A total of 65 legal actions are being taken following allegations that a Drogheda-based consultant obstetrician performed unnecessary caesarean hysterectomies, the North Eastern Health Board has indicated. In the face of demands for a full public inquiry, the health board vigorously defended its response to complaints against Dr Michael Neary when it appeared before the Joint Oireachtas Committee on Health and Children.
The consultant, who was based in the Our Lady of Lourdes Hospital, Drogheda, is the subject of a Medical Council fitness to practise inquiry, though a ruling could be a year away.
The NEHB's chief executive, Mr Paul Robinson, made the health board's presentation to the Joint Oireachtas Committee on May 24th - though his prepared statement has only come to light now.
An initial assessment into Dr Neary's record was completed shortly after the first complaints were made to the health board's legal adviser, Mr Gary Byrne, by two midwives on October 22nd, 1998.
However, Dr Neary offered an explanation for the high number of caesarean hysterectomies during a meeting with health board officials four days after these allegations were made. "At this meeting, Dr Neary agreed to submit his practice to a peer review, conducted by personnel from outside the Board's area. Dr Neary also agreed at this time to take immediate annual leave," Mr Robinson told the committee.
However, a three-strong panel, created by the Institute of Obstetrics at the request of the health board, was rejected by Dr Neary, "notwithstanding his offer to submit his practice to a peer review", Mr Robinson said.
In November 1998, the consultant's solicitor produced reports by three obstetricians which found that his management of nine cases, selected by him, was "without fault and acceptable".
"The influential nature of these reports was such that if accepted, the substantive concerns about Dr Neary were without foundation," said Mr Robinson, who added that they also made it difficult to refer the matter to the Medical Council.
However, the "serious concerns" of senior managers were not allayed. By mid-November 1998, an agreement was reached that he would not perform caesarean surgeries without another consultant obstetrician "being present and giving a second opinion".
However, these restrictions "proved difficult to implement". "Final mutual agreement on their implementation only occurred on December 3rd, 1998, following lengthy consultations between the respective legal advisers to Dr Neary and board management."
In December 1998, Dr M. Maresh, a Manchester-based consultant obstetrician gynaecologist, reported he had "major concerns" about Dr Neary's conduct after he reviewed the same nine cases that had earlier been viewed by consultants on behalf of Dr Neary, the committee was told.
On the same day, the NEHB received a complaint from a patient of Dr Neary after a clinic visit. "This complaint further heightened the concerns of health board management with regard to Dr Neary's care and treatment of patients. An initial assessment that included contact with this patient's family doctor confirmed the authenticity of this complaint," the health board chief executive said in his statement.
In February 1999, the Medical Council removed Dr Neary's name from the Medical Register following a High Court hearing. Two months later, the Institute of Obstetrics' review found that his decision to opt for caesarean hysterectomies did not conform to "acceptable medical practice" in 46 per cent of cases.
Since then, the NEHB said it has revised rules to improve checks, to regularly examine consultants' surgical records and to ensure better communication between consultants and midwives.
The NEHB has "always endeavoured to deal with the serious concerns" about the case "through a confidential and sensitive process" that had regard for the board's statutory duty of care, Mr Robinson said.
During its appearance before the Joint Oireachtas Committee on May 10th, a patients' lobby group said the women and their families "need to know the full truth". "For this to happen and for trust to be repaired in some way, it is essential that the hospital be subjected to a public and independent inquiry as a matter of urgency," said Patients' Focus.
