09 March 2006
Senator Henry: As Senators can imagine, it is difficult for me as a member of the medical profession not to hang my head in shame, having read this report and listened to the contributions of Senators Feeney and Terry, as I speak in front of some of those who have been so grievously injured by a member of my own profession. No adequate reason can be given for the behaviour of Dr. Michael Neary. This has been an appalling tragedy. I am glad that the Minister of State, Deputy Tim O'Malley, apologised on behalf of all of us, not just to the women in question but also to their families. The women and their husbands were denied children, their parents were denied grandchildren and the children they already had were denied siblings. A substantial number of people were affected by the appalling operations that took place at Our Lady of Lourdes Hospital in Drogheda.
Whoever stole the huge volumes of birth registers and charts which comprised the maternity theatre register should send them back at once, anonymously if necessary, as I am sure they have not destroyed them. The charts in question are of great importance to the 44 women to whom they relate, not just as they take legal cases, etc., but also as they try to get some kind of satisfaction in their attempts to find out exactly what happened. The registers contain details of the stillbirths which took place during the period in question, which means that women who had stillbirths at the hospital during that time are not in a position to register their cases. A national stillbirth register has since been put in place, fortunately. I assume that the theft of the registers and charts was done by someone with a misguided sense of loyalty to Dr. Neary, but it was a dreadful thing to do. They should be sent back at once. I hope the Garda investigation into the robbery will be satisfactory.
The commission that inquired into the practices at Our Lady of Lourdes Hospital has done an incredible job. I compliment Judge Maureen Harding Clark on what she has done. Not only did she have to deal with the information she could get, but she also had to try to cross-reference it with other records to ensure that each of the horrific number of the cases was accounted for. The vast majority of cases involved Dr. Neary although some of them involved Dr. Finian Lynch. During the period in question, an excessive number of peripartum hysterectomies was carried out at Our Lady of Lourdes Hospital, compared to any other hospital in this country or any other part of the world. It beats me how members of the medical profession who were working at the hospital at the time can say they did not know anything unusual was happening.
The issue of gender has been raised in the context of the debate on this report. The membership of the Institute of Obstetricians and Gynaecologists during the timeframe under discussion was almost entirely male. The men in question were in a position of great power, whereas a degree of hierarchical obedience was expected of the women involved, who were either patients or nurses and were in a subservient position to the consultants.
Ms O'Rourke: Yes. That is my point.
Senator Henry: Our knowledge of the hierarchical structures which were in place does not make the whole procedure any less inexplicable.
It is most unfortunate that those who inspected Our Lady of Lourdes Hospital were Dr. Neary's peers. Ireland is a very small country with a small number of obstetricians. That there were under 100 obstetricians in the country at that time meant that such people were inspected by their friends, which was entirely unsatisfactory. When the Royal College of Obstetricians and Gynaecologists carried out inspections, they were carried out by its Irish members, which was also unsatisfactory. I share Senator Feeney's grave concern about the fact that three obstetricians gave Dr. Neary a clean bill of health, as it was described locally, in 1998. That caused enormous distress to those in the local area who had objected to his conduct. If peer review is to be meaningful, it needs to be impossible for people to be reviewed by their friends.
Some people objected to the procedures which were taking place at Our Lady of Lourdes Hospital. The hospital matron deserves great credit for making an objection. Midwives, including young student midwives in some cases, objected to the old-fashioned practices of Dr. Neary, who had never been retrained and had been appointed at a very young age, after limited training in the United Kingdom. Despite their criticisms, Dr. Neary was still able to make midline incisions for caesarean sections, to practise shaving and to examine women in the lithotomy position, as Senator Terry so well described. The people who raised concerns were told that their complaints were unjustified. They had to withdraw their complaints in tears. The anaesthetists are criticised in the report, which states that they should "recognise their professional obligations to fill in clinical incident forms" in the theatre when untoward events occur.
As I was reading the report, I started to wonder whether things went on in the Rotunda Hospital, where I worked for three and a half decades, which I simply did not realise were happening. It happened on three occasions that two peripartum hysterectomies were done in a single day at Our Lady of Lourdes Hospital without anyone taking any notice of it. When I worked at the Rotunda Hospital, such a procedure was second only to a maternal death and everyone in the hospital would know about it. I was relieved when I read the section of the report which mentioned that Dr. Peter McKenna, who is a former master of the Rotunda Hospital, had examined the incidence of peripartum hysterectomies between 1975 and 2001 and found that 52 such procedures took place in the hospital, which had an annual average of over 6,000 deliveries, during that time. Just 52 peripartum hysterectomies resulted from the many thousands of deliveries which took place in the hospital over that 27-year period, whereas there were 189 such procedures in the Our Lady of Lourdes Hospital, which had a much smaller overall number of deliveries in that time.
The staff of the maternity unit at Our Lady of Lourdes Hospital seemed to feel that loyalty to the unit was more important than loyalty to their patients or to the medical profession. They were under the impression that Dr. Neary, who I accept was a hard-working man with a very heavy workload, could not fail to do the right thing. It is suggested in the report that the nuns of the Medical Missionaries of Mary thought that Dr. Neary "walked on water". There are great dangers in small units; for example, there might not be anyone there of sufficient seniority to query the practices which might be taking place. When the matron complained to her colleagues in the unit, she was told by the consultants that it was none of her business. There seems to have been a bad atmosphere between the unit's consultants and the rest of the staff of the unit. The hospital's culture meant that no advice regarding contraception could be given. No tubal ligations could take place, for example.
Ms O'Rourke: Why?
Senator Henry: I knew some of the Medical Missionaries of Mary quite well because they used to accompany me to meetings in London and elsewhere. They were kind and good women who were very determined in their religious beliefs. The mixture of religious beliefs and human reproduction can sometimes lead to serious situations which are perhaps not to the advantage of patients, who may not share such religious convictions. The Minister of State said that "patients require assurances that their interests are paramount and override any sectional concerns". That principle should be at the forefront of whatever happens.
When Dr. Neary arrived in Our Lady of Lourdes Hospital, it was one of the major hospitals in the country for carrying out symphysiotomies. The others were the National Maternity Hospital in Holles Street and the Coombe Hospital. I do not know the exact number of symphysiotomies that were carried out in the hospital, but I have been at meetings where patients wept about them to me. This procedure was carried out by cutting the front of the pelvis to allow a vaginal delivery, rather than carrying out a caesarean section. Therefore, there was a culture of applying the Catholic ethos in a very strict manner when Dr. Neary arrived.
He claims that this fact was important in explaining why he carried out so many peripartum hysterectomies, but this claim cannot be taken seriously. It is true that he objected and was allowed not to take part in tubal ligations in England, but when he arrived in Our Lady of Lourdes Hospital, both he and Dr. Lynch asked the Medical Council and the Medical Defence Union about the situation regarding tubal ligation, and they were told they would have to abide by the ethos of the hospital.
We should recall that these issues were not just due to the ethos of the hospital, but to the culture at the time. That is why the pathologists frequently reckoned that the perfectly normal uteri they examined were being removed for sterilisation purposes. These procedures were referred to as "compassionate hysterectomies" in the report. The figures at the Coombe had to be revised upwards when Dr. James Clinch became master there. He added another 70 cases to the list of what was described as compassionate hysterectomies. There were no pathological problems, yet serious operations were carried out to remove the uterus.
I was appointed to the Rotunda Hospital and to Sir Patrick Dunne's Hospital to look after women who had previously suffered from deep vein thrombosis. This can occur when a person gets a clot in the legs which goes to the chest and it is still a high cause of maternal mortality, but it is nothing like it was then. It occurred much more frequently to women who were older and who had many pregnancies. I looked up the maternal mortality figures for the years 1966 to 1973. A total of 23 patients had died from pulmonary emboli in those years. Their age and parity for a sample went as follows: age 33, 11 children; age 40, 12 children; age 43, nine children; age 42, 13 children; age 31, eight children; age 33, 12 children and so on.
One woman was 48 years old and was on her 19th pregnancy. I wrote this paper in 1975 and I thought that someone at least would comment on it, but nobody did. I presented it at a meeting which I believe was of the Institute of Obstetricians and Gynaecologists. I asked what could be done about it because I was seeing women who badly needed tubal ligation and the only contraceptive available at the time was a high dose pill, which was described as a cycle regulator and which was totally unsuitable for such women. One person replied from the floor, saying that surely I knew some friendly gynaecologist who would carry out hysterectomies on these patients for me.
That was the culture of the time and it cannot be allowed to continue. Senator Feeney stated that she fears such an issue could arise again and I feel the same way. I read reports recently about women with seriously advanced carcinoma of the breast. A multicentred trial was carried out where these women were given combined chemotherapy in the hope that they might last another few months, which might mean a lot to them and their children. Patients in the Mater Hospital were delayed and may have been disallowed completely from taking part in the trial because of the insistence that they use contraception unless they abstained from sexual activity. Who has the right to tell women what they must do to be allowed to have a few more months of life? If the women think it is all right then they should be allowed to do it. There should be no interference between them and the clinicians involved. The Mater Hospital is one of the leading institutions for treating women with breast cancer and people should not be put in a situation like that.
A medical practitioners Bill is absolutely vital, but I have been promised such legislation for more than six years. If it is not brought before the House immediately, we will not be able to deal with it before the next election. We must also address the danger of small units. I have implored people in this House to stop asking for the retention of small units for political purposes. The report recommended that small units in different areas should compare their results. It was suggested that hospitals in Cavan and Drogheda should compare results and I suggest that Daisy Hill Hospital also be included, even though it is outside the jurisdiction. The courageous women who eventually blew the whistle came from outside the jurisdiction and had also been trained outside the jurisdiction.
This issue can occur again. We must have people who are prepared to work together as teams, but that has not been sorted out yet. We must have proper peer review, rather than review by friends. We must also introduce a medical practitioners Bill which allows the Medical Council to act swiftly and courageously, as it did in this case. The solicitor for the health board and the lay staff at the time also acted very swiftly. Unfortunately, the medical profession comes out worst from this investigation for not trying to stop a man, with some obvious kind of phobia and personality disorder, from doing dreadful damage to a great number of people. As a member of the medical profession, I apologise profusely to all those who have been so grievously affected by his actions.
Ms O'Rourke: I welcome the Minister of State and the representatives of Patient Focus who are in the gallery.
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