Tim O'Malley (Limerick East, Progressive Democrats)

The number of caesarean hysterectomies carried out by Dr. Neary in 1978 and 1979 caused the matron of the time some concern but her concerns were not heeded. No other person or institution raised any issues until October 1998 when two midwives, who were consulting the health board solicitor on an unrelated matter, sought his advice on serious concerns which one of them had about Dr. Neary's practices.

The Royal College of Obstetricians and Gynaecologists inspected the maternity unit in 1987 and 1992 and found it to be suitable for training obstetric registrars but made a series of recommendations. No return visit was planned to determine whether any recommended changes had been effected. The Royal College of Surgeons in Ireland approved the maternity unit for undergraduate training. An Bord Altranais carried out periodic assessments of the midwifery school at the maternity hospital for accreditation purposes. It advised in 1980 that women should be offered a full choice of contraception and that midwives ought to be fully trained in these methods. Nothing happened.

Among the many disturbing findings in the report is the fact that three consultant obstetricians from Dublin maternity hospitals, having examined a number of examples of his practice, found that Dr. Neary had no case to answer. In considering their report, prepared at Dr. Neary's request, the inquiry concluded that it may well have been the intention of his union advisers and his three colleagues to enable Dr. Neary to continue working, pending the review of the Institute of Obstetricians and Gynaecologists. This raises major concerns about the methodology employed in the peer review.

The inquiry found that management's initial response to the revelations about Dr. Neary's practice was prompt and appropriate. The decisions made and the procedures introduced to deal with the situation at the time were courageous and correct. Now most of the elements are in place and the importance of quickly completing the process has been stressed to the National Hospitals Office.

The inquiry found that over 23% of obstetric hysterectomy records, representing 44 cases, for the period 1974 to 1998 are missing and were intentionally and unlawfully removed from the hospital. The inquiry is satisfied that a person or persons unidentified, who had knowledge of where records were stored and who had easy access to those records, was responsible for a deliberate, careful and systematic removal of the key historical records which are missing, together with master cards and patient charts. Alterations were made to the maternity theatre register after complaints were made against Dr. Neary. Most of the missing records refer to Dr. Neary's patients. The Tánaiste has invited the Garda Síochána to read the report in order to determine whether any further action is warranted in the light of Judge Harding Clark's findings.

Among the many other disturbing findings is that a number of the patients were not told of their hysterectomies until some time had elapsed. Very few patients questioned Dr. Neary for carrying out a hysterectomy, but those who did found that his attitude became defensive and unfriendly when he was challenged. The most common complaint from patients was how the doctor carried out procedures on them without discussion beforehand.

As for the hospital today, the inquiry found that the possibility of the maternity unit falling behind in current practice is now remote. However, we cannot be complacent regarding this finding and must ensure that all necessary measures are taken on foot of the report's findings. There have been major changes in practice in the maternity unit to minimise or entirely remove the climate of isolation referred to in the Medical Council report. The incidence of peripartum hysterectomy has fallen precipitously and now accords with national rates.

A team of consultant obstetricians is now in place, which should facilitate improved clinical audit and governance. The current consultants have developed a strong collegiate approach to practice. The unit is moving forward and offering care that is evaluated against known benchmarks. The inquiry found the medical board and the new consultants to have the motivation, skills and energy to move the hospital forward as a fully recognised teaching hospital with specialist registrar training in all its departments. The Tánaiste met the medical board following the publication of the report and was impressed with its obvious commitment to ensuring that the very highest standards of care prevail in the unit.

Members of this House will agree that this is a most comprehensive and fair report but it is also clear that many lessons need to be learned and changes made to ensure that such events do not happen again in Irish hospitals. The findings and recommendations are being examined in detail by the Department of Health and Children, in consultation with the Health Service Executive, the Medical Council and the other professional regulatory bodies.

The report's recommendations will act as a significant catalyst for the reform agenda. They confirm the appropriateness of the actions taken in the preparation of the new medical practitioners Bill, the reform of the consultant contract and the changes in management systems in hospitals. They also confirm the importance of establishing the new health information and quality authority to set standards in health services and the provision of information, as well as to provide an early response to any suggestion of systems failure.

We owe it to the women affected by the events outlined in the report to learn lessons quickly and to put in place safeguards to prevent recurrences in any hospital.