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Thursday, 9 July 2015

Questions (2)

Caoimhghín Ó Caoláin

Question:

2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he is aware of the significant level of discontent, and, in some cases, outright dejection being felt and expressed by victims of the barbaric practice of symphysiotomy, at the unsympathetic and adversarial conduct of the Government-initiated payment scheme established for the ever-decreasing number of aged survivors; if he will undertake to address the serious shortcomings in its out-working, including the disbelieving disposition of its principal, and the confrontational and interrogational operation of the process; the qualifications of the various medical experts employed by the scheme; if he is satisfied that they are sufficiently qualified to make judgments on the particular cases presenting; and if he will make a statement on the matter. [27899/15]

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Oral answers (9 contributions)

I seek to draw the Minister's attention to the expressed dissatisfaction of victims of symphysiotomy who have contacted me regarding the conduct of the State's scheme of payment to survivors of this barbaric procedure. I appeal for the Minister's intervention, even at this late stage, to ensure a more compassionate and humane approach is adhered to from this point forward.

The surgical symphysiotomy payment scheme commenced on 10 November 2014. It was estimated that 350 women would apply to the scheme, but in fact 577 applications have been accepted. The applications are being assessed by former High Court judge Ms Justice Maureen Harding Clark.

Contrary to the Deputy's assertion, the scheme has brought about an end to years of uncertainty and costs for women who have undergone surgical symphysiotomy. The scheme was designed to be simple, straightforward and non-adversarial and it aims to minimise the stress for all women concerned. The scheme was designed following meetings with all three support groups, two of which have welcomed its establishment. It was set up to give women who do not wish to pursue their cases through the courts an alternative option in which payments are made to women who have had a surgical symphysiotomy, whether or not negligence is proven.

The scheme is voluntary and women did not waive their rights to take their cases to court as a precondition of participation in the scheme. Women may opt out of the scheme at any stage in the process, up to the time of accepting their award. It is only on accepting the offer of an award that they must agree to discontinue legal proceedings against any party arising out of a symphysiotomy or pubiotomy.

Ms Justice Clark has informed my officials that as of 3 July 2015, 235 offers have been made to women. In some cases, however, the applicants or their legal advisers have not yet provided the necessary documentation and information in support of their applications. Ms Justice Clark has indicated that she will write to each of these applicants to request that all outstanding documentation and information that the applicant may wish to rely on in the assessment of their application is furnished to the scheme. The judge will specify a time limit in which information must be furnished and after this time has expired, the applications will proceed to assessment on the basis of the documentation and information furnished. Given the legal and other costs involved and the frailty of some of the women, the judge wishes to ensure that the scheme does not continue for longer than is necessary.

Ms Justice Clark has commissioned medical experts in the areas of obstetrics and gynaecology, radiology and orthopaedic surgery to assist her in assessing applications where there is an absence of available evidence either that the procedure was undertaken or of its consequences on the health of the woman. The three consultants concerned are eminently qualified in their respective fields to do this work.

The Government has given careful and detailed consideration to this complex and sensitive matter. It believes that the provision of the scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represents a comprehensive response to this issue that should help bring resolution for the women - many of whom are elderly - and their families.

Individual claimants, survivors to this day of a barbaric procedure performed on them without their consent or understanding, before, during and, in some cases, after childbirth have been speaking out regarding their personal experience and the experience of other women known to them who have presented before the Government's payment scheme to these victims and have, in their own words, had their lifelong pain compounded by the experience.

These women spoke of a process that is challenging and, despite the Minister's claims, adversarial. It appears to lack compassion or understanding and for some it has been demeaning. The former judge, Ms Clarke, who is the sole overseer of the process, has described women subjected to symphysiotomy as making a full recovery over a relatively short period of time and with no continuing ill effects. Neither of these claims stands up to Irish or international scrutiny. In some cases she has looked for a pathological gap in the pelvis in a belief this would represent objective evidence of injury even though the High Court accepted in a recent case there is not necessarily a link between such a gap and the pelvic pain that is a reality for many of these women.

I ask the Minister what steps he will take to address the inappropriate disposition of Ms Clarke in the carrying out of her role and to ensure that all women victims presenting before her are treated to true compassion and respect rather than made to face a process that is nakedly operated to keep payments to the lowest possible level, which in some cases is nothing.

The scheme was established in this manner so that it would not be adversarial. One alternative was to require people to go through the courts and make their case on the witness stand, with the possibility of being subjected to cross-examination and significant financial losses if the case is unsuccessful. The Deputy will be aware that judgments in a number of recent cases have found against the women concerned. The other alternative was a form of tribunal which would adopt a similarly adversarial approach. The chosen scheme is the least adversarial system that could be established. It is not unreasonable to require the 577 people who have made applications to produce evidence that they underwent surgical symphysiotomy. Of the 235 offers made, 222 have been accepted.

Further to the cases I outlined earlier, Judge Clarke has dismissed claims regarding urinary incontinence as a direct consequence of the invasive procedure, arguing that it is just as likely to be a product of the ageing process, and has disputed claims of mental ill-health resulting from symphysiotomy. I do not know anyone else who would dismiss victims' claims of depression, anguish and social withdrawal. Let us not forget that the UN Human Rights Committee has condemned this so-called surgery as torture.

I do not doubt that the Minister believes the response he has given but I ask him to heed the voices not of this Deputy, but of the women who have spoken to me in this institution and elsewhere. If he has a difficulty in doing that, a number of them are currently in the Gallery and they can inform him personally about the reality of their experiences. It is not good enough for the Minister to simply accept that everything is well and is going as he intends. Nothing could be further from the truth. I invite him to make an intervention to ensure that the process is indeed non-adversarial and has the compassion required.

The scheme is voluntary and participants can withdraw at any time if they are not satisfied, and can pursue their case through the courts in the normal way. It remains voluntary until the point at which somebody accepts an award. Judge Clarke receives advice from medical experts but she was appointed to act as an independent assessor. That is why I will not attempt to go over her head or overrule her. Her medical advisers include an eminent consultant, an obstetrician, a gynaecologist, an eminent consultant radiologist and an eminent consultant orthopaedic surgeon. I do not know whether the Deputy's claims are correct but I am sure-----

Will the Minister undertake to check them?

-----any decision she makes is based on medical advice.

Will the Minister undertake to check them?

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