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
Successive Health Ministers must
also share the blame for not introducing, as promised,
new laws to allow better monitoring of doctors by the
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 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
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
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
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
would like Eileen to explain more on what she means.
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
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
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
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
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
Anonymous Posted: 21/08/2003
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.
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
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
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
Anonymous Posted: 20/05/2004
vets are often better trained