The removal of a woman's womb by a Co Louth gynaecologist shortly after the birth of her first baby by Caesarean section would have been unnecessary had he carried out certain procedures at the time, the High Court found yesterday.
Awarding Ms Alison Gough some €273,223 damages and costs in her action against Dr Michael Neary and Our Lady of Lourdes Hospital, Drogheda, Mr Justice Johnson said it was practically unheard of to perform a Caesarean hysterectomy on a woman in Ms Alison Gough's circumstances.
Ms Gough (37), of Market House Lane, Ardee, is one of several women who have sued Dr Neary over allegedly unnecessary hysterectomies performed on them. She was aged 27 at the time of the birth on October 27th, 1992.
In his reserved judgment, Mr Justice Johnson found that Dr Neary was negligent. Had he carried out certain procedures at the time, on the balance of probabilities, Ms Gough's bleeding could have been stopped and the operation would not have been necessary.
For a Caesarean hysterectomy to be performed on a young woman of this nature without having complicating conditions such as either cancer or placenta praevia was practically unheard of and occurred something in the region of one in a 100,000 cases.
At the time, Ms Gough was prima gravida, expecting her first child. She claimed Dr Neary was negligent in carrying out the operation and in failing to take sufficient and proper steps to stop the haemorrhage from which she was suffering. Alternatively, she claimed Dr Neary embarked on the procedure without having given proper and sufficient time to "conservative" methods of stemming the blood.
The judge said that, some days after the operation, Ms Gough spoke to the nurses and said that if she was going to have another child, she would prefer to cut out the labour and go straight to have a section.
They told her to ask her doctor. Dr Neary visited her in a public ward and she said that if she was going to have any more children, she would like to have them by section, to which he replied No. She asked him what he meant.
Dr Neary said he had had to remove her womb and that she had had a hysterectomy. He said he "had saved her life" and "could have sent her son home without a mammy". He said she had lost so much blood he had never witnessed anything like it and that he had used all the top drugs.
When at the six-week check-up she met Dr Neary again, she told him she could not sleep and could not come to terms with what had happened to her.
Ms Gough had said that Dr Neary had said that if he told her what happened on that night, she would never sleep again and she was better off not knowing. He told her to go home and get on with her life.
Mr Justice Johnson said there had been evidence from an obstetrician called on behalf of Ms Gough that between 1990 and 1998 there was not a single case of Caesarean hysterectomy of a prima gravida patient in the National Maternity Hospital.In his evidence, Dr Neary dealt in detail with his treatment of Ms Gough and the "excessive" bleeding after the removal of the placenta.
The judge said both sides in the case were in agreement regarding what the two main issues were - whether Dr Neary took all conservative steps, including administration of drugs that should have been taken before the hysterectomy; whether he persisted long enough in them and whether, had he persisted for longer with them, the haemhorrhage would have stopped.
Mr Justice Johnson said he believed that the evidence of Dr Wingfield and Professor Bonner (two witnesses for the plaintiff) could only mean that had Dr Neary persisted longer with the conservative methods, on the balance of probabilities, the hysterectomy would not have been necessary. This was proved by the fact that hysterectomy in a prima gravida situation occurred once in every 100,000 cases and for the reason of, for example, placenta previa or cancer.
The judge said he had had the opportunity of observing Dr Neary in the witness box and noting the manner in which he gave his evidence, the words he had used, his body language and tone. He found that he was very unconvincing in his explanations.
Ms Gough had been traumatised by the loss of her womb and spent 10 years in a most difficult situation. The judge said that seeing her in court was sufficient to appreciate the despair to which she had been put by the operation.
She had received counselling from the defendants but it was very inadequate, of no use to her and did not appear to have had any effect at all. Dr McCarthy, a psychiatrist who had treated her, had stated her condition was absolutely genuine and one of utter despair and distress.
Dr McCarthy indicated she had guilt feelings because she felt she might have been "one of the early ones" who could have stopped others suffering the same fate.
The doctor had indicated she appeared to get some good from medication she was on. But whenever she had to revisit the initial incident, her distress returned. The doctor was very pessimistic regarding a future, having regard to the fact that there may be other cases of this nature.
Dr McCarthy indicated that, eventually, if Ms Gough perceived that justice had been done, it would assist her in coming to terms with the matter.
Mr Justice Johnson awarded €150,000 for general damages to date; €100,000 for the future and €23,223 special damages, together with costs of the eight-day hearing.