I propose to read as part of my reply to Question No. 4 the statement to which I have already referred.
The letters to the Cork County Manager, referred to in the question, conveyed my findings arising out of a Sworn Inquiry held into the circumstances of the death of a patient in Fermoy Hospital.
The patient in question was a married man, aged 29 years, a farm labourer with three children, the oldest aged five and the youngest two years. He was a non-paying patient. He was admitted to the County Hospital, then at Fermoy, after 5.30 p.m. on the 10th May, 1957, as a case of suspected sub-acute appendix. He was seen in the hospital by the House Surgeon at about 6.00 p.m. and again at 7.00 p.m. The House Surgeon telephoned the County Surgeon at his home in Mallow, 20 miles away. The County Surgeon did not see the patient, but in the course of this telephone conversation, it was decided that an operation should be performed. The County Surgeon instructed the House Surgeon, who, at that time, had had, since qualification, only about eight months' surgical experience, to start the operation at 8.15 p.m. and said that he would probably be over.
The House Surgeon, accordingly, commenced the operation as directed about 8.15 p.m.
These facts are not in dispute.
It was no part of the duties of the House Surgeon to carry out operations as substitute for the County Surgeon. The relevant duties of a house officer, as laid down in the Regulations clearly indicate this. For convenience I shall quote them:—
"To take charge of all patients on their admission to the hospital and to assign them to their proper wards pending examination by the surgeon or the physician of the hospital, as the case may require."
"To visit the several wards of the hospital at least twice daily and at such other times as the due performance of his duties may require, and to report to the surgeon or physician of the hospital, as the case may require, any condition of a patient or other matter affecting the hospital, or the patients therein, which he considers requires attention."
"To attend at the hospital in any case of sudden emergency when sent for by the matron or other responsible officer."
"In case of urgency or sudden emergency, to send at once for the surgeon of the hospital or the physician of the hospital, as the case may require."
"Generally to assist the surgeon of the hospital and the physician of the hospital in the performance of their respective duties and to observe and execute all such orders and directions as may be given by the surgeon or physician of the hospital, as the case may be, applicable to his office."
On the other hand, the duties of a County Surgeon include the following:
"To examine the state of all surgical cases on admission to the hospital and to decide whether the cases are suitable for treatment therein."
"To attend all surgical cases in the hospital and see that they receive such surgical treatment and advice and assistance as may be necessary."
"To perform all such surgical operations as may be proper to be performed by him in the hospital."
All the foregoing duties which I have quoted are brought to the notice of appointees to these posts.
During the course of the operation to which I have referred, a complication arose with which the House Surgeon could not cope and about 9.00 p.m. a nurse, acting on his instructions, telephoned the County Surgeon's home in Mallow. The County Surgeon had not yet left for Fermoy. The County Surgeon told the nurse that he would be in the hospital in three-quarters of an hour. He appears to have arrived in the hospital at about 9.45 p.m. Shortly after the County Surgeon's arrival the patient got a spasm or convulsion. The convulsions became consistently worse and the patient died at 12.45 a.m. on the 11th May, 1957.
When the matter came to my notice I decided that the facts could be established only by a sworn inquiry into the circumstances surrounding the death of the patient, and into the manner in which the County Surgeon had performed his duties. The Inquiry was held in November, 1957 and occupied 11 days.
Having considered very carefully the evidence given at the hearing and the report of the Inspector who held the Inquiry, I caused the Cork County Manager to be informed, by letter dated the 14th April, 1959, that I was satisfied that:—
(1) In accepting the diagnosis of the House Surgeon and giving him instructions to operate, without personally examining the patient, the County Surgeon was, in all the circumstances, acting contrary to his terms of appointment;
(2) In the particular circumstances, the County Surgeon acted improperly in remaining in Mallow without any adequate reason and in not going to Fermoy to operate on or to attend at the operation on the patient (until he received a telephone call when complications had developed during the operation);
(3) The practice of the County Surgeon in instructing the House Surgeon to start operations when in Mallow and leaving for Fermoy was undesirable. It introduced unnecessary risk.
The letter went on to state that I was satisfied that I would be justified in removing the County Surgeon from office but that in view of the length of time which had elapsed between the holding of the Inquiry and my decision—a delay which arose out of circumstances for which neither I nor the Inspector was responsible—the County Surgeon should be afforded an opportunity to resign as an alternative.
The County Surgeon refused to resign by the specified date and I extended the period in order to afford him an opportunity to reconsider the matter. The County Surgeon still refused to resign and I made an Order removing him from office as from the 25th May, 1959.
In regard to the House Surgeon, as I have already mentioned, it was no part of his duties to operate, in substitution for the County Surgeon. In the event, he was unable, owing to lack of experience at the time to cope with the emergency which arose in the course of the operation—and while I felt that I should take into account that he was acting on the instructions of the County Surgeon, I could not entirely exonerate him from his share of responsibility for this tragedy. Accordingly, I caused a further letter, also dated 14th April, 1959, to be addressed to the Cork County Manager, requesting him to inform the House Surgeon that, in my view, he was lacking in judgment on the occasion in commencing the operation without having previously satisfied himself that experienced surgical opinion and help would be readily available to him to overcome any difficulty which might arise in the course of the operation.
The letters in question to the Cork County Manager were, at the request of the members of the Cork County Council, read to them at a meeting of the Council on 20th May, 1959 and were published in the daily press on the following day.
I have no information regarding the precise reasons why the Irish Medical Association should have seen fit to attempt to impose this boycott on all medical posts in every local authority hospital—regional hospital, county hospital, district hospital, fever hospital, mental hospital, orthopaedic hospital, sanatorium and county home in the State. These hospitals at any time cater for about 40,000 patients. The only explanation I have is that which appeared in a single daily paper on Monday, 25th May, attributed to an unnamed spokesman of the Association and was to the effect that the purpose was "to allow the Organisation to make clear the duties of any younger medical practitioner taking up a job in a public hospital"; that the house surgeon referred to above had done "nothing more than his diligent duty" and that "until the responsibility and duties of house officers in local authority hospitals were clarified by the Minister the present action of advice from headquarters would continue".
It was recognised by me that the house surgeon was an inexperienced young man at the time. The reproof administered to him was of the mildest and, in fact, he has since been employed, with my consent, in a more senior post. In the light of this, it is impossible for me to accept that the reason for the far-reaching boycott is, as stated by the Irish Medical Association spokesman, concern for the house surgeon concerned or for house surgeons generally.
If the boycott was imposed in retaliation for the action I have taken against anybody, that person must be the County Surgeon who delegated to a young man, who then had only very limited experience, a duty which it was no part of that young man's duty to perform and which the County Surgeon himself should have performed. I have been unable to trace in the voluminous evidence that there was, in the case of the unfortunate patient who died, a degree of urgency such as would necessitate an operation before the County Surgeon could reach Fermoy—indeed there was ample time for the County Surgeon to reach Fermoy between the time at which he decided that there should be an operation and the time he fixed for commencement of the operation.
I think every reasonable Deputy will agree that this attempt on the part of the Irish Medical Association to paralyse the local authority hospital services, which, as I have said, cater at any one time for about 40,000 patients, in the interests of one of its members who proved to be so negligent in the performance of his duty towards a husband, the father of three young children, is unjustified and reprehensible. I cannot see how such action will advance the interests or enhance the reputation of the medical profession as a whole nor can I believe that it has the support of the general body of responsible medical practitioners, least of all those who are attached to local authority hospitals.
If ever the word infamous were to be appropriately applied, surely it is to the conduct of a person who, sitting in his home, and without even seeing the patient concerned, in flagrant dereliction of his duty, directs an inexperienced junior to commence and continue an abdominal operation which ends in the death of a young husband entering on the prime of life, leaves his young wife a widow and deprives three very young children of their father. An even grosser infamy, however, would be for a Minister for Health to condone and palliate such conduct, by failing to punish it with the severity for which it cried out. It is to coerce the Minister for Health to do this that the Irish Medical Association have taken action in support of the dismissed officer. The boycott which the executive of the Association has imposed is an attempt by inflicting hardship and suffering on innocent persons, to intimidate the whole community. I am sure, as such, it will be repudiated by all right-thinking persons.
