Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein) | Oireachtas source

My goodness. I am sorry I missed the Minister of State's opening remarks. I was attending the briefing on the Traveller accommodation issue in County Louth in the AV room. I have to say it is a very serious matter and most disturbing indeed.

The Medical Practitioners Amendment Bill 2014 had its genesis, as I recall, in a Private Members' Bill in 2009. Some might dispute that, but that would certainly be my view. I actually thought we had spoken on this already. I was checking with the Bills Office today because I thought I had spoken on that already and could not understand how I would get a second bite at Second Stage, but it was almost seven years ago now and I did indeed speak on it. To put the Minister of State at her ease, I will say at the outset that we will, of course, be supporting this Bill. We welcome it. It is regrettable that it has taken so long to get to this point, but we will be supporting it through all Stages and I hope the Minister will have the opportunity, other matters considered, to progress it to finality before the whistle is blown.

It alarmed me then and has continued to alarm me through all the intervening years that the current status in respect of medical practitioners and the legal obligation to acquire medical indemnity insurance had not already been provided for. It is a most disturbing fact. This has been reflected in the Seanad address of the legislation, where this Bill has come from. I concur with those in the Upper House who have expressed surprise and alarm that this "strange situation," as it was described, has been maintained over all these years.

Under this Bill, the medical practitioners themselves will have to ensure they have suitable cover. The Medical Council will be in a position to sanction a medical practitioner engaging in medical practice who does not indemnification or the appropriate insurance. I also welcome the fact that there will be an exemption from indemnity for those who are not actively engaged in medical practice, including those who are lecturing, those who may be retired, and those who may have taken time out for whatever reason and who are not actively involved as medical practitioners over a given period. That is absolutely appropriate. We have had instances that were much worse than unintentional adverse outcomes. We have had possibly intentional interference with the bodily function of individual patients over the years, matters that we have addressed in this Chamber on many occasions, including on a number of occasions during the course of this Dáil term. As this is a Bill related to the health service, Second Stage affords me an opportunity to address some of those matters that have been particularly disturbing and that I can only refer to as scandalous. I hope these scandals are confined to the past. I am speaking particularly of the horrors of the Michael Neary scandal and the dreadful experiences of those who were subjected to symphysiotomy at a number of hospital locations over the years. The Government has introduced redress in respect of the Dr. Michael Neary case.

However, there was a significant cohort who were not covered by the redress scheme, some of whom were subsequently brought in under an additional or subsequent tranche of supports. There was also the symphysiotomy situation, which is currently being addressed, however unsatisfactorily in the eyes and minds of many of those who have suffered grievously. Some progress has been recorded on some of these matters, and that must be welcomed.

In relation to a Bill dealing with the requirement for indemnification and medical insurance, I feel obliged to draw attention to the very small number of victims of Dr. Neary who have not been included in the extended redress provision. I have recently spoken to the senior Minister in this regard. I speak quite particularly in relation to four women. There may be other cases, but I am familiar with four who have a commonality, not only of experience but of the expert analysis and assessment of Dr. Richard Porter, who carried out specific reviews of each of their cases. I have a copy of each report. I am, again, bringing them to the Minister of State's attention in a last-ditch - for the want of a better word - appeal in the closing days of this Administration, and I ask that she exercise her position to speak to the senior Minister and that they jointly review the situation that still obtains in relation to these four cases.

I have three of the reports prepared by Dr. Porter here, and I will highlight one of these cases. I will maintain the anonymity of those concerned. I will not refer to them at all by name, but I have met all of them. I know them personally and I must say that the exclusion of their cases from acceptance under the terms of the scheme compounds the hurt and pain that they have suffered over many, many years. No woman should be left in that position. Having the little bit of time, I will demonstrate the type of case that we are talking about here, read into the record the opinion of Dr. Porter and ask of the Members here, particularly the Minister of State, why any woman who has been through what these women have suffered could be refused inclusion under the terms of the Neary redress scheme.

Dr. Porter states:

I have been asked to comment on the appropriateness or otherwise of the surgery performed in June of 1991.

Before doing so I think it is appropriate to comment on the management leading up to that.

Although I do not have the full details of [the management of the patient concerned], there must be a strong suspicion that the management was inappropriate and inadequate.

It appears, to me, inconceivable that in 1991 a couple could be followed for prolonged infertility without semen analysis having been performed. In addition it appears extraordinary to me that at no stage in the management of her infertility had she undergone an ultrasound scan. Both of these omissions raise serious questions about the professionalism and the adequacy of the clinical evaluation.

In February 1991 a laparoscopy was performed which purported to demonstrate endometriosis. No attempt was made to establish the patency of the fallopian tubes, indeed this is actually explicitly mentioned as having not been performed during the laparoscopy.

I should add in passing that the sub-umbilical incision used for this laparoscopy was, without exception, the largest such incision that I have ever seen. I have to say that this raises for me questions concerning the competence with which this procedure was undertaken.

Dr Neary elected to perform a laparotomy some four months later.

It is not clear to me on what grounds this operation was undertaken.

[The lady concerned] was not complaining of abdominal pain at this time, indeed her only complaint was of a failure to become pregnant.

If the intention of the surgery was to maximise her fertility prospects then it is hard to see how the removal of the left tube and ovary would come under that category. Nor is it easy to understand how it was proposed that removing an endometriotic cyst on an ovary, which would inevitably result in a potential increase in scarring within the pelvis, could be expected to result in enhanced fertility prospects.

These facts were known in 1991.

The operation was performed through a midline sub-umbilical incision. This was a wholly unnecessary approach to the surgical area. This is an uncomfortable and unsightly incision and it was totally unjustified to perform this surgery for benign gynaecological disease through this incision.

Dr Neary has described the operation as taking 2 1/4 hours.

This is contradicted flatly by the anaesthetic chart, which suggests that the operation only lasted 1 1/4 hours - but there is a possibility that it lasted 1 3/4 hours [...]

Dr Neary mentions that the pelvis was very fixed.

By definition this was an area that required specialist surgery performed by an expert in the field, if surgery was indicated at all (which remains in my [Dr. Porter's] view highly debatable).

I have no reason to believe that Dr Neary was an expert in fertility surgery and it is my view that he should not have been undertaking this operation in the first place.

He drained a right ovarian cyst, which he claims was an endometriotic cyst. I believe that this diagnosis remains open to very considerable doubt.

This uncertainty is made all the greater given the histological findings on the left ovary.

Dr. Neary proceeded to remove the left ovarian cyst but he omitted, it would appear, to send this for histological analysis. This was incompetent and unacceptable.

He did, however, declare in his operation note that the left ovary contained several endometriotic cysts and that there was 'no functioning ovary' at the end of the removal of the ovarian cyst. He therefore removed the ovary and sent it for histological analysis.

Histological analysis of this ovary however refutes both the clinical diagnosis of endometriosis and the assertion that the ovary was 'non-functioning' at the end of the operation.

The ovary was in fact of considerable size at the end of the procedure, as shown by the histology report, and far from being a non-functioning ovary it clearly contained the potential for useful endocrine and probably fertility function.

The histopathological analysis makes it very hard to believe that the clinical diagnosis of endometriosis was correct, and it clearly indicates that the surgical removal of the ovary was wholly unjustified.

The subsequent findings at surgery in 1994 suggest, far from surprisingly, that there were an increased number of adhesions around the right adnexal region, probably as a direct result of the surgery that had been undertaken in 1991.

My conclusion therefore has to be that:- There was little or no pretext for performing the laparotomy in June 1991

- The diagnosis of endometriosis was in any event highly unlikely to be correct ([Dr. Porter believed] that [the patient] had haemorrhagic follicular cysts in her right ovary)

- The surgery on the right adnexal region worsened, rather than enhanced, her prospects for future fertility

- The removal of the left ovary was totally unnecessaryOverall, therefore, [Dr. Porter believes] that the surgery in June 1991 was unjustified in the first place, and incompetently performed, and that the operation note is probably not a true record of what was found at surgery.

I have taken the time to read this and I appreciate the Members' listening carefully. It is just one of three of the four cases, and it is unnecessary for me to repeat it for each of the others.

The Bill seeks to ensure everyone under the inclusive term "medical practitioners", which covers the Dr. Nearys - God bless us and let us hope there are no more of his ilk - has indemnity insurance. That on the one hand we are seeking to regularise the absolute requirement of indemnification while on the other hand we are ignoring the most learned report of a highly respected practitioner, Dr. Porter, who has presented in so many of the cases concerned, coming from the neighbouring island to be of assistance in these cases, is a sad reflection on all of us in political life.

This woman, whom I have met and whose report and conclusions by Dr. Porter I have just read, is, like all the others, a victim of Dr. Michael Neary. She and those who presented with her have made repeated appeals, time after time, to have their cases respected, included and properly recognised. I appeal to the Minister of State, who would share my wish that no woman would be excluded from due recognition, acknowledgement and compensation. While it is very difficult to put into compensatory or monetary terms anything that would reflect on the extent and depth of the hurt and pain she and others have been put through, if some such recognition took place it would help these women and this woman who was denied the chance of ever becoming a mother, something which she feels grievously to this day.

I appeal to the Minister of State, using the opportunity of this not unconnected legislation. It is very important that the connection is there. I am using my Second Stage address to confirm my support for the passage of the legislation and to appeal to everybody in the House, especially the Minister of State and the Minister, Deputy Varadkar, to use the remaining days of the Dáil term to revisit these cases. I will have the copies of these reports, which have already been presented to the Minister and the Department, in their pigeon holes first thing in the morning, in confidence and in the understanding that they will be treated respectfully. I ask the Minister of State please, in all justice, to use the remaining days to help see that justice is done for all who have suffered so much at the hands of this individual who should never have been allowed to practise as he has. I have adequately reflected my surprise that this has not been enshrined in legislation heretofore and I welcome the fact that, hopefully, before the Dáil rises for the general election, the legislation will be on the Statute Book.

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