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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.
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.
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
Last Reviewed: 30th July 2003
|eileen(faulknere) Posted: 01/08/2003 18:25|
|I belive that this is not just about Dr Michael Neary but the unit n Our Lady of Lourdes Hospital in Drogheda in the Seventys Eighties and Ninties.|
|Anonymous Posted: 03/08/2003 22:53|
|i would like to know what consultants stood by or gave reports supporting dr neary as i believe three irish obstetricans having looked at 9 cases reported they were 'without fault' and a uk obstetrican reported on the same 9 cases that there were 'major concerns'|
|Anonymous Posted: 06/08/2003 15:00|
|I am also very concerned that 3 Irish gynaecologists/obstetricians who reported on the 9 cases reported that they were \"without fault\" and I am concerned that they did not speak out against one of their own Surely they were not condoning the high level of caesarean hysterectomies being performed by Dr Neary. I am really disappointed in the medical profession as a result of all this and I also feel very upset that women of my own generation were treated like \"pieces of meat\" by a man who thought he was \"God\" and spoke to them as if they were inferior beings!!|
|Anonymous Posted: 06/08/2003 16:16|
|I would like Eileen to explain more on what she means.|
|John(seamed) Posted: 06/08/2003 19:15|
|The culture of secrecy in the Lourdes over the last few decades has allowed any amount of poor practice to occur. A major change in the atmosphere there is long overdue.|
|John(maddenj) Posted: 06/08/2003 19:17|
|The Medical Council still has a long way to go. I am amazed at how quick it has been to jump to its own defence over the Neary controversary. It has been given the privilige to regulate itself. With this comes responsibility. Responsibility that it has failed to meet. Not for the first time either, this case just happens to have a very high profile. This is the tip of the iceberg and hopefully the house of cards will be tumbling soon. What can we say to the victims in this? I think the whole country feels for the women so brutaly mutilated. No amount of financial recompense can numb a pain of this magnitude. I hope the members of the Fitness to Practise Committee can sleep at night. The public must get Consultants down off their pedestals and ALWAYS demand second opinions. Correct me if I am wrong (Ed.) but is this not just one of our many basic entitlements under the 1992 Charter of rights for hospital patients?|
|Anonymous Posted: 07/08/2003 08:04|
|I myself was treated by Dr Neary and always found him very competent. However, this is a very serious matter and I am glad it was stopped before any other women's lives were ruined.|
|Anonymous Posted: 09/08/2003 23:29|
|As a former patient of Dr. Neary, a man in whom I placed my complete trust - he delivered my children and \"saved my life\" I was also one of the people that was \"lucky not to be going home in a box\". He performed a Caes/ hysterectomy on me and like the rest of us was led to believe that he saved my life and that of my children, but it was only on receipt of my medical files from the hospital, that my eyes were opened to what had been told to me. Whether or not I would have had more children is not the point - Dr. Neary took that decision from me. Thanking you for listening to our stories - thank you Medical Council - even if it took you over 3 years.|
|Anonymous Posted: 13/08/2003 12:54|
|I think that all of Dr. Neary's patients records should be looked at and the enquiry widened. This would give other patients and their relatives the opportunity to pass on valuable information to the Medical Council.|
|Anonymous Posted: 21/08/2003 20:22|
|The time taken to investigate this tragedy,merely proves that the nedical council is not capable of policing this sector.Typically,not one consultant voiced concerns, and indeed endorsed one of their own.Is it any wonder the public are pissed off,with all the health scandals.|
|Michelle(michelle33) Posted: 23/08/2003 23:27|
|Dr. Neary and Obstetrics I would ask people to consider the person and the behaviour. Do we expect too much from our medical professionals? Insurance shortly will be prohibitive and we will be unable to provide the services. This has serious implications. I would suggest it is time that the cartel - high point criteria that applies to medicine be seriously reviewed. I agree with Noel Dempsey and the science route. Nursing degrees ought to permit the option of entry to medicine. Several of the nurses I know had wanted to study medicine but did not get the points. If you break the cartel, supply and demand alters. The cost of the services reduce. Then the insurance will fall. We must also consider that if within a constitution, a system of checks and balances applies, the same ought to apply to the medical profession. It must be remembered at all times doctors are human; they have one of the highest rates of suicide (nicely concealed) and this in itself states a non supportive system in times of crisis. It is my belief that doctors level of fear regarding depression etc. is suffice for them to exclude their own. i.e. Denial. Reduce salaries; empower others to realise their ambitions and not necessarily on crazy high points. For the people who witnessed what was going on......and this applies in Government; in Religious institutions; in schools, etc. I provide this quote. Try listening to people, if even to speak to a homeless person and just listen to what it is they have to say. My experience is that they talk the language of children i.e. the truth Confucious (Beween 4-5 centuries) 'To know what is right and not to do it is the worst cowardice' There is an epidemic in this country....nobody acknowledges corspondence; nobody listens and hears; nobody goes 'y the book'...... the parameters are there for the widening. I suggest these people stand accountable. As a woman recently returning to Auschwitz remarked about a statue........those who don't react are basically capitulating. We need Ethics revived. Also it is okay to say 'I don't know'. Medicine is the worst offender here. We are all actors on a stage but in some cases therein lies real danger. Michelle|
|Anonymous Posted: 04/09/2003 22:26|
|There is hope for the future - pupil midwives saw what was happening, asked why? Result - exposure of this horrific practice of unnecessary hysterectomy. Members of health profession have a legal and moral obligation to 'do no harm'. Perhaps now the culture of secrecy will end and a climate of openness and humility, coupled with patient centre care based on best practice will flourish within our health service. The Consultants who reviewed Mr Neary's case files obviously were more keen on protecting their profession rather that ensuring that patients were safeguarded. Now the Medical Council is ashamed of Mr Neary - do they not also share some blame as the culture of arrogance is tolerated in and by the ranks of the medical profession. Doctors have God given talents but there are not God.|
|Anonymous Posted: 17/04/2004 18:36|
|I think a full investigation is nessessary not only from the days of Micheal Neary but to present, there needs to be a full clean out of the hospital, there are doctors working there that are only fit to work as vets.|
|Anonymous Posted: 20/05/2004 20:39|
|vets are often better trained|
|Shane(YCW37215) Posted: 02/03/2006 19:23|
|Why in God's name are the state..read TAXPAYER..going to suffer because of this character. Surely, HE should be sued, both personally, and thro his insurers. Also, prosecute him and the people who covered up for him, for GBH and reckless endangerment. Looking back at the "Blood tribunal", committees don't make decisions...PEOPLE make decisionas, and should be held accountable for them, whatever their position.|
|AML Posted: 03/03/2006 18:31|
|The WHO recommends that low risk pregnancies (80% of Irish women) are attended to by MIDWIVES not consultants. Midwifery care is woman centered and has been shown time and time again to result in better outcomes for mums and babies i.e. less intervention and less cesareans. Why isn't the government waking up and taking notice ? Why keep paying ridiculous salaries to consultants who are experts in SURGERY not normal birth ? They should be seeing women who have problems...not the vast majority of Irish women who have normal pregnancies. Think of the costs both monetary and in humanity that we could save by Irelands maternity system being midwife led and not obstetric led...|
|EGL Posted: 05/03/2006 21:22|
|I agree with aml I think that women must now speak out and ask questions about their care and not trust doctors blindly....ask the midwife look it up ...ask more qustions...don't pay huge sums of money for something that is natural and mostly normal!|
|Lillith Posted: 04/07/2007 23:15|
|Women have been treated as second class for years in hospitals. Males dominate the top positions and with people like the Pope making decisions on women's fertility- is it any wonder we are in this position?? Those of us who live in Drogheda knew well not to go to that hospital to have a baby as the Catholic belief is to make the woman suffer for some old fashioned reason. Yes, childbirth can be totally pain free as I discovered but women have been conditioned to believe it is always going to be painful.In fact we would do better to have babies at home and save ourselves the money.|
|Anna Posted: 03/04/2008 16:16|
|Unfortunately too many doctors are causing too many irriversable damage to people. http://www.a-little-wish.co.uk / http://forums.a-little-wish.co.uk is a group that picks up the pieces of such surgery and tries to prevent others following this path|
|med student Posted: 28/08/2008 22:49|
|Dr. Neary's actions were nothing short of disgraceful and those who spoke up were extremely brave. The impact on the women in question is something that is hard to even fathom. However, i believe this case should be taken on its merits and not used to further condemn doctors(and nurses) who work extremely hard under huge pressure and give up huge areas of their lives to help people. The vast majority of them are on your side and the comment about some of them not "being fit to practice as vets" is in poor taste and is offensive to both doctors and (I'm sure) vets, who work similarly hard. Please let common sense and decency prevail here.|
|JamesH Posted: 29/08/2008 16:10|
|Med Student, You are of course correct that most doctors and nurses are doing a fine job under tremendous pressure. I do have a lot of respect for doctors in general and really admire what they do. However, regarding the Neary case there is a feeling in the medical community that he was a one-off and it is unfair to tar them all with the same brush. This misses the seriousness of the whole thing. If you read the Judge Harding report on the matter it reads like a horror story. First the Neary case really was the big one that got away. To have a case as big as this requires an underlying culture of near-misses not being adequately being dealt. Secondly, the Neary case highlighted a lack of adequate performance measurement, which would have highlighted straight away how far from the norm he was performing. Thirdly, there was all the in-house surgeons and anaesthetists who knew his performance levels but did nothing about it. It took the new nurse with experience in the NHS to finally blow the whistle. Fouthy, there was the reviews by the college of surgeons which were totally inadequate and gave Neary a clean bill of health. The Neary case highlights a culture of doctors watching out for each other at the expense of the women involved; as Judge Harding called it “collegiality”. It highlights a culture of not measuring performance for fear of what might be found out. The medical world has a long way to go yet to learn the lessons of Neary. The trust has been broken in a big way with the public. We, the public, don’t trust them anymore, which is why Mary Harney’s move to have a lay majority on the medical council is to be welcomed. However it does nothing to build confidence to hear doctors objecting to this. They still do not appreciate that we let the doctors self-regulate and we got Neary.|
|med student Posted: 31/08/2008 22:38|
|JamesH, in response to your well expressed comments I think anyone in irish society who has seen, time and time again, a self-regulated profession (solicitors etc.) fail utterly to weed out from within, will agree that it is certainly not conducive to good practice. As someone at the bottom of the ladder in this profession which is so steeped in hierarchy, i understand the need for external review. "Whistleblowing" cannot and should not be relied upon. "Collegiality" is at best a euphemistic understatement. I must disagree with you however in your assertion that not to tar the whole profession with the same brush is to miss the seriousness of the situation. Surely it is an extreme failure of a system and not a reflection on doctors and nurses everywhere. Furthermore while you are absolutely correct in saying that there is a feeling in the medical community that this Dr. Neary's case was unique in the extreme, it is not to say that we don't want to ensure, with the correct structures, that it doesn't happen again. I don't believe that medical professionals in general need to be discredited to achieve this.|
|Anna(VFR41244) Posted: 01/09/2008 13:19|
|"Dr. Neary's case was unique in the extreme," Why do people feel this. I am a victim of a post pregnancy hysterectomy that I did NOT need and refused consent for. I am one of the thousands that can not sue (because of the way the notes are written up) and the police ignore, 'beucase you were in a hospital'. There is NO legal reason for any doctor or hospital to declare when a post pregnancy hysterectomy is done so the situation OVER THE WORLD is hidden!! There are MANY procedures that have been discovered to save a uterus if it is eg bleeding but again there is NO legal requirement to use them. www.a-little-wish.co.uk has been working for nearly a decade for the situation to be changed and doctors to be trained AND forced to save uteri. Many doctors and other medical people would like changes but they will not speak out against the bad apples in their profession, when womens and childrens lives are on the line they should! The situation is BAD, its unreported, hudden, its victims threaterned if they speak out and not taken seriously. I know I support its victims and have done for nearly a decade!|
|JamesH Posted: 01/09/2008 13:52|
|Med Student, You are of course correct that the Neary case in not a reflection of every single individual doctor and nurse. However I would disagree with you that Neary was unique in the extreme. In fact the evidence of the Judge Harding report would indicate that the underlying culture is one where errors are not addressed or even acknowledged to the extent that they should be. There are likely to be many cases of a less serious nature not adequately dealt with, and it is almost a certainty that there are other Neary’s not yet discovered.|
|Anonymous Posted: 01/09/2008 15:11|
|The Department of Health will not acknowledge financially the women who were over 40 at the time of their womb or ovaries being removed unnecessarily.|
|john Posted: 02/09/2008 00:41|
|This was a state in which The Blessed Virgin mother figure was revered, yet at the same time Mna na hÉireann was put under the control of the organisation namely the Roman Catholic Church that revered this figure but totally neglected the mothers of Ireland. What our hypocrisy and double dealing did to our own and most vulnerable can never be forgotten. While Neary was the one who did the damage what about all the extended support staff that stood aside and let it take place, many being mothers themselves. What I cant understand is the Irish peers of Neary were prepared to allow him to continue while a British one could see quite clearly he was out of control . As far as I’m concerned many heads should have rolled. Strange we had to rely on an outsider from a godless country to put standards in place in a country that we believed the women of Ireland especially the mothers of Ireland were primary and protected. It’s strange that Neary was finally unmasked with all the power and authority that supported him up to his position becoming untenable. Of the people we must single out are the brave and courageous two nurses who brought this to the attention of the lawyer of the Health Board and the brave a courageous way he fought to right the situation. Only for them Neary would still be in place destroying women’s lives.|
|zoltan(ZEW35773) Posted: 05/09/2008 00:08|
|One point which as far as I can see, no one has picked up on. There was mention of it in the film, This is the point of retraining. Here was a person, I will not dignife him by calling him a doctor, who had been in prctice for over 25 years, and does seem to have done any refresher courses or read any of the literature, which is always coming out. THere have been enormous advances during this time, and he knew none of them. Surly this should have been focused on by collegues long before. I think there is talk of GPs having do these courses, what a bout the "Gods" above them.|
|anna *a little wish* Posted: 08/12/2008 13:07|
I know that this is Ireland, however *a little wish* http://www.a-little-wish.co.uk did bring this problem up ('doctors' not updating their skills) with the powers that be in UK. Unfortuantely they are not taking the matter seriously and say that this is done, we know it is not.
In 2009 *a little wish* will be starting a campign that will be calling for real training to save uteri BEFORE removing them AND for it to be compulsary. That doctors will not longer have the CHOICE to save uteri as they do now.
If you would like to help us, please contact us, as this has been going on for too long and too many are not doing enough to change things ...
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