlikely that any Minister for Health between now and the turn of the next millennium will have any desire to introduce legislation on either abortion or embryo research. Why draw trouble on one's head when these problems are being dealt with for us by the country next door?
The fact that the whistle was blown in the Neary case by two midwives, one of whom was trained outside the state and not by one of Dr. Neary's medical colleagues, had a profound effect on Members and was expressed forcibly in the Seanad debate by Senator Geraldine Feeney. Senator Feeney, a most respected Government senator who was elected in 2002 on the Labour Panel, is a former member of the Medical Council herself and the first ever lay member elected Chair of the Fitness to Practice Committee. She was a member of the committee which enquired into complaints against Dr. Neary.
When I spoke on the Bill I said that it was unfortunate that one of the excuses Dr. Neary was able to use to explain the high number of C.S. hysterectomies he had carried out was the ethos of the Lourdes hospital which forbade sterilisation operations, even though the operation was legal in Ireland. Other obstetricians came forward to support this assertion saying that what were described as "compassionate hysterectomies" were carried out in their hospitals, too.
Senator Feeney spoke of the responsibility of those doctors who had been present at the C.S. hysterectomies and those who had received specimen after specimen of normal uteri where pathology had been suspected but not found. I quote what she said:
"The pathologist and the anaesthetist did nothing except write a report. I will not use all my time on a discussion of Dr. Neary but if I were a pathologist who received a diagnosis from a doctor that a fungus or other defect necessitated the removal of a uterus but did not find the problem, I might write a report and say no more. If I received a second diagnosis, bells would start ringing in my head. However, if I received 48 diagnoses, I would be breaking down every door in the hospital to see the man directly rather than send him a report because I would be afraid for my practice. The same would apply in the case of the anaesthetist."
Back to the 'compassionate hysterectomies'. Women had a major operation which was not medically necessary because the Boards of certain hospitals had decided a perfectly legal lesser operation could not be carried out instead. Let us not forget that not all of these Boards were made up of members of religious orders alone. Many had a majority of lay members on them. I would not like anyone to think that lay members were or will be more ethical in their decisions than doctors. Also, I do remember in some hospitals the Boards were willing to allow doctors perform sterilisations where medically necessary but theatre nurses to assist could not be found.
This sort of subterfuge regarding clinical practice should never again be entertained. If it is happening anywhere it should be stopped. Remember, when contraception was illegal here the 'pill' was referred to as a 'cycle regulator'. Instead of relying on such euphemisms far more of the medical profession should have campaigned for the legalisation of contraception. The then high dose pills were prescribed to older women with medical conditions with a greater risk of thrombotic episodes. Other, more suitable, methods of contraception should have been available to them.
If anywhere in legislation or proposed codes of practice there is any attempt at 'gagging' doctors, it has to be disregarded. Reporting to 'line managers' or 'directors' should not be tolerated if the issue seriously affects our patients. We have a duty to speak out and have been too reticent in the past. Civil disobedience has a long and noble tradition.
Senator Mary Henry, MD
