Ceisteanna–Questions. - Gynaecological Procedures.

Liz McManus


67 Ms McManus asked the Minister for Health and Children the action, if any, his Department has taken on foot of the revelations concerning the number of caesarean hysterectomies carried out by a certain obstetrician; if a counselling programme has been set up for the women involved; the consideration, if any, he has given to instituting a clinical audit policy; the status of any investigation and inquiry into the matter currently under way; and if he will make a statement on the matter. [2273/99]

The matter raised by the Deputy is currently under investigation by a group of experts nominated by the Institute of Obstetricians and Gynaecologists at the request of the North Eastern Health Board. I understand the group's report is expected by the North Eastern Health Board in a few months. The consultant involved is on administrative leave.

The board has arranged for a small number of patients of the consultant in question to be contacted through their general practitioner. The board has also established a helpline to provide advice and assistance to patients and families who have concerns regarding the treatment received. Each call is followed up and appropriate advice, support and counselling is provided as necessary. There is access to a medical social work and to a psychologist for those who wish to discuss any matters further.

I must emphasise that all cases involving individual consultants are a matter for the relevant employer – in this case a health board – and it would not be appropriate for me, as Minister, or for my Department to become involved in an ongoing investigation of this nature. However, the North Eastern Health Board has been keeping my Department fully informed of developments.

In relation to the question of clinical audit raised by the Deputy, I fully support its development across all levels of the health service. Under their contractual commitments in public hospitals, consultants are required to participate in a process of clinical audit. My Department is currently engaged with health agencies in putting the structures in place to allow for the implementation of these contractual undertakings. I recently approved the development of an accreditation system for the acute hospital sector, on a pilot basis. I am confident that this system, which would allow hospitals to assess their overall performance against an objectively agreed set of standards, will greatly assist in the development of individual quality improvement measures such as clinical audit.

Will the Minister not accept that his rather leisurely approach to this issue is unacceptable when one considers that it is profoundly alarming to women patients who may have undergone procedures by this consultant or who may do so in the future under some other consultant? Will he not agree that an investigation of this type should take a shorter period than the rather open-ended timeframe of a number of months? I remind the Minister we were promised a Green Paper on another issue which we were told would take a couple of months, yet over a year later we have not seen it. Will the Minister accept that he should be in a position at this stage to state clearly when this investigation will be concluded? Will he indicate the status of this investigation? What is the procedure in regard to the outcome of this investigation and what is his role and that of the Department in dealing with what is a profoundly serious life-altering experience for certain female patients?

The Minister referred to a small number of operations. The number of operations carried out was not small. What does the Minister mean by a small number and why were all the patients not called in for investigation? Were all patients contacted personally and asked if they needed counselling?

I ask the Minister to give us a serious answer in relation to clinical audit policy. He cannot refer to the previous Government on this issue; the Minister seems to be obsessed with looking at the past. When will clinical audit policy be established in all our hospitals? Does the Minister agree this should be a matter of course to which all consultants should be subject to ensure best practice and to reassure patients that when they finally get through the system they will be treated to the best possible standard in all cases?

I congratulate the Deputy on her promotion. This matter was raised by the Deputy's predecessor – I commiserate with her on her demotion – on 15 December last when the Minister of State, Deputy Moffatt, answered a question on the Adjournment outlining this issue. As has been stated in my reply, it is not a question of being leisurely but of due process taking its course.

The question relates to a consultant obstetrician. On 22 October last, the employees of a hospital alleged to the legal adviser of the health board concerned that there was an abnormally high caesarean hysterectomy rate. This procedure is only carried out in urgent medical circumstances and is avoided as much as possible since it precludes any further pregnancies. On being informed of the complaint, the health board concerned immediately set about dealing with it. It carried out a preliminary assessment over the weekend of 23-26 October. It met with the consultant on 27 October. He consented at that meeting to submit his practice to peer review conducted by personnel from outside of the board's area. It was subsequently claimed that the complaints against him were groundless. The chief executive officer was presented with reports from three obstetricians acting on behalf of the consultant concerned indicating that his management of a number of cases selected by that consultant were without fault and acceptable. The board referred the cases to a UK consultant obstetrician gynaecologist contacted via a reputable health care risk agency. There was a failure by the consultant to agree initially to the board's proposed approach to reviewing his case by an expert group nominated by the Institute of Obstetricians and Gynaecologists but he subsequently agreed to the terms of reference of this group through his legal advisers on 23 November last. The board received a report from the UK consultant obstetrician gynaecologist on 8 December and, based on that report and a separate complaint received from a patient on the same date, the chief executive officer invoked Appendix 4 of the consultant's contract and instructed the consultant to take immediate administrative leave from 11 December.

As has been said, the board set up a helpline on 16 December to provide advice and assistance to patients and families with any concerns regarding the treatment received. The helpline has been manned by a medical social worker, an assistant director of nursing and a complaints officer. It received a total of 173 calls between 16 December and 21 January. Each call was followed up with advice, support and necessary counselling. The board has a psychologist available in that regard.

In relation to the question of clinical audit, while it is not directly connected to this case the use of clinical audit would clearly help to identify quickly apparently abnormal practice patterns. I agree with the Deputy that it should form part of our system and that is the reason we are introducing it. In recent weeks further complaints have been received from patients and copies of those complaints have been forwarded to the group nominated by the Institute of Obstetricians and Gynaecologists. The due process is taking its course and I assure the Deputy this matter is being dealt with in a serious way. Far from a leisurely approach being adopted, the facts confirm that upon immediate notification prudent steps were taken by the board to ensure the matter was dealt with appropriately and in a way that will not be open to legal challenge.

Will the Minister state publicly that there is now no problem in relation to any question of liability with regard to the investigating doctors? This issue has been raised on a number of occasions. Will the Minister clarify the situation? What will be the status of this investigation in terms of its outcome and the responsibility of the Department of Health and Children?

Whatever decisions will be necessary will depend on the outcome of the investigation and the board will consider that as soon as the investigation is complete. The employer relationship is with the board, not the Department.

With regard to the first part of the Deputy's question, there were claims in a medical journal that the inquiry by the Institute of Obstetricians and Gynaecologists might not proceed because of medical indemnity problems for the three members of the group. However, this was refuted by the health board on 26 January and the review is to proceed as planned.