|
| 
|
 |
 |
 |
|||||||||||||||||||||||||
|
142,740 registered members
|
 |
||||||||||||||||||||||||||
|
|||||||||||||||||||||||||||
 |
 |
 |
 |
 |
 |
 |
 |
ADVERTISEMENT | |||||||
|
|
|||||||
Transcripts an epitaph for self-policing
By Niall Hunter - Editor
Self-regulation of the medical profession in Ireland will no longer exist in a few months time, when the new Medical Practitioners Act is brought into law and the Medical Council, the doctors' regulatory body, will have a non-medical majority.
While doctors may express concern about the loss of their self-policing role, outside the profession, few who have witnessed the Lourdes Hospital scandal and the role of three eminent obstetricians in reviewing Dr Michael Neary's practice will mourn its passing.
The initial exoneration of Dr Neary by Drs John Murphy, Walter Prendiville and Bernard Stuart was not carried out under the aegis of the Council but following a request by the Irish Hospital Consultants Association (IHCA) after Dr Neary, a prominent member of the IHCA, was initially placed on administrative leave by the North Eastern Health Board following concern expressed over Dr Neary's caesarean hysterectomy rate by two midwives.
On the basis of this review, Dr Neary briefly returned to work before a further report by a UK obstetrician expressed serious concern about the nine cases reviewed by the Irish obstetricians and about Dr Neary continuing to practice.
This set in train the unfolding of the probably the greatest healthcare controversy in the history of the state after the blood contamination scandal, culminating in the suspension of Dr Neary from his post, his being struck off the medical register, the telling of the stories of the women unnecessarily operated on by Dr Neary, a damning inquiry into how the scandal was allowed to happen, a finding of professional misconduct, but no sanctions made, against the three obstetricians, and shortly, the establishment of a redress process for the women who were damaged by the Drogheda obstetrician.
Health Minister Mary Harney, at the launch of the Judge Clark report last year, said of major concern in the whole scandal was that 'nobody had shouted stop'. The three obstetricians certainly did not, and in fact said the opposite. They were of course, not the only ones not to shout stop; no-one at Lourdes Hospital appears to have raised serious concerns about Dr Neary from 1974 until two midwives raised concerns in 1998.
Dr Neary carried our 129 peripartum hysterectomies at Lourdes Hospital between 1974 and 1998, when most obstetricians would, it is reckoned, carry out only around 10 of these in their entire careers.
The three obstetricians, defending their exoneration of Dr Neary when they reviewed his practice in 1998, said they made an honest assessment of the evidence of the nine cases placed before them at the time, were acting under time pressure, were reluctant to do the review in the first place, and that their report was preliminary pending a fuller investigation by the Institute of Obstetricians.
It is also evident from the transcripts that the obstetricians' review was performed for a representative body in the context of an industrial relations situation where that body was acting on behalf of one of its members, Dr Neary, who was threatened with suspension. Any warning signs about patient care appeared to take a back seat in this particular narrowly-focused review process.
This process seemed to focus more on Dr Neary's relationship with the local health board and the industrial relations issue than with any possible patient care implications behind the disciplinary action being taken against him by his employers. The impression that has been given is that the obstetricians' report was done more to assist than to scrutinse Dr Neary.
The obstetricians' review does not appear to have heeded any potential flashing lights about the extent Dr Neary's practice and some of the quotes from the doctors in the transcripts, such as that women in the north east were lucky to have the services of Dr Neary, that Dr Neary appeared to be someone who cared about his patients, that he was a good practitioner etc, do not paint the medical profession or its 'collegial' peer review process in a good light, particularly in view of what subsequently emerged.
Dr Murphy has since apologised to the Patient Focus group, which represents the women operated on unnecessarily by Dr Neary, for his part in compiling the report. The Medical Council, according to the transcripts, believed that the other two obstetricians appeared more inclined to stand over their reports.
Of particular note in the transcripts is that the Medical Council's Fitness to Practise Committee recommended that sanctions be imposed on the three obstetricians, but the Council itself decided simply to find the doctors guilty of misconduct without imposing sanctions. Sanctions which could have been imposed included suspension or removal from the medical register, or being allowed stay on the register under certain conditions.
Would the same no-sanctions decision have been made by a Council with a larger number of non-medical members and with a non-medical majority, as is soon to be the case?
The three obstetricians are well-respected within their profession and by their patients, and, of course, the Council decision had nothing to do with the standards of their own practice. It is being suggested, however, that teaching sanctions should be placed on the doctors by the training bodies to which they belong in view of what many feel was a gross error of judgement made by them in relation to the Neary case, and in particular the actual and potential consequences of their review.
Certainly, there will be many within the profession who feel that this is going too far, and is ignoring who the real culprit is in the Neary case. Counsel for two of the obstetricians, in the transcripts, refers to the 'bandwagon of injustice' against his clients which is still rolling on. Certainly, the doctors have suffered personally and professionally as a result of an apparently rushed, although misguided report of nearly 10 years ago.
However, this has to be juxtaposed with the emotional and physical damage and suffering caused to the women operated on unnecessarily by Dr Neary. Many will feel it was lucky that Dr Neary's return to work was brief and that there was a subsequent report which cast doubt on his clinical practice and led to his suspension.
The Medical Council has made its decision about the three doctors. Any further decision in relation to their role within their academic bodies will be up to these bodies.
However in the meantime, Dr Murphy has resigned his position as President of the Royal College of Physicians in Ireland (RCPI). Patient Focus welcomed this and praised him for having the courage to resign.
The publication of the transcripts of the fitness to practise hearings into the three obstetricians will do little to dispel the view that any type of future regulation of doctors in Ireland should ultimately not be run by the medical profession itself, and that clinical peer review and audit processes need to be more robust.
The Medical Council in its current format, and current audit and peer review processes as they are structured in the health service, would have made it difficult to spot early on that something was very wrong at Lourdes Hospital.
While it is argued that the Neary case is an extreme and rare one, and that the medical profession is being unfairly demonised, this does not mean that we should simply cross our fingers and hope that such a scandal does not occur again.
Things are set to change. The Medical Council itself will have more lay involvement in its decisions; it will be running more rigorous monitoring and competence assurance processes for doctors and ensuring that underperforming or poorly performing doctors are identified at an early stage. Doctors' practices will have to meet specified standards or they will not be able to remain on the medical register.
In addition, we will shortly have the new Health Information and Quality Authority (HIQA), which will inspect and monitor hospitals and, compare clinical practices between hospitals.
Included in the HIQA legislation will be 'whistleblower' provisions which will, in theory anyway, make is easier for a healthcare worker to raise issues of concern about a colleague without fear of recrimination.
'Shouting stop' at an early stage in these cases can prevent much suffering for all concerned.
The full transcripts can be viewed can be viewed at...http://www.medicalcouncil.ie/
|
Maria Posted:
22/02/2007 16:48 |
| While this has been a terrible nightmare for those women who had their wombs removed by Dr. Neary, I would like to say that the real culprits are Dr. Neary and his immediate colleagues in the Drogheda Hospital. I am a patient of Dr. John Murphy and had ovarian cancer over fourteen years ago. I could not have wished for a more committed, caring and wonderful surgeon and doctor and I feel that any one can make a mistake. I would hate to see him being vilified because of this. |
|
Delmarie Posted:
22/02/2007 22:31 |
| I agree with Maria - I was really shocked when the Neary scandal broke and really surprised when I heard that Dr Bernard Stuart and Prof Walter Prendiville were two of the obstetricians who reported on Dr Neary. From personal experience I found both of these men to be very competent and caring. Dr Stuart I met some 28 years ago when I was having my daughter and Prof Prendiville performed my hysterectomy about 5 years ago. Why haven't the Doctors who practised alongside Dr Neary in Drogheda ever been taken to task for not bringing his excessive use of caesarean hysterectomies to the notice of the Health Board? |
|
PAB Posted:
22/02/2007 23:38 |
| As a doctor of many years\' experience, I find it very difficult to understand why Dr. Neary performed so many perinatal caesarian hysterectomies. My experience of assisting at many operations is that a possible cause may be that Dr. Neary lost his nerve in the case of haemhorrhage and his judgement of the severity of the bleeding was impaired. I can see no other reason for the excessive use of hysterectomy in so many cases. Operative procedures are, by their very nature rather nerve-wracking experiences for the surgeon and I have seen several very experienced surgeons become very over-wrought in the theatre surroundings. In some cases I have known the surgeon to request help from a colleague and it may be that Dr. Neary either could not, because of the unavailability of another consultant in the hospital, or was not able to admit that he was having problems, to ask for assistance. |
|
Kitty Posted:
23/02/2007 08:57 |
| While it\'s good to see that the Medical Council will have more non-medical involvement in its review processes, an apology by Dr Murphy, while all very well, will not restore the damage done by Michael Neary which Dr Murphy and his two colleagues appear to have either not noticed or not seen (or worse, covered up) in their review. |
|
Anne Posted:
23/02/2007 09:23 |
| I was a patient of Dr Bernard Stuart in the Coombe Hospital on both my pregnancies following the death of my first baby under a different consultant in a different hospital and I have to say the care and attention given to me was second to none. I feel Dr Stuart is a very competent doctor. |
|
TVI Posted:
26/02/2007 16:22 |
| As usual too little too late. So many young womens' lives distroyed by a profession that, like so many others is self regulating. It has been proved over and over not only here but everywhere that self regulation is non-regulation. Self regulation becomes self protection. Recent examples: the Guardai, Legal Profession, Estate Agents etc. This is not just a Medical Council problem. At the root, as with so many other self regualting bodies, there seems to be no political will to do right by the people. What is the problem with sucessive Governments?? Does the Medical Council have too many friends in high places? The Medical Practioneers Act comes too late for all these young women.It appalls me to think of all these lives destroyed. Its the same old story, we have known for a long long time that there are many many things wrong in the medical profession but it takes a disaster to get any reaction from our Government. One cannot help but be synical. If it was not election time would we have this act at all. I just hope that The Act has real teeth and is not just another sop to the hard pressed tax payer, who is yet again footing the bill. The Medical Council should have no more than a 25% participation. I also question the fitness to practice credentials of the existing Medical Council's Fitness to Practice Committee. Should not some members of this comittee resign. The Minister should have at least offered her resignation. Its time for change, real change. Gone should be the days of our godlike fear and trust of Consultants and the medical profession in general. It is very interesting that to get an independant opinion we had to go abroad. Maybe the new Act should make provision to include non-state medical professionals to negate all possibility of bi-partisanship as part of our Medical Council's participation. Its time for us all not to fear making a complaint, to know that any complaint we may have will not be whitewashed. Its time for the whistleblower to be reveered and not cowered. There are many put to jail for non-payment of refuse charges. What does it take to see that justice is not only done but is seen to be done. No teeth no vote. TVI |
|
Siobhan Posted:
27/02/2007 23:08 |
| The moral of the story never changes - self-regulation is no regulation, never has been never will be. Just out of interest who will the members of the general public be on the Medical Council? A brother-in-law or sister-in-law of those already on the committee? The parents of the Alder Hey and Bristol Royal scandals here in the U.K have re-named the General Medical Council as Great Medical Cover-up. Any suggestion for our great and wonderful friends at the Medical Council of Ireland? So far I\'ve come up with Medical Cowboys of Ireland. Any other suggestions? |
| To join the discussion, register by clicking here |
|
QUICK LINKS: asthma | arthritis | psoriasis | crohn's | heart | epilepsy | eczema | osteoporosis | pregnancy | depression | alzheimer | cancer | sex | anxiety | overweight |
 |
About Irishhealth.com | Privacy Policy | Contact us | Why Register? | Make this your home page | Site Map |  |
| Copyright © 2010. All rights reserved. We subscribe to the principles of the Health On the Net Foundation |
