When people blow the whistle on bad practice in the health service they can suffer, as can those who have to pick up the pieces, writes Eithne Donnellan, Health Correspondent.
In 1998, when a midwife in Our Lady of Lourdes Hospital in Drogheda was being interviewed by a solicitor in connection with an investigation into allegations that an anaesthetist at the hospital had failed to respond to a call, she took the opportunity to raise concerns she had about another matter.
She told the solicitor she was anxious about the high number of hysterectomies being performed at the hospital, particularly on young women, some of them after they had just delivered their first child. She had been accompanied to the solicitor by another midwife from the hospital, who supported her story.
The solicitor acted immediately and within days the consultant obstetrician and gynaecologist, Dr Michael Neary, was sent on leave.
But instead of general relief at the hospital that an appalling practice which had come to light would finally be stopped, there was resentment towards the whistleblowers.
There was resentment from other staff at the hospital rather than their employer, the North Eastern Health Board, which tried to protect them by permitting the perception that the whistleblowers were student midwives to be circulated.
"We heard comments to the effect that the whistleblowers would 'never get a job in Ireland', that they would be sued for defamation and would generally come to a bad end," reported Judge Maureen Harding Clark following her inquiry into practices at the Lourdes Hospital, the findings of which were published last week.
"The support for Dr Neary was considerably stronger than for the several midwives who through various means had tried to raise their concerns and were known to have done so," she added.
There were also repercussions for those who tried to pick up the pieces after Dr Neary was suspended. The doctor brought in as a locum to replace Dr Neary was not welcomed and "was treated with silence and coldness for several years", the inquiry report said.
The need to change was only slowly recognised and frequently obstructed. "The huge efforts by the medical director of the hospital, the director of nursing and the assistant CEO of the NEHB to introduce reforms and promote changes in practice took considerable personal strength of character and commitment. They were frequently vilified, condemned and isolated."
The medical board of the hospital voted to condemn the actions of the health board in suspending Dr Neary and passed a vote of no confidence in the medical director's leadership.
The experiences of these people, just seven years ago, would not provide encouragement to others working in the health sector today to expose poor or dangerous practices or to muscle in, when such practices are exposed, and try to put things right.
Neither would the experiences of health sector staff in other countries who have tried to expose bad practice. Take, for instance, the experience of young anaesthetist Dr Stephan Bolsin who, in the early 1990s, exposed the high death rates among children who underwent heart surgery at Bristol's Royal Infirmary. Two surgeons there had mortality rates of more than 60 per cent when they performed corrective surgery on infants. An inquiry followed and new systems were put in place. But Dr Bolsin found it difficult to secure another job at the same level in Britain afterwards and left the country.
The annual conference of the Irish Nurses Organisation (INO) heard last year how in another case a male nurse in the UK who spoke out about dangerously inadequate staffing levels had been fired.
There has been much discussion again in the wake of the publication of the Lourdes Hospital Inquiry report on the need for a Whistleblowers Act, to protect those who blow the whistle on bad practice and to stop staff being fearful of reporting their concerns. The Government does not support the idea however. The Taoiseach Bertie Ahern told the Dáil only a few countries had gone down this road. He said the best way forward was to "insert provisions for a investigative system for whistleblowers into sectoral legislation".
The INO called for legislation to protect whistleblowers at its conference last May and since then the Health Service Executive Employers Agency has set up a committee, in partnership with health sector unions, to draw up a code of practice for whistleblowers. Its work is at an early stage.
"We are happy to do this in the absence of legislation but our preferred option is a system that is underpinned by statute," said Dave Hughes, the INO's deputy general secretary.