Clare Daly (Dublin Fingal, Independent)
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The Harding Clark report into the symphysiotomy redress scheme has been described as deeply skewed, profoundly unfair, subjective and selective, intellectually dishonest, morally bankrupt, replete with false allegations, omissions, distortions, misrepresentations and contradictions, and biased throughout. Those who said that are being soft on Judge Harding Clark whose report cannot go unchallenged or uncorrected. She goes way beyond the terms of reference of her assessor report to the Minister for Health when all she was asked to do was deal with the activities and expenditure of the scheme. Instead, she deviated into personal and unsubstantiated commentary, which is highly inappropriate in the context of outstanding litigation. Her report is riddled with false allegations, such as alleging that leading campaigners against symphysiotomy had alleged they had the procedure when they had not. That is completely and utterly untrue.

The only interpretation one can draw from this report is that it is a defence of the uniquely Irish practice of non-emergency symphysiotomy. It serves to diminish survivors’ claims and is a further violation of those women’s human rights. Symphysiotomy as practised in Ireland is a human rights abuse and that is the case regardless of this report. There can be no denying that the State has been culpable in this but rather than address these matters honestly, the report has served to diminish the suffering caused and undermined the experiences of the women. There is a continued suggestion that the women were lying. Nobody who met these women could ever believe that.

Of course, Judge Harding Clark met hardly any of them. It was a paper review with no right to appeal any of her decisions. It was her opinion and her opinion only. It is hugely traumatic for the women involved that this horrific report has been published. I believe the Minister needs to intervene to have it withdrawn. It is hostile in its tone and it smears and discredits survivors rather than dealing with a bad and deliberate policy and a poorly-administered scheme. It needs to be withdrawn and we need clarification on this matter.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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I, too, have been absolutely appalled by the media coverage and the commentary of certain people in the media in the last week in response to this report. I agree that the methods of assessment were defective. I agree with Deputy Daly on the policy of Judge Harding Clark of taking oral evidence and meeting only a handful of the women involved. If she had met more, she would have seen for herself some of the injuries and limping, etc., that these women endure. Using contemporaneous radiology in one particular case, the judge stated that a 2004 X-ray did not show injuries to the women and that therefore the injury had happened afterwards. The judge went way beyond her brief, showed her own bias and showed contempt for these women. I believe it is absolutely vital that this Dáil and the Government agrees to set aside time to have a proper analysis of this report.

There are a couple of myths that the report tries to knock down. The first is that symphysiotomy was a normal procedure practised in many countries, as argued by Paul Cullen, for example, in The Irish Times. In 1944, there were four of these operations in the national maternity hospital. In 1948, there were 43. That was because of the arrival of Dr. Alex Spain, an arch-Catholic, as head of the hospital, who refused caesarean sections and said that their result would be contraception, the mutilating operating of sterilisation and marital difficulty. It is utterly wrong to say that. They also argue that symphysiotomy was not dangerous. Clearly, it was. It was not a benign procedure. It was not used in other countries as a first resort; it was used as a last resort. This is the third whitewash report there has been. It is a disgraceful indictment of the system that it does this to women who were brutalised in Catholic Ireland of the past.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputies Daly and Coppinger for raising this very important matter. It occupied quite a considerable amount of time in the last Dáil, particularly with the cross-party report into symphysiotomy.

Judge Maureen Harding Clark submitted her report on the surgical symphysiotomy scheme on 19 October last. The Minister for Health, Deputy Harris, examined the report and submitted it to Government last week prior to its publication on the Department’s website on 22 November. The Minister, Deputy Harris, has asked me to convey his apologies to the Deputies that he cannot be here this evening.

The Government agreed in July 2014 to establish an ex gratiascheme for women who underwent the procedure. The surgical symphysiotomy payment scheme was established in November 2014 and Judge Clark was appointed independent assessor. The scheme provided an alternative, non-adversarial option for women, many of whom were elderly and did not wish to pursue their cases through the courts. The total cost of the scheme was just less than €34 million and payments of €50,000, €100,000 or €150,000 were made to 399 women who met the criteria for an award. All of the women have received their respective payments, totalling €29.85 million. The majority of claimants were aged more than 75 years and payments were made to women between the ages of 51 and 96 years of age. A total of 185 women who applied to the scheme could not establish that they had a surgical symphysiotomy. Pubiotomy was frequently claimed but was established in only one case. Significant disability was established in this case.

As the scheme was designed to be simple, straightforward and non-adversarial, the women were not expected to give oral testimonies as they might do in a court setting. In the interests of accountability, the scheme required each applicant to prove that she had a surgical symphysiotomy or pubiotomy in order to be considered for the assessment of an award. The level of proof required was clearly set out in the terms of the scheme. Judge Clark worked with each woman or her legal representative to locate medical records. The judge met some women in different parts of the county when she considered necessary. Where claims could not be reconciled with established facts, women were examined by relevant medical experts. Judge Clark encouraged women who believed they had a symphysiotomy to apply to the scheme, advising them that they did not give up their right to pursue their case through the courts by doing so. It was only on accepting an award under the scheme that a woman had to discontinue her legal proceedings. The vast majority of women opted to do so.

The scheme was established following two independent reports which were commissioned by the Department of Health and following consultation with all three support groups by the then Minister for Health. Two of the support groups welcomed the scheme and one support group did not. The first of these reports was commissioned in 2011, when the Department commissioned Professor Oonagh Walsh to undertake independent research into the practice of symphysiotomy. Professor Walsh’s research also included a public consultation. The report recommended that an ex gratiascheme be established.

In 2013, retired Judge Yvonne Murphy was commissioned by the Government to undertake a further independent review of the legal aspects of symphysiotomy in Ireland. Judge Murphy advised the Government on the merits and costs of proceeding with an ex gratiascheme relative to taking no action and allowing the court process to proceed.

Symphysiotomy was an exceptional and rare intervention in obstetric practice in Ireland. It occurred in fewer than 0.05% of deliveries between 1940 and 1985. It is estimated that around 1,500 symphysiotomy procedures were undertaken in Irish hospitals and that there are around 450 women still living who underwent the procedure. In most of the world, especially in Europe, the symphysiotomy procedure had been replaced mainly with the caesarean section procedure by the 1950s. Currently, the procedure is rarely performed in developed countries, but is still performed in rural areas and resource-poor settings of developing countries where caesarean sections are not available or obstetricians may not be available to deliver subsequent pregnancies.

The brief given to Judge Clark in November 2014 was not an easy one. At that time, the advice to the Department of Health was that many women would face an uphill struggle in proving their claims in the courts, with an uncertain outcome, as each case would be adjudicated on its merits. In her substantial report, Judge Clark has provided a comprehensive overview of the historical and medical context of symphysiotomy. Judge Clark had a unique opportunity to do this and her findings support the earlier findings of Professor Walsh.

Payments under this scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represent a comprehensive response to this issue by Government, which should help bring resolution to the women, many of whom are now elderly, and also to their families.

Clare Daly (Dublin Fingal, Independent)
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I have to say that there has been a certain rewriting of history again. We know that the majority of survivors never accepted this redress scheme to begin with. The Minister of State is dodging the key elephant in the room, which is that this report goes one step even further from that. It is riddled with factual inaccuracies, unverifiable anecdotes and is severely damaging. It is well known that people experience trauma and upset as victims of abuse if their stories are not believed. The report is done in a manner which disbelieves the testimony of the women involved. It makes outrageous claims. We know that not one woman anywhere submitted that she had consented to or was aware of that procedure, yet the judge said that she found it very difficult to believe that is the case. There is no evidence to support her view in that situation. This is the same judge who, when awarding payments previously, told the women they were getting the money to redress their "unhappy experience". This was deliberate butchery that was carried out on people for ideological reasons.

What the report shows is a deliberate undermining of the human rights campaigners and groups whose work actually led to the setting up of this scheme to begin with, bad and all as it is. I remind the Minister of State that it took a former Minister to go to court to get the Guerin report withdrawn. We know the McAleese report into the Magdalen laundries was hugely criticised and controversial. The point that is being made here is that this document cannot stand. In and of itself, it abuses the women involved. It has to be withdrawn and considered further by this House.

Ruth Coppinger (Dublin West, Anti-Austerity Alliance)
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There has been an attempt by the Catholic right to seize on this highly flawed report to argue against the whole question of Catholic control of maternity hospitals. There is no question that this was done and motivated by a Catholic medical theology. It is also argued very patronisingly that these women did not know the difference between a caesarean section, a symphysiotomy or anything else that was happening to them.

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I know women were kept in ignorance but I think most women would know if they had their pelvic bones broken.

The scheme relied on written and radiological evidence which was extremely unfair because proving a symphysiotomy happened over 50 years ago is incredibly difficult if medical records do not exist. In that sense, the scheme militated against the older women and some younger women were able to pursue their claims successfully. The fact there were 185 unsuccessful applications does not mean that 185 symphysiotomies were not carried out. As I said, it was difficult to prove. People were also only given 20 days to apply to the scheme which is highly restrictive in the context of gathering up information.

There is no way that this Dáil could or should stand over this report. A debate must take place in this Chamber to question the rationale of Judge Harding Clark.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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Any of us who have had the privilege of delivering healthy children and who have had good childbirth experiences cannot but have sympathy for those women who underwent such a dreadful procedure.

I will provide some information on Judge Harding Clark's methodology in carrying out her role as the assessor to the scheme. The terms of reference informed Judge Harding Clark to draw together a team of medical experts in obstetrics, radiology, orthopaedic surgery, pelvic injury, urology and urogynaecology who advised her throughout the process. Hundreds of hours were spent going through each applicant's medical records. Each applicant received an individual, careful and fair assessment. Medical evidence was sought to explain delivery records and when claims could not be reconciled with facts, the applicant was examined by an orthopaedic surgeon or a gynaecologist. Some applicants were examined by several experts. When all efforts to obtain records failed, the scheme moved to seeking secondary proof of symphysiotomy by scar and radiology evidence. In 12 especially difficult applications, Judge Harding Clark held a discussion conference between her own medical team and the medical experts representing the women and a consensus was reached based on the medical facts in the cases.

It is probably cold comfort to the people represented by the Deputies Coppinger and Daly but I would remind them that there were three organisations advancing the cause of women who were scarred by symphysiotomy and the scheme was accepted by two out of those three organisations.