An obstetrician faces an inquiry following reports that he carried out an abnormally high number of hysterectomies on young mothers, in some cases removing their ovaries, in the past three years.
The health board in which he works is to request the consultant to take paid "administrative leave" while the inquiry is carried out by the Institute of Obstetricians and Gynaecologists in Ireland.
This morning the health board will inform patients of the situation through their general practitioners.
The request follows an independent assessment of nine cases when the doctor removed wombs from young mothers immediately after the delivery of their babies by caesarean section. The report following that assessment is believed to have said that in many cases the consultant's decisions to perform hysterectomies were taken too quickly and unnecessarily.
This report was carried out by a professor of obstetrics at a UK university who specialises in infant mortality. It was commissioned by the health board and the professor was recommended by the Royal College of Obstetricians and Gynaecologists.
However it is understood that three Dublin-based consultants produced another report at the request of the doctor involved reviewing the same nine cases. This report was not critical of the procedures he adopted and the decisions he made.
The doctor has performed 21 caesarean hysterectomies - removal of the uterus just after a woman has given birth by caesarean section - in the past three years. The average for a hospital comparable in size to the one where he works would be around one per year, the report is believed to say. Most obstetrician/ gynaecologists would perform only a handful of such procedures in a lifetime.
A caesarean hysterectomy is a radical and uncommon procedure, performed when there is uncontrollable haemorrhage from the uterus following birth by caesarean section. It is performed only when other measures to control the bleeding have failed and there is concern over the woman's life.
It is believed the report expressed concern that because of the procedures carried out by the consultant the young women involved would be denied the opportunity to have children in the future. In one case the woman lost her baby (through no fault of the consultant) and will never be able to have children.
The situation came to the attention of the health board in October, a month in which the consultant performed two such operations. Two midwives who had worked in theatre with the doctor are believed to have expressed concern to a solicitor retained by the health board about procedures he was carrying out on women.
The doctor agreed to go on annual leave for a period and the British consultant was asked to review nine cases in which the doctor had carried out the procedure.
He found there had been a sudden increase in the number of hysterectomies carried out at the hospital from an average of one per year in 1994 and 1995 to an average nine per year in 1996, 1997 and 1998.
The consultant's report also says that if the hospital had reviewed its data for 1996 it should have seen cause for concern. However the matter was not noticed. There should also have been an in-house analysis as to why so many caesarean hysterectomies were being carried out but this does not appear to have happened, the report says.
It says that the doctor has reported findings in his notes which are not confirmed by subsequent pathological examination of the removed uterus. He resorted to caesarean hysterectomies quickly, it says. Some of those he described as bleeding profusely had not needed blood transfusions at the time. Other means of controlling bleeding were not used enough.
It is believed that no complaint has been made against the doctor to the Medical Council. The health board refused to answer queries on the case last night.
It issued the following statement: "At any one time, with the co-operation of the parties involved, expert groups examine the practice in particular areas of the board's remit. When such examination is in progress, it is [the health board's] policy not to make public comment, in order to protect the interests of patients and professionals involved. Appropriate private methods of informing patients are used."
Woman who lost first baby can never have another: page 4