Seanad Debate on Lourdes Report

Copernicus, of the thoughtful Midnight Court quotes Senator Geraldine Feeney’s statement regarding Michael Neary. I’ll repeat some of those quotes here. All of them are worth reading.

He also suggested that Senator Mary Henry’s statement, made as both a Senator and a Doctor, might be of interest. I think it is and I reproduce sections of it below. It is worth reading in its entirety.

But first, a small attempt at justification. The Lourdes Hospital Report was published on 28th February. There was considerable coverage of it, and then the media spotlight moved on to something else. By the 1st March, the top story on RTE was “Fresh Hopes for 300 jobs at Jacobs.” The Neary scandal wasn’t even in the top ten. It deserves more attention than that.

As individual citizens we are more or less powerless in the face of institutional failure. It is only by harnessing the collective will of the citizens through the organs of the state that we can push back against that kind of betrayal. However, even presuming that there are not invisible forces attempting to protect a status quo, the political organs of the state only respond to sustained, long term pressure. And that pressure only comes about if a broad mass of people are aware of the causes of institutional failure and have an idea of what can be done to solve them.

And all I can do is tell everyone reading, or unfortunate enough to be passing me on the street, about what the Neary scandal tells us. A bit like the Ancient Mariner, but without the big birds.

So, on to the quotes.
From Sen. Geraldine Feeney’s speech:

The people to whom I really point a finger are Dr. Neary’s senior colleagues, the pathologists and anaesthetists, who were not and should not have been afraid to address the matter. The anaesthetists were in the delivery rooms and operating theatres and saw there was no raised blood pressure or increased pulse rates and they knew the women would not die in 15 or 20 minutes. The pathologists who examined the uteri and sent them back to Dr. Michael Neary saying no abnormality could be found in them have many questions to answer.

The “three wise men??? sent to Our Lady of Lourdes Hospital by the Irish Hospital Consultants Association – Drs. Prendiville, Stuart and Murphy – issued a report giving Dr. Neary a clean bill of health, as implied in Judge Harding Clark’s report. She adduced that they did so out of congeniality and compassion for Dr. Neary. They must have told her so. Shame on those men. If I had a stronger word or if I were permitted to use offensive language in this Chamber, I would certainly use it in respect of them. Shame on them.

I’d like the consequences to more tangible than shame, if that’s all right with everyone. You can search for these doctors’ names on the Irish Medical Council’s website if you’re interested in knowing more about their background.

Now let’s hear from Senator Dr. Mary Henry:

As Senators can imagine, it is difficult for me as a member of the medical profession not to hang my head in shame, having read this report and listened to the contributions of Senators Feeney and Terry, as I speak in front of some of those who have been so grievously injured by a member of my own profession. No adequate reason can be given for the behaviour of Dr. Michael Neary. This has been an appalling tragedy. I am glad that the Minister of State, Deputy Tim O’Malley, apologised on behalf of all of us, not just to the women in question but also to their families.

The vast majority of cases involved Dr. Neary although some of them involved Dr. Finian Lynch. During the period in question, an excessive number of peripartum hysterectomies was carried out at Our Lady of Lourdes Hospital, compared to any other hospital in this country or any other part of the world. It beats me how members of the medical profession who were working at the hospital at the time can say they did not know anything unusual was happening.

The issue of gender has been raised in the context of the debate on this report. The membership of the Institute of Obstetricians and Gynaecologists during the timeframe under discussion was almost entirely male. The men in question were in a position of great power, whereas a degree of hierarchical obedience was expected of the women involved, who were either patients or nurses and were in a subservient position to the consultants.

Our knowledge of the hierarchical structures which were in place does not make the whole procedure any less inexplicable.

It is most unfortunate that those who inspected Our Lady of Lourdes Hospital were Dr. Neary’s peers. Ireland is a very small country with a small number of obstetricians. That there were under 100 obstetricians in the country at that time meant that such people were inspected by their friends, which was entirely unsatisfactory. When the Royal College of Obstetricians and Gynaecologists carried out inspections, they were carried out by its Irish members, which was also unsatisfactory. I share Senator Feeney’s grave concern about the fact that three obstetricians gave Dr. Neary a clean bill of health, as it was described locally, in 1998. That caused enormous distress to those in the local area who had objected to his conduct. If peer review is to be meaningful, it needs to be impossible for people to be reviewed by their friends.

When the matron complained to her colleagues in the unit, she was told by the consultants that it was none of her business. There seems to have been a bad atmosphere between the unit’s consultants and the rest of the staff of the unit. The hospital’s culture meant that no advice regarding contraception could be given. No tubal ligations could take place, for example.

I knew some of the Medical Missionaries of Mary quite well because they used to accompany me to meetings in London and elsewhere. They were kind and good women who were very determined in their religious beliefs. The mixture of religious beliefs and human reproduction can sometimes lead to serious situations which are perhaps not to the advantage of patients, who may not share such religious convictions. The Minister of State said that “patients require assurances that their interests are paramount and override any sectional concerns???. That principle should be at the forefront of whatever happens.

When Dr. Neary arrived in Our Lady of Lourdes Hospital, it was one of the major hospitals in the country for carrying out symphysiotomies. The others were the National Maternity Hospital in Holles Street and the Coombe Hospital. I do not know the exact number of symphysiotomies that were carried out in the hospital, but I have been at meetings where patients wept about them to me. This procedure was carried out by cutting the front of the pelvis to allow a vaginal delivery, rather than carrying out a caesarean section. Therefore, there was a culture of applying the Catholic ethos in a very strict manner when Dr. Neary arrived.

He claims that this fact was important in explaining why he carried out so many peripartum hysterectomies, but this claim cannot be taken seriously. It is true that he objected and was allowed not to take part in tubal ligations in England, but when he arrived in Our Lady of Lourdes Hospital, both he and Dr. Lynch asked the Medical Council and the Medical Defence Union about the situation regarding tubal ligation, and they were told they would have to abide by the ethos of the hospital.

We should recall that these issues were not just due to the ethos of the hospital, but to the culture at the time. That is why the pathologists frequently reckoned that the perfectly normal uteri they examined were being removed for sterilisation purposes. These procedures were referred to as “compassionate hysterectomies??? in the report. The figures at the Coombe had to be revised upwards when Dr. James Clinch became master there. He added another 70 cases to the list of what was described as compassionate hysterectomies. There were no pathological problems, yet serious operations were carried out to remove the uterus.

I was appointed to the Rotunda Hospital and to Sir Patrick Dunne’s Hospital to look after women who had previously suffered from deep vein thrombosis. This can occur when a person gets a clot in the legs which goes to the chest and it is still a high cause of maternal mortality, but it is nothing like it was then. It occurred much more frequently to women who were older and who had many pregnancies. I looked up the maternal mortality figures for the years 1966 to 1973. A total of 23 patients had died from pulmonary emboli in those years. Their age and parity for a sample went as follows: age 33, 11 children; age 40, 12 children; age 43, nine children; age 42, 13 children; age 31, eight children; age 33, 12 children and so on.

One woman was 48 years old and was on her 19th pregnancy. I wrote this paper in 1975 and I thought that someone at least would comment on it, but nobody did. I presented it at a meeting which I believe was of the Institute of Obstetricians and Gynaecologists. I asked what could be done about it because I was seeing women who badly needed tubal ligation and the only contraceptive available at the time was a high dose pill, which was described as a cycle regulator and which was totally unsuitable for such women. One person replied from the floor, saying that surely I knew some friendly gynaecologist who would carry out hysterectomies on these patients for me.

That was the culture of the time and it cannot be allowed to continue. Senator Feeney stated that she fears such an issue could arise again and I feel the same way. I read reports recently about women with seriously advanced carcinoma of the breast. A multicentred trial was carried out where these women were given combined chemotherapy in the hope that they might last another few months, which might mean a lot to them and their children. Patients in the Mater Hospital were delayed and may have been disallowed completely from taking part in the trial because of the insistence that they use contraception unless they abstained from sexual activity. Who has the right to tell women what they must do to be allowed to have a few more months of life? If the women think it is all right then they should be allowed to do it. There should be no interference between them and the clinicians involved. The Mater Hospital is one of the leading institutions for treating women with breast cancer and people should not be put in a situation like that.

A medical practitioners Bill is absolutely vital, but I have been promised such legislation for more than six years. If it is not brought before the House immediately, we will not be able to deal with it before the next election.

The solicitor for the health board and the lay staff at the time also acted very swiftly. Unfortunately, the medical profession comes out worst from this investigation for not trying to stop a man, with some obvious kind of phobia and personality disorder, from doing dreadful damage to a great number of people. As a member of the medical profession, I apologise profusely to all those who have been so grievously affected by his actions.

I think I may have mentioned earlier that the government likes to see reports being issued as being the end of a matter. There’s a day of kerfuffle and then you’re done. But here’s a helpful hint at what the deep background issue which runs through the Lourdes Report is and how it is still relevant to what is going on now in Irish hospitals.

“Patients in the Mater Hospital were delayed and may have been disallowed completely from taking part in the trial because of the insistence that they use contraception unless they abstained from sexual activity.”

Certain hospitals are described as having an ‘ethos’. I don’t mind that if it means there are statues of the Virgin Mary in the corridors of my local hospital. I do mind if it means that patients are prevented from taking part in a treatment that may give them an extra lease of life. Or that their reproductive organs are taken without anyone shouting stop.

4 Comments

  • copernicus says:

    Some people (Auds, commenters to Sarah Carey’s article) seem to be unhelpfully irate at references to the “ethos” of hospitals. I prefer to lend an ear to Dr. Henry’s contribution.

  • EWI says:

    One to watch will be how what’s going on in the US finds its’ way over here – namely the new wingnut vogue for medical professionals to refuse to issue contraception and give the accepted, impartial medical care expected of them (I seem to recall that there have been cases where American homosexuals have been refused service, too). As I say, look for the first signs of it here soon.

  • celtictigger says:

    Medico stuff is not my area of expertise. However, reading the commentary and root causes of the Neary affair, I am drawn back to one of the leading figures in Quality Management (my area of expertise) W.Edwards Deming. Part of Deming’s core philosphy was the elimination of fear in an organisation so that people would be able to report quality problems. Fear seems to have been a contributory factor here. As they say in the book Dune “Fear is the mind killer, fear is the small death that brings total oblivion”. Science Fiction and TQM theory all point the finger to a failure in the culture of these organisations that allowed fear to obstruct people doing the right thing.

  • […] Tuppenceworth, The Midnight Court and Sen. Geraldine Feeney managed to ‘establish’ the Doctors’ names about a week and a half ago. See what I mean about not kicking hard enough? […]

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