Dr Neary claimed many women asked for hysterectomies, according to documents made available yesterday. Mary Carolan reports.
Dr Michael Neary, who was struck off the Medical Register this week following a finding of professional misconduct arising from the removal of the wombs of 10 women at Our Lady of Lourdes Hospital, Drogheda, told the Medical Council's Fitness to Practise Committee inquiry into complaints against him that Caesarean hysterectomies "seemed to be very prevalent" at the hospital even before his arrival there in 1974.
The documents recording his comments have now been made available by the High Court.
Dr Neary, a consultant obstetrician, told the Fitness to Practice Committee that the non-availability of sterilisation, due to the Catholic ethos of the hospital, "reduced our threshold" for Caesarean hysterectomies. "The other thing is that we developed an expertise for Caesarean hysterectomy in Drogheda," he said. "They seemed to be more frequent than in other places down through the years."
The documents recording his comments have now been made available by the High Court. They show Dr Neary said he had written to many people, including two Ministers for Health, about the fact sterilisations could not be performed in Drogheda but only received acknowledgements and "nothing came out of it".
In his evidence to the FTP Committee, Dr Neary said he and other consultants believed the non availability of sterilisation was contributing to the high incidence of Caesarean hysterectomies in the hospital.
Because no sterilisation was available, a lot of patients asked for hysterectomies, he said. The rate of Caesarean hysterectomies "worried us greatly at the time and had done for some years". The worries were made known to the hospital down the years "but most severely in October 1998". In June 1998, with the North Eastern Health Board taking over the running of the hospital from the Medical Missionaries of Mary (MMMs), patients were "not just requesting but demanding sterilisation".
Dr Neary made his comments while giving evidence at hearings of the FTP which began in 2000 and concluded earlier this year. The committee subsequently found Dr Neary guilty of professional misconduct relating to the removal of the wombs of 10 patients. A decision by the Medical Council that he be struck off the medical register was confirmed by the High Court earlier this week.
In his evidence, Dr Neary said the issue of sterilisation was raised in June 1998 at a meeting with Mr Peter McGrath, a hospital manager, which was attended by Dr Neary, Dr Finian Lynch, another consultant obstetrician, and the senior nursing officer, Ms Duff. It was again raised in October 1998 at a meeting attended by Dr Neary, Dr Lynch, Dr O'Quigley (another consultant obstetrician), Mr McGrath and Ms Duff.
Dr Neary said: "The issue of sterilisation was raised. We felt it ought to be available. We felt at the time lack of sterilisation availability was contributing to the high incidence of Caesarean hysterectomy within the hospital in that there were patients coming in we had to do a Caesarean section on, whom we felt should have no more children, but we could not do a sterilisation."
He said a lot of patients requested sterilisation and, when told it was not available, asked for hysterectomies.
He said the Patients Charter of the early 1990s required hospitals to provide contraception if requested and he and other doctors took the view they were also required to provide sterilisations if these were asked for.
Counsel for Dr Neary said Dr Lynch had written in November 1998 to the hospital general manager about the "dilemma" Dr Lynch felt he was in in performing Caesarean hysterectomies. Dr Neary agreed Dr Lynch had referred in the letter to a particular case or cases which he, Dr Lynch, had had a problem with. Dr Neary said the issue, essentially, was sterilisation and Dr Lynch was emphasising the medical/legal problems which might arise if that problem was left unresolved.
Dr Neary said that patients who were refused sterilisations would ask for their uteruses to be removed but this could only be done if the uterus was sufficiently damaged.
"Patients would go to sleep hoping it would be so damaged it would be removed and they would wake up with it but they were not too happy about it."
"It reduced our threshold for Caesarean hysterectomy. There is no doubt about that. The other thing is that we developed an expertise for Caesarean hysterectomy in Drogheda. They seemed to be more frequent than in other places down through the years. We felt that we had a certain expertise with the operation and generally we had no complications after we performed it. We would have a lower threshold because of the velocity that existed and the demands from the patients."
Sterilisation was absolutely never permitted, he said. One of the conditions of handing over the hospital to the North Eastern Health Board in 1998 was that the existing ethical code came with doctors' contracts.
Dr Neary said the doctors wanted the ethical code removed by the Medical Missionaries, which had established the hospital in 1941 and the board also wanted it out but the nuns would not allow it, "... and so the ethical code came with the health board." Sterilisation was introduced about a year after he left the hospital, he said. He left in December 1998.
Dr Neary also said that, up to 1991, the maternity unit had no access to an Intensive Care Unit except in the general hospital but that was so overcrowded it was often difficult to get a bed in it. They had converted one of the labour wards in the new maternity hospital premises, which they moved to after 1991, to "a kind of ICU".
He added that prostoglandin, a drug used to help stop obstetrical haemorrhage, was not available.
"The nuns ran the pharmacy. I think they had a vague idea in the back of their heads we might use it for purposes other than contracting the uterus and for various reasons it did not seem to come in."