By Deborah Condon

Health Minister, Micheal Martin, has come under increasing pressure to set up an independent inquiry into the workings of consultant gynaecologist, Dr Michael Neary, following the decision by the Medical Council to strike him off the medical register.

Dr Neary, who worked for over 20 years at Our Lady of Lourdes Hospital in Drogheda, was found guilty of professional misconduct for needlessly removing the wombs of 10 patients.

Over 60 women who claim their wombs were removed by Dr Neary without their consent or knowledge are currently pursuing legal actions.

Earlier this month, the Supreme Court turned down an appeal by Dr Neary against a High Court award to a patient, Alison Gough, whose womb was removed by Caesarean hysterectomy after the birth of her first and only child. Ms Gough had been awarded over €250,000 after the court found that had he carried out certain procedures at the time, a hysterectomy would not have been necessary.

Caesarean hysterectomy is a rare medical procedure, involving the removal of the womb and ovaries to stop uncontrolled bleeding in childbirth.

The Medical Council said it was impossible to offer any consolation to the women involved for the 'unacceptable care' that they had received. However while the decision to strike Dr Neary off the medical register was welcomed by the women, they criticised the council for the delay in reaching this decision and demanded a public inquiry.

The controversy at Our Lady of Lourdes Hospital first came to light in 1998 after two midwives reported concerns to the North Eastern Health Board, which had taken over the running of the hospital from the Medical Missionaries of Mary.

An independent review was ordered and in 1999, it concluded that Dr Neary had a clinically unacceptable level of Caesarean hysterectomies. The health board placed Dr Neary on leave and set up a helpline. The Medical Council was notified of the complaints in 1999.

An earlier report carried out by former Attorney General, Mr Harry Whelahan, found a number of shortcomings in the way in which the Neary case had been handled by the Medical Council. He found that a number of complaints against Dr Neary had not been acknowledged and in some cases, were not recorded correctly.

He added that the fragmented way in which the inquiry had been conducted over such a long period of time, gave rise to a sense of disillusionment amongst those making complaints and recommended an overhaul of the way in which Fitness to Practise cases are dealt with.

The report of the inquiry has been sent to Minister Martin and the Medical Council is due to meet again in August to look at the case. Dr Neary now has 21 days to appeal the Medical Council's decision to the High Court.

See our view on the controversy at...

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Lessons from Neary controversy..

The controversy over the high level of Caesarean hysterectomies performed by an obstetrician at Our Lady of Lourdes Hospital in Drogheda first came to attention in 1998. It has taken until now for the Medical Council, which polices doctors’ behaviour, to rule that consultant obstetrician, Dr Michael Neary be struck off the medical register for professional misconduct.

Successive Health Ministers must also share the blame for not introducing, as promised, new laws to allow better monitoring of doctors by the Medical Council.

Trust in doctors has been lost in Ireland due to the blood infection scandal, the organ retention controversy and high-profile lawsuits.

The fact is that once a doctor qualifies, there is no formal mandatory procedure to ensure that he or she remains competent. Currently, the Medical Council catches bad doctors - after patients have been hurt or have died. This can not continue to be the case.

The alarm bells in this controversy were first raised at the hospital in late 1998, not by medical colleagues, but by two student nurses. In some respects, they risked their future careers by challenging a medical consultant. A Caesarean hysterectomy is a very rare emergency procedure involving the removal of the womb and ovaries to stop uncontrolled bleeding. After being notified of the issues, the Medical Council suspended Dr Neary from the register in early 1999, pending a formal inquiry by its Fitness to Practise Committee.

Initial inquiry

Meanwhile, after the complaints were reported to the North Eastern Health Board, (which had taken over the running of the hospital from the Medical Missionaries of Mary) an independent review was ordered. It was conducted by thee members of the Institute of Obstetricians and Gynaecologists (IoG). While the result of that review in 1999 found that Dr Neary had a high rate of Caesarean hysterectomies which was ‘clinically unacceptable’ it did recommend that he be allowed back to work with certain conditions. No patients were interviewed as part of that inquiry. The inquiry found that Dr Neary performed close to 40 Caesarean hysterectomies over a six year period.

After this report, the North Eastern Health Board set up a helpline for those affected and a support group was also set up by women who had been treated by Dr Neary.

Women spoke of shock and devastation at the news and the fact that they would never be able to have children after having an unnecessary hysterectomy. For others it also meant the early onset of the menopause.

In his defence, Dr Neary said that he had been working hard for many years; his ready availability in the hospital exposed him to a lot of emergency work; he had little time for postgraduate education and he undertook work over and above his expected clinical responsibilities. However, the inquiry by the IoG team had found that he overestimated blood loss in patients.

Medical Council – internal report critical of its handling of the Neary controversy.

The Medical Council has now ruled that Dr Neary was guilty of professional misconduct in relation to 10 female patients who had their wombs removed. It has decided that he be struck off the register. Dr Neary has 21 days in which to appeal this decision to the High Court. If he does appeal, the case will be reheard in full, but this time in public. The Medical Council inquiry was held in private.

Medical Council President, Dr Gerry Bury has said that if the Council has made any mistakes in dealing with the case, it apologises. In fact, a recent private report, commissioned by the Medical Council, on its handling of the Neary case, was highly critical of the Council. The report, conducted by former Attorney General, Harry Whelahan SC, found that some complaints made against Dr Neary were not acknowledged, at times not recorded and there were long delays.

Mr Whelahan said that the fragmented way the Neary inquiry was conducted and the length of time it took had caused a sense of disillusionment. He has recommended a standard procedure for dealing with future complaints from patients.

In some respects, the Medical Council has its hands tied under current legislation and does not have the resources or structures to stop doctors working if there is a risk to patients.

State - failure to act

This controversy also raises big questions about how the State ensures that patients are properly protected from doctors who may have lost the ability to perform to an acceptable standard. Since 1989, the Medical Council has asked successive Health Ministers to introduce new legislation to give the Council new powers to act against doctors who place people’s lives or health in danger. For well over a decade, despite repeated promises, the Department of Health has failed to produce that vital legislation. Over that time we have seen the astonishing Dr Harold Shipman affair in Britain, the scandal over the deaths of children at the Bristol Royal Infirmary and many controversies here too.

It is time that our Government took the protection of patients seriously and gave the Medical Council powers to act before more people get hurt by bad doctors. There is also a need to allow Medical Council inquiries to be held in public and generally more openness in relation to how inquiries are proceeding. We need to see more ‘lay’ members on the Fitness to Practise Committee of the Medical Council and a system that allows speedier inquiries.

Public inquiry

The pressure is also mounting for a public inquiry into the Neary case and related matters at Our Lady of Lourdes Hospital in Drogheda. This hospital has been at the centre of several controversies in recent years, some of which have still to complete their course in the courts and can not be referred to here for legal reasons. To restore public confidence, the Health Minister now needs to act on calls for a proper investigation into the unit at Lourdes. He also needs to meet his Department’s long-standing commitments in relation to new legislation.

With some 60 other cases pending in relation to Caesarean hysterectomies, this is a controversy that will run for some time. Of concern is the fact that in around 20 per cent of cases, the medical files relating to the women have gone missing.

Many questions remain unanswered: why did it take so long for the difficulties to be spotted and the authorities notified? why were no controls in place to spot problems in the hospital unit? Why did it take the Medical Council so long to rule on the matter? So many questions, so much hurt and the final cost will be very high indeed.

* Fergal Bowers is editor irishhealth.com