True drama of a nameless heroine

The dramatisation of the Dr Michael Neary case for RTÉ, while having to rely on the writer's imagination, gets across the tenor of the events that led to a woman's stand against injustice and a powerful man's fall from grace

THERE IS NOTHING subtle about Whistleblower. From the opening scene, it is clear who rules the roost in the bleak red-brick hospital and at whose convenience.

An old banger arrives at the entrance. The nervous young driver is confronted as he gets out to assist his distressed, heavily pregnant wife, Karen: "This area is set-down only." A mid-range car driven by a health board administrator, Dr Flor Wycherley, heads for the most convenient car park. He is turned away: "Consultants only." By the time a long, sleek car glides straight into the consultants' car park, we know where we stand. The well-padded, self-satisfied gent who emerges is the monarch of this little kingdom. The receptionist in the maternity unit simpers adoringly at him, before snapping dismissively at the inconvenient Karen and her husband. The mighty consultant, of course, is the obstetrician and gynaecologist Dr Michael Neary.

The time is the late 1990s and these early-morning arrivals are joined by Louise, a new midwife. She is humorous, attentive, professional and an outsider. "What are you doin' here?" asks candid Karen (a flinty, endearing Charlene McKenna), noting the English accent. "Following a man, I suppose," Louise replies.

Louise is called into theatre as Dr Neary performs an emergency Caesarean on Karen. The midwife's eyes widen as Neary uses a long, vertical incision (as opposed to the expected and more discreet bikini cut) to remove a healthy baby boy. Bleeding follows and the tension rises. "That's no use . . . Open the hysterectomy kit," he commands. In a graphic re-enactment, in utter calm, we see scalpels slice and scissors snip at soft young flesh. "Uterus out," he announces briskly. As viewers digest what is most likely their first sighting of a womb, the doctors breezily discuss their Christmas holidays and the nurses chat normally. The point is made: Karen's tragedy is so routine as to be unworthy of comment.

Later, an alarmed Louise mentions that despite eight years working in obstetrics in England, she has never seen a peripartum hysterectomy - a last resort to save the life of a woman with persistent bleeding - before. "Really?" shrugs a colleague. "It's my third this month."

Again and again, Louise nags her colleagues about her concerns and is told to get on with her job. Their denial comes back to haunt them when one of their own, Josephine, is in labour with her third child. In one of the drama's most distressing scenes, Josephine anticipates what is to come: "Please don't take away my womb, Dr Neary. Please. My pulse and blood pressure are fine. Look - they're fine."

Finally, at an interview with a health board solicitor about an unrelated investigation, Louise reveals her concerns. Cloak-and-dagger meetings follow in hotels and car parks, and as the stakes are raised she receives silent phone calls, unsigned notes and her relationship founders. The male hero of the drama - unlikely as it seems - is a health board administrator, played with brooding, chin-out determination by Adrian Dunbar.

It might all sound a little simplistic and far-fetched to anyone unfamiliar - or very familiar - with the story of Dr Michael Neary and the Lourdes Hospital Inquiry. Then again, the story itself is barely credible. The Institute of Obstetricians Review Group reported in April 1999 that out of 39 peripartum hysterectomy cases reviewed, 18 represented unacceptable practice and five were doubtful. Some 40 per cent of Dr Neary's peripartum hysterectomy patients were having their first or second baby; two women who underwent the operation ended up childless.

Another four years would elapse before Michael Neary was finally struck off the medical register in July 2003. The drama offers little in the way of pop psychology explanations for his actions, adhering rigidly to the recorded evidence.

WHILE SOME OF the characters in Whistleblower, such as Wycherley, are composites, or, as in the case of Louise, the product of writer Rob Heyland's imagination, they reflect the tone and tenor of the events that led to one young woman's extraordinary stand against injustice and one powerful man's fall from grace. There is no doubt that health board individuals distinguished themselves. "They immediately and remarkably kicked into action . . . They did everything perfectly," says Whistleblower researcher Sheila Ahern. "I get a lump in my throat when you see the health board people looking for one woman's file. There are files that remain missing to this day and they have never got to the bottom of it."

Would any of this have come to light without Louise's courage and persistence? In her Lourdes Hospital Inquiry Report, Justice Maureen Harding Clarke, spelled it out. "No one saw anything out of the ordinary, no one heard even a whisper of disquiet, and no one was given any reason to say or think that any of the hysterectomies were questionable. Few complained or questioned. Not the patients, their partners nor their families . . . ; not the junior doctors nor the post membership registrars; not the anaesthetists who received the patient, administered the anaesthesia, wrote up the operation notes and spoke to each patient in the recovery room and were always present at the operations; not the surgical nurses, who were frequently midwives, and always women, who handed the hysterectomy clamps to the surgeons and counted the swabs; not the midwives who cared for the women after their operations and who recorded each day the women stayed in the post-natal ward and the fact that they had had a peripartum hysterectomy; not the pathologists and technicians who received the wombs and specimens from the maternity theatre, who dissected, examined and reported; not the matrons who made ward rounds and who contacted the public health nurses; not the sisters of the Medical Missionaries of Mary who owned the hospital and employed the obstetricians; not one of the various GPs whose patients attended the IMTH [International Missionary Training Hospital] and underwent Caesarean hysterectomy; not any of the parties who read the maternity hospital's biennial reports in the years when it was published."

In the report, Justice Harding Clarke referred to the whistleblower as "Ann" and wrote: "If it were in the power of the Inquiry to make an award of bravery to any person, it would be to the midwife who we shall call Ann who made the first complaint to the North Eastern Health Board solicitor."

While Rob Heyland had to fashion her out of his imagination, she certainly exists. What made his creativity necessary and "Ann" rarer than pearls is her determination to remain anonymous in an era that creates Hollywood blockbusters out of less.

No one on the production team of Whistleblower has met her. "We have an intermediary who goes and talks to her, and although we made her character English she could be from anywhere. The important thing is that she was from outside the State," says Siobhán Bourke, the producer with Saffron Pictures, who made the drama in association with Newgrange Pictures.

Her outsider status was crucial in terms of her willingness to think and act independently, in the view of Justice Harding Clarke as outlined in her report. "We uncovered a complex story, and many strands remain tangled in the personalities of the participants and the difficult relationship between religious beliefs and human reproduction overlaid with a sense of intense loyalty to the maternity unit. It is a story set in a time of unquestioning submission to authority, whether religious or civil, when nurses and doctors were in abundant supply and permanent jobs were few and treasured." It was worthy of note, said the judge, that the four nurses who contributed to the exposition of systemic wrongs in Drogheda, were "all trained outside the Lourdes".

ALL WE KNOW of Ann as a real individual is contained in Justice Harding Clarke's report. It states that she came from the North of Ireland and was trained as a nurse and midwife in the Royal Victoria Hospital in Belfast. By the time she arrived in the maternity unit in Drogheda in late September 1997, she had five years under her belt as a staff midwife in a busy maternity hospital. Siobhán Bourke says the production team was aware of these details in the report, but was "unable to get anyone to verify it".

It did, however, get her reaction to the storyline; this was a request to change some of the names. Some of them were too close to reality, apparently.

In the drama, there are scenes where she is getting silent calls and unsigned notes, scenes where she is obviously feeling under pressure and intimidated. "We don't know if it was quite like that," says Lesley McKimm, executive producer from Newgrange Pictures.

For all the dispiriting scenes of Neary being applauded in the local pub, the medical staff in catastrophic denial, and the final scene (real or imagined) of Ann/Louise compelled to leave the country to get work, it is ultimately a story of hope. "It is one of the most traumatic stories in Irish medical history," says Whistleblower researcher Sheila Ahern, "and yet the drama is uplifting, because it's about the courage of the midwives, it's about the resilience of the women, it's about the public servants who did the right thing. It's a celebration of doing the right thing."

They held a special screening last week for all of the former patients, led by the women who spearhead Patient Focus, Sheila O'Connor and Cathriona Molloy. Some 200 were in attendance, of whom about half were patients, hailing from a huge social spectrum, demonstrating that Neary at least made no social distinctions. There were no emotional outbursts, which concurs with Justice Harding Clarke's description of them at the inquiry, as "sound women accompanied by supportive spouses . . . They were able to present their history without either high emotion or rancour."

There are varying hopes for this drama. RTÉ hopes to achieve a debate about personal responsibility, public systems and public accountability, in the words of commissioning editor Jane Gogan. Patient Focus is advocating that a patient-safety authority be established as "an immediate priority". The screen tells us at the end that there is no statutory provision for whistleblowers in Ireland and that there is still no mechanism to report malpractice or injuries other than recourse to the courts.

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• Whistleblower begins on RTÉ1 tomorrow at 9.30pm and concludes on Mon at 9.35pm