Vol. 569 No. 3
87 Mr. Morgan asked the Minister for Health and Children if his Department has researched possible procedures to alleviate the medical problems faced by women who underwent symphysiotomies in Irish hospitals without their consent; if he has consented to meet representatives of Survivors of Symphysiotomy to discuss their situation; and the way in which he proposes to resolve the outstanding issues. [17668/03]
103 Mr. Boyle asked the Minister for Health and Children if he has received reports from women who have experienced difficulties following symphysiotomies; his plans to investigate their complaints; and if he will make a statement on the matter. [17627/03]
140 Ms O'Sullivan asked the Minister for Health and Children the investigation which has been undertaken into the use of the procedure known as symphysiotomy in Irish hospitals in previous decades; if information is available as to the numbers of women who were subjected to such procedures; if procedures are in place to assist women overcome the subsequent health problems associated with these operations; and if he will make a statement on the matter. [17534/03]
I propose to take Questions Nos. 87, 103 and 140 together.
Arising from concerns about the use of symphysiotomy in obstetrical practice in the past, the chief medical officer, CMO, at my Department, in April 2001, asked the Institute of Obstetricians and Gynaecologists for its comments and advice on the matter. The institute represents obstetrical and gynaecological opinion in Ireland, acts as an advisory body on matters relating to education, research and administration in the specialty and seeks to raise standards in obstetrics and gynaecology in this country. The institute replied in May 2001 to the CMO and confirmed that from around 1920 until around 1960 symphysiotomy procedures were carried out on selected patients, mainly at the National Maternity Hospital and the Coombe Hospital in Dublin.
My Department does not have details of the numbers of women who underwent this procedure throughout the country, but my Department has asked the regional chief executive of the ERHA and the chief executive officers of the health boards to reply directly to the Deputy in this regard. The institute advised that excellent results were claimed for the procedure which had the effect of permanently enlarging the pelvis and allowing women to undergo normal delivery. This was at a time when caesarean section had a high mortality rate due to sepsis – sepsis was one of the leading causes of maternal death at that time. The institute stated that in properly conducted cases, complications were rare. Published medical reports of the time indicated favourable results for the procedure. Many of the cases referred to in these reports were emergency admissions with obstructed labour where sepsis following caesarean section would have carried a significant risk of maternal death.
From 1950 onwards, the operation of symphysiotomy for obstructed labour was gradually replaced by the modern caesarean section, as antibiotics were available by then to treat infection and sepsis was less of a hazard. The institute also stated that "the operation of symphysiotomy remains an accepted indication for the management of a trapped after coming head of a breech" but that caesarean section is now recommended for all mature infants who present with a breech presentation. We must be cautious about judging procedures and interventions which were used in previous generations in light of current knowledge and experience. Enormous medical advances have been made in obstetric practice since the 1950s and procedures were not as advanced then as they are in Ireland today.
Under the circumstances, I have no plans to establish an inquiry into the use of symphysiotomy in obstetrical practice. I am aware that a request has been made by a group representing women who have experienced this procedure for a meeting in relation to the issue and I expect to be in a position to respond at an early date. We must be cautious about judging procedures and interventions which were used in previous generations in the light of current knowledge and experience. Enormous medical advances have been made in obstetric practice since the 1950s, and procedures were not as advanced then as they are in Ireland today. Under the circumstances, I have no plans to establish an inquiry into the use of symphysiotomy in obstetrical practice. I am aware that a request has been made for a meeting by a group representing women who have experienced this procedure and I hope to be in a position to respond at an early date.
When will the Minister meet members of this organisation that represents a very considerable number of women who have endured what are called "properly conducted cases". I do not even know what "properly conducted cases" means. The answer given by the Minister is identical to that given to Members of this House some 18 months ago and to an answer given to me in this House some weeks ago. Not one word has changed.
The Minister has been advised that this practice ended around the 1960s. I assure him that it continued into the 1980s. This is where an investigation is needed; if the Institute of Obstetricians and Gynaecologists thought that this practice finished in the 1960s, who then is responsible for the brutality that carried over into the 1970s and even as late as 1983, when I understand three operations were carried out in Our Lady of Lourdes Hospital in Drogheda, and others at The Coombe Women's Hospital? As for the assertion that the results of these operations were very good, there are grounds for inquiry there too. If the Minister were to meet representatives of the group, he would know that the results were not very good. I asked the Minister to meet them some time ago.
Supplementary questions are limited to one minute. The Deputy has exceeded one minute.
Will I be allowed to ask a further supplementary question?
If time permits.
I have no difficulty in meeting the group concerned. That will be processed as quickly as possible.
That is appreciated.
We refer to the Institute of Obstetricians and Gynaecologists for advice in terms of standards and quality of care on a range of issues relating to obstetrics, gynaecology and such matters. The institute has written back to me, as Minister, on such matters. Regarding any practices that took place even as far back as the 1970s, changes have occurred since then in a range of medical areas and disciplines. Retrospective judgment in terms of the wisdom or efficacy of a particular procedure is fraught with difficulty. That is the point I made. One must proceed with some caution in this matter.
Does the Minister agree that the reply he has given in the House today is very much a cut and paste job? I raised this issue over two years ago, and the exact phrases he used today were in the reply then and, indeed, in the letter sent to me on 1 October 2001. I first raised this issue in May of that year. Does the Minister agree that the reply received in the Department by Dr. Kiely, from Dr. John Bonnar, was totally inadequate? It consists of a number of paragraphs and a reference to some journal, the British Journal of Obstetrics and Gynaecology. It is really quite insulting, particularly to the women who have suffered so much from this operation.
Does the Minister recognise that there has been great suffering and that, to this day, some womencannot walk properly and experience pain as a result of the operation? I am glad the Minister intends to meet them, but does he believe that the issue now warrants a public inquiry? That is what these women are demanding. Does the Minister agree that that is what they should get?
I wish to seek clarification. Is Deputy Gormley seeking a full statutory public inquiry?
Yes. That is what the group is seeking.
That is what the Deputy wants too. We need to be cautious. As we know, a statutory inquiry involves a whole range of procedures which could last a significant time. I have no plans to go down that route. I will meet the group to hear its concerns at first hand.
There are three questions listed. I must call the Deputies who tabled them, or their substitutes.
Does the Minister accept that there is a problem about depending solely on the Institute of Obstetricians and Gynaecologists to assess what happened in the case of these women? The information the Minister has is inaccurate. The procedures went on quite extensively later than the 1960s. Does the Minister accept that simply leaving it to the institute to provide an overview on this issue is not confronting what many people would feel was a value-laden decision to carry out the procedure in certain instances? It is important to recognise that health care and hospital care have moved on. That is not to say that judgments were always made purely on medical grounds. Issues relating to this procedure need to be investigated and considered, rather than simply leaving the matter to an institute of professionals.
The Deputy has a one minute time limit.
I appreciate that, but this is an important issue. If we let this go without an inquiry, statutory or otherwise – and I do not think the Minister has responded to whether an inquiry can be held which is not statutory –
The Chair must go by the rules of the House laid down by the Members.
Can we have an inquiry, even a non-statutory inquiry? What is the Minister's view?
Let us be clear that the question opened up here is potentially enormous. I am talking about any area of medical procedure that can be quite clearly examined retrospectively and declared to be wrong. I take Deputy McManus's point on the question of there being a value-laden approach to this particular procedure, and whether that was the motivating factor behind it. If so, that would certainly be a matter for con cern. We are opening the door to a scenario of returning to the 1960s, the 1950s and the 1940s and raising the possibility of instigating inquiries about procedures adopted in hospitals in other medical areas. Why would one investigate one such matter and not another? We would have to grapple with that issue.
I will meet the group. We will acquire information during that meeting and take it from there.
I support the request for a meeting. I am not seeking a statutory inquiry at this stage because I do not think we know enough to make that call. I met some of these women today for the first time – the most harrowing meeting I have ever had with any group – and judging by what they said and what the Minister has said, some of the Minister's information is factually incorrect. There is no reason to believe that what these women are saying is wrong. The operations were not carried out in lieu of caesarean sections, but in addition to them. The operations were also carried out without any consultation and in some cases by stealth, with some women not being told that the procedure was being carried out.
I accept what the Minister says about practices being different in the 1950s, but I agree with Deputy McManus that we do not know what was the motivation. It was definitely suspect. I ask the Minister to bear in mind that this totally barbaric and unacceptable practice, carried out by stealth without the permission of the women involved or their husbands, continued to be carried out in this country up to the 1980s. Before the Minister makes a decision, I ask him to keep an open mind and to go beyond the initial reply he received from Dr. Bonnar. There is more to this issue than meets the eye. I would not say that lightly. The Minister should keep an open mind until he has met these women.
I will take note of Deputy Olivia Mitchell's comments. I will meet the women concerned and revert to her and other Deputies.
I commend the Minister on agreeing to meet the group. That is very progressive. At this stage at least, he is not the bad guy and has the possible solution to the problem. If it is a case that wayward and semi-insane consultants conducted this crazy stuff on these female victims, the Minister certainly has it within his power to do something about it. If he were to hear some of the cases of these women and if they could get through the wall of the Civil Service to allow him hear what happened, he would take steps to initiate a solution. I submit that what these women suffered is on a par with institutional abuse, albeit on a smaller scale.
Irrespective of what doors are opened through action taken, a small number of people are being asked to carry a very heavy load. This is grossly unfair and unjust. Will the Minister bypass the institute to reach out to these people and find out what is happening? If he is a fair-minded person, I am satisfied that he will come to the same conclusion as many on the Opposition benches.
Will the Minister agree that we can take this in stages? I have submitted a request that we deal with this in the Joint Committee on Health and Children. That would be the first step and we could then examine the possibility of a non-statutory inquiry. We could take it step by step and that would be the most reasonable approach.
The Minister appears to indicate he is taking the matter seriously. Will he listen carefully to what these women are saying, and will he ensure that what they say is not dismissed? The fact that their concerns were dismissed has added to their pain. Is the Minister aware that, the first time their concerns were raised in the House, the reply I received from the then Minister of State at the Department of Health and Children, Dr. Tom Moffatt, was quite insulting? The women were completely insulted by the approach adopted.
This matter cannot be dismissed. Will the Minister take it seriously and give an undertaking to the House that he will meet the women sooner rather than later?
It is important that this matter be investigated further. Will the Minister agree in principle to an investigation? The idea of a statutory inquiry at this point may be premature, but does he accept that to refer back to the institute, a professional body that clearly will have a view from a certain perspective, is an inadequate response from him? This is especially so when the Minister has resources within his Department to conduct even a limited investigation or inquiry to examine what was possible at the time in the provision of care for women, and what was the driving force that led to what most people now recognise as a barbaric practice when there were possibilities of alternatives?
I said I would agree to meet the group concerned but I will add a number of qualifications. Notwithstanding the serious issues raised and concerns expressed by the group, it is difficult to go down the road of retrospective analysis of medical procedures 20, 30 or 40 years ago. Once that door is opened, other issues may come through, such as the advisability, acceptability and effect of a range of procedures that may have been carried out in different specialities in years gone by.
Deputy Morgan said he would place this issue on the same level as institutional abuse. We must learn lessons from the processes we have put in place to inquire into those issues. I was involved in the Department of Education and Science in establishing such commissions and processes. I am sure victims and survivors of the institutions in question, if they had their time over again, would wonder if the long period that has elapsed since the commencement of those inquiries has not created its own stresses and strains.
My experience of three and a half years as Minister for Health and Children and as Minister for Education and Science before that has been that the easiest action to take is to announce the establishment of an inquiry of some description. The pain, trauma and so on that occur thereafter can be quite significant. I put it to the House that the models we have used to date may not be the best for the future—
Will the Minister examine something?
We accept that.
—and that we must put our thinking caps on to resolve some of these issues.
Written Answers follow Adjournment Debate.
