No action was taken until a complaint in 1998, writes Eithne Donnellan, Health Correspondent
It was October 22nd, 1998. Two midwives working at Our Lady of Lourdes Hospital in Drogheda were giving a statement to the legal adviser to the then North Eastern Health Board about another matter when one of them said she also wanted to express their concerns about one doctor at the hospital and the high number of young women whose wombs were being removed by him at the hospital after giving birth.
A few days later the doctor involved, obstetrician Dr Michael Neary, agreed to take annual leave after a meeting with health board officials. He also agreed to submit his practice to a peer review.
But the peer review which followed was of nine cases selected by him. The following month, November 1998, Dr Neary's solicitor produced reports by three Dublin-based obstetricians which found that his management of the nine cases was without fault and acceptable.
Dr Neary returned to work, subject to restrictions, and meanwhile the health board sought the views of an independent UK specialist on the same nine cases.
Dr Michael Maresh, professor of obstetrics at the University of Manchester, filed his review on December 8th, 1998. He had major concerns about Dr Neary continuing to practise. He believed Dr Neary's clinical judgment to be significantly impaired and that women appeared to be put at risk. The health board instructed Dr Neary to take administrative leave on December 11th, 1998.
The news was reported in The Irish Times on December 14th, 1998. It said a consultant obstetrician was under investigation following his performance of a large number of Caesarean hysterectomies. Until then the nine women concerned knew nothing about the reviews of their cases. They were contacted by their GPs the following day.
In the days afterwards many other women contacted the local radio station LM/FM. Up to 70 women called saying they had been patients of Dr Neary. Many were distressed at the situation and were very critical of the doctor. Some were also supportive, describing him as a "caring doctor".
There was then a flood of letters of complaint to the NEHB about Dr Neary and a more thorough search of the maternity theatre register was conducted in the hospital. It revealed hysterectomies had been carried out more frequently than previously thought.
A helpline was set up by the health board. Some women who contacted it discovered their medical records were missing.
The Institute of Obstetricians and Gynaecologists, Dr Neary's professional body, carried out a review of a larger number of cases in which Dr Neary was involved.
While its review was taking place, the medical council went to the High Court in February 1999 with an application to have Dr Neary suspended from the medical register pending an inquiry by its fitness to practise committee. The application was granted.
When the Institute of Obstetricians and Gynaecologists reported in April 1999 it raised questions in relation to almost two-thirds of the Caesarean hysterectomies Dr Neary carried out between 1992 and 1998. Three members of the institute had reviewed 39 cases he was involved in and found Dr Neary's clinical practice in regard to Caesarean hysterectomies was unacceptable in 46.2 per cent of these, acceptable in 41 per cent of cases and doubtful in 12.8 per cent.
It said Dr Neary had a Caesarean hysterectomy rate of 5 per cent, which is one for every 20 Caesarean sections he carried out. This was 20 times the recorded rate in one Dublin maternity hospital, the report said.
But it recommended Dr Neary should return to work after a six-month period of supervised postgraduate work. This was never allowed, however, as he had already been suspended from the medical register.
The medical council's inquiry into Dr Neary's practice opened in June 2000 and in July 2003 the council ruled he should be struck off. Its fitness to practise committee had found him guilty of professional misconduct over the unnecessary removal of the wombs of 10 patients between 1992 and 1998. Four of them were having their first baby when their wombs were removed. Dr Neary, who resigned in June 1999 and has not practised medicine since, strongly defended his actions.
The medical council's report noted it was clear that Dr Neary was "by no means alone in having a high Caesarean hysterectomy rate" at the hospital. The medical council, which passed its file on Dr Neary to the Garda, called for a further inquiry.
In November 2003 a non-statutory inquiry chaired by Judge Maureen Harding Clark of the International Criminal Court was announced by the then health minister Micheál Martin. It began hearing evidence in June 2004. Its report was published yesterday.