Dáil debates

Wednesday, 8 March 2006

Lourdes Hospital Inquiry: Statements.

 

12:00 pm

Photo of Liam TwomeyLiam Twomey (Wexford, Fine Gael)

The Government has been found wanting in terms of the recommendations of this report, many of which have been promised on many occasions but were never implemented. There will be no cultural change in the medical services unless we make it happen. As a doctor, I am disgusted by what I read in the report about the actions of one doctor and the support given to him by other consultants. Doctor Neary's reign of destruction was allowed to continue due to complicity, misplaced loyalty and fears of authority and the possible consequences for anyone who spoke out. Doctors, nurses, administrators and members of the Medical Missionaries of Mary can be implicated in Dr. Neary's actions at Our Lady of Lourdes Hospital. Not all are as guilty as the media alleges, however. Many areas of the Irish health services continue to be extremely stressful environments which inspire loyalty among colleagues. Unfortunately, the isolation and the bunker mentality noted in the report is a consequence of not applying checks and balances to the system. The Government, particularly the Tánaiste, has a role to play in this matter.

The leadership of the hospital, from consultants and nuns to management, was completely inadequate, as is the management systems in many other parts of the health services. Consultants in the Irish health services hold as much power today as they did when Dr. Neary ran the maternity department in Our Lady of Lourdes Hospital.

The victims of this story are the women whose uteri were removed because Dr. Neary went unsupervised for too long. It is only right that the Tánaiste has committed herself to making sure that compensation will be paid promptly. If other issues arise regarding justice for these women, these must also be addressed without delay.

The issue of who was responsible for these events must be discussed. Having worked in eight different hospitals, I do not consider junior doctors as the villains. I was never in a position to stand up to the all-powerful consultants who dictated career pathways. Nobody questioned them because careers could be finished by doing so. These consultants continue to control the careers of junior doctors, be they Irish or non-national.

However, consultants from outside the hospital and weak management systems exacerbated the problem. Dr. Neary may be discredited as a consultant but the Tánaiste had little to say with regard to the other consultants mentioned in the report. We know that the three consultants who went to Drogheda to investigate Dr. Neary provided the first report on his activities. I want to know what the Tánaiste has to say on the implications of that investigation. The same consultants who accepted restrictions on their terms of reference felt fully qualified to pronounce Dr. Neary safe. They found no grounds to suspend Dr. Neary or to place any restrictions on his public or private practice.

The reference to "public or private" reveals that money was an important aspect of this matter. If Dr. Neary was suspended, his public salary would continue to be paid but his private practice would be affected and legal pressure was applied on the administration of the hospital and the former North Eastern Health Board in that regard. The consultants who came from Dublin were complicit in this, as is evident from the fact that eight of the 17 cases they were asked to review were excluded because Dr. Neary informed them that these were consensual hysterectomies. I do not think the consultants were satisfied that this was the case. Imagine a criminal demanding to see the evidence against him or her and deciding whether it should be presented in court. These terms of reference were nonsensical but were accepted by somebody.

The report of the Lourdes inquiry implies that legal pressure was placed on the then North Eastern Health Board before the review of the Institute of Obstetricians and Gynaecologists. The Tánaiste never clearly stated who was responsible for that review. Did the Medical Defence Union call in the three consultants? It is vital that we know that answer. The consultants involved have expressed regret for allowing compassion and collegiality to come before due process. Was this misplaced loyalty or does it smack of incredible arrogance? Issues of criminal negligence also arise. These consultants could have obviated the need for an inquiry and if the Tánaiste is serious in her claims for self-regulation or on changes to the Medical Practitioners Acts, she must speak to this issue. Self-regulation is important but it must not follow the practice in this case.

Before the three consultants became involved, Dr. Ambrose McLoughlin discovered that the incidence of peripartum hysterectomy in Our Lady of Lourdes Hospital was out of line. He was supported in this by the medical director at the hospital and the director of nursing, who had examined a number charts and found major problems. To the best of my knowledge, the three consultants from Dublin never consulted Dr. McLoughlin and his colleagues, even though they were in charge of the hospital. We need more clarity on this because I am aware of the power held by some in the health services. The events at Our Lady of Lourdes Hospital could recur elsewhere and fine words will not correct the problems. We need something more robust. Look at what happens when a doctor in the UK, Dr. Michael Maresh, reads the same nine charts that the three consultants read. He believed "Dr. Neary's clinical judgement to be significantly impaired and that women appeared to be put at risk". This line should be compared to the other nonsense written by the three other consultants. They were more concerned about image, private practice and not looking bad. This should be highlighted much more.

Other consultants were involved who attempted to hijack the investigation which was going on. I researched this, going back on media reports on the time this came out. Marches and protests were organised, and other consultants were involved, using their power to stop this going ahead. I believe it could happen again.

The only factor which endears me to this issue is the way some of my colleagues carried on. People such as Professor Bonner, Dr. Patricia Crowley in the Coombe Hospital, Dr. Jim Kiely of the Department of Health and Children, and Dr. Finbar Lennon acted in the appropriate manner as doctors protecting their patients. They deserve full respect for that, and they are not the only ones. Surprisingly, politicians across parties do not come out too badly either. These politicians include Deputies O'Dowd, Crawford, Ó Caoláin and even Deputy Noel Dempsey. All emerged quite well when the background scenes are considered.

The real heroes in this were the midwives who were prepared to put their careers on the line and who stood up to incredible pressure. Some midwives and administrators in the hospital genuinely did not know what was going on there, and some had lost control of their lateral thinking. They may have been carried away on what was occurring inside. Individuals in the hospital were prepared to do significant work for patients, be they politicians, doctors or nurses.

We must support these people, and not just with fine words. Every recommendation discussed by the Tánaiste and those put forward by Judge Harding Clarke has been Government policy in some form for the past five years, but without implementation. They have not moved forward. The role of legislators and Government in this has been disgraceful. One can see that many practices such as clinical audit, peer review and risk management have not been implemented. Competence assurance is still in the planning stage, and no resources have been given to these issues for the past five years. The system is still a complete mess. There is no information dispersal on the health care services.

With regard to legislation, we know about the Medical Council and we have been calling for it for the past seven years. The Tánaiste is telling us it will arise this year. The Minister for Enterprise, Trade and Employment, Deputy Martin, last night spoke on the whistleblowers legislation, stating he would deal with major legislation sector by sector. The Tánaiste has promised both the Health Information and Quality Authority and new medical practitioners legislation, due to come out in the next couple of months, from the Department of Health and Children. Will we see a section covering whistleblowers in the legislation?

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