Colm Burke (Fine Gael)

I welcome the Minister and thank her for her comprehensive overview of this issue. I thank the Labour Party for bringing forward this important debate. It is necessary that the House recognises the pain and distress which have been suffered and continue to be suffered by women as a result of symphysiotomy procedures which were carried out in Irish hospitals.

It is interesting to read a Supreme Court judgment which offers a one line definition that sums up the grotesque procedure. It states that a symphysiotomy is the cutting of the cartilage that binds the two pubic bones, thus permanently enlarging the pelvis. This was in the case of Olivia Kearney v. Ethna McQuillan and the North Eastern Health Board. The pain of sufferers was described by the report of Mr. Clements in that case, when he stated: "as a result of [the procedure] Mrs. Kearney has suffered 35 years of pain, discomfort, loss of sexual amenity and loss of opportunity for further children. The operation was wholly improper and unjustifiable. That it was done without consent or explanation, in clear contravention of the hospital's own ethical guidelines, adds to Mrs. Kearney's grief and anger".

It is deeply regrettable that symphysiotomy procedures were carried out in Ireland for some time after the practice had been discontinued in other developed countries. It is especially regrettable given that the preferred alternative delivery method of caesarean section had become the standard for difficult births from the 1930s in most other parts of the developed world. The practice of symphysiotomy was allowed to continue in Ireland because of deep regulatory failure. The women who underwent the procedure were in some cases used as clinical training material for staff bound for developing countries, because the practice was a low cost surgery. This almost undoubtedly led to the procedure being used in cases where it was wholly inappropriate.

However, as the Minister said, it is suggested that some 1,500 symphysiotomies took place in Ireland during the period 1944 to 1992, that is, six symphysiotomies per 10,000 births. The maximum rate appears to be six per 1,000 births per year. It was therefore a rare intervention in comparison with caesarean sections, which rose from three per 100 births in the early 1940s to over 20 per 100 births now. These figures are not presented to minimise the suffering of the women concerned, but to indicate that the procedure was rare in Ireland overall.

In recognising the pain and needless suffering caused to the women who underwent the symphysiotomy procedure it is important to ensure that a situation like this can never arise again. I welcome the commissioning of an independent report by the chief medical officer of the Department of Health into the practice of symphysiotomy in Ireland.

By compiling an accurate picture of the use of the procedure and protocols of the time relative to other countries, it will be possible to formulate guidelines for the future. I also recognise the attention and care services that already have been put in place, including the provision of medical cards, the availability of independent clinical advice, the organisation of individual pathways of care and the arrangement of appropriate follow-up. The Minister for Health has also stated his intention to have in place a named person to deal with all queries in respect of symphysiotomy, which will make it easier for women who have suffered the procedure to obtain the services to which they are entitled. I note the Minister of State has already referred to this measure. The provision of these services is monitored and overseen by the HSE, which is committed to offering help to women who underwent the procedure.

I hope the recommendations of the report that is due to be published will be implemented and together with the support services already in place, a holistic care and support structure will exist for women who have suffered long-term side-effects to their health and quality of life as a consequence of a symphysiotomy procedure. It is through the creation of co-ordinated initiatives that scenarios such as that which arose in Drogheda, where Our Lady of Lourdes Hospital continued with the practice of symphysiotomy after it had been discontinued in many other Irish hospitals, will not happen into the future.

I refer to a decision of the High Court in the aforementioned case of Olivia Kearney v. Ethna McQuillan and the North Eastern Health Board. Ms Kearney's case initially was dismissed by the High Court on the grounds of undue delay, thereby creating a further hurdle for her in receiving justice for a gratuitous and improper procedure carried out on her. I believe it is unfortunate the courts have been the route to justice for those who have suffered as a consequence of the procedure. The Supreme Court decision was delivered on 26 March 2010. It is important that on publication of the report, the recommendations will be implemented at an early date.

I am glad to note the circumstances in which women give birth have changed significantly. Ireland now is one of the safest places in which to have a baby. We have one of the lowest perinatal mortality rates in Europe and have set up a number of procedures to which the Minister of State has referred. As recently as 1998, only 14 years ago, maternity hospitals were not inspected on a regular basis but this practice is now in place. There is a new national clinical director, Dr. Michael Turner, who, as a former master of the Coombe Women and Infants University Hospital, has considerable experience. Guidelines are issued and updated on a regular basis on all obstetrical and gynaecological procedures. Moreover, each maternity unit carries out its own internal reviews when errors arise and I acknowledge errors will arise in any hospital, regardless of the area of medical care. However, reviews are put in place immediately to ensure the mistake does not arise again. There is in place a medical competency assurance scheme for all medical consultants that is overseen by the Medical Council and each maternity unit must produce an annual report setting out the figures for each procedure performed in that unit. These six measures set out clearly the focus on ensuring the mistakes that occurred in this regard for many years will never arise again. Moreover, it may be necessary that such procedures be reviewed and updated on a continuous basis. Taken together, this new guidance and regulatory structure should be robust to prevent a situation similar to that which arose and to ensure similar mistakes never are made again. I look forward to the report's publication and to the full implementation of its terms. I again thank the Labour Party for facilitating this debate and the Minister of State for her attendance and for giving Members the time to deal with the matter.