Dáil Éireann díospóireacht -
Wednesday, 12 Oct 1994

Vol. 445 No. 7

Adjournment Debate. - Imprisonment of Surgeon.

Mr. Flanagan

I am grateful to you for allowing me to raise this matter and I am grateful to the Minister for coming in to reply. The Minister will be aware of the case of a doctor jailed in England for gross misconduct and negligence in that he performed surgical operations on patients while suffering from a highly contagious form of hepatitis B. Hundreds of patients were put at risk and many contracted the virus. There is an Irish dimension in so far as the doctor in question worked for periods in Dublin, Limerick, Galway and in the General Hospital, Tullamore, in my constituency. I understand that during that time he assisted in many routine surgical procedures. The Minister should ensure that the hospitals in which he worked carry out a detailed survey to ascertain the number of operations performed and how many patients were exposed to the risk in this country. What steps have been taken to date to compile this information? What action does the Minister propose in view of this experience and what procedures are in place to deal with this problem?

I understand the guidelines state that a doctor suffering from a contagious disease must confide in a colleague who is empowered to restrict the practice of the person in question and surgery would be prohibited as the surgeon would, in effect, refrain from performing operations. Hepatitis B is a contagious virus and can result from contact with blood, saliva, urine or semen of an infected person. It must be noted that the disease can be transmitted through the tiniest scratch with a contaminated needle. Patients can fall seriously ill as the liver becomes inflamed or damaged. Most sufferers have few, if any, symptoms but others suffer from fever, nausea, vomiting, jaundice or abdominal pain. Fatigue and debility may persist.

I am aware that all front line health care staff are offered vaccination against hepatitis B but this is not sufficient for a number of reasons. It has been suggested that all non-national doctors should be vaccinated on a compulsory basis. This would be a doubtful procedure from an ethical point of view and would be less than acceptable on medical grounds because a person may already be a carrier. Will the Minister be specific in his intentions to allay public anxiety in this matter? I understand that within two months of a vaccination health care workers are screened to establish that they are sero positive. Those who fail to respond are offered a further vaccination and screened and those who still fail to respond may have an immune deficiency or may be a carrier. I also understand that a specific blood test is required to establish if a person is a carrier. Is this routine practice in this country?

I hope the Minister will tackle this problem to ensure that patients who may have been exposed are traced and dealt with accordingly and that patients in the future are not placed at such a risk. I look forward to hearing his reply.

Minister for Health (Mr. Howlin)

I thank the Deputy for raising this matter and for giving me the opportunity to respond. The Medical Council's guide to ethical conduct and behaviour and fitness to practise stipulates that doctors suffering from contagious infectious diseases, including hepatitis B, should put themselves in the hands of their professional colleagues for treatment and counselling and for advice on how far it is necessary for them to limit their professional practice to protect their patients. It is clearly unethical for doctors who consider that they might be infected with a serious contagious disease not to seek diagnostic testing.

Hepatitis B is a condition usually characterised by jaundice, nausea, vomiting and a variety of other symptoms. It occurs worldwide and is endemic in parts of Asia and Africa. In western Europe hepatitis B is most prevalent in high risk groups.

The causative agent in the hepatitis B virus infection can be diagnosed by blood tests which can also determine the degree to which the patient is infective. Vaccination against the disease is available and effective. As the Deputy rightly said, it has been my Department's policy since 1988 that all health care staff whose occupation exposes them to contact with blood should be offered vaccination against hepatitis B. These include staff working in accident and emergency, haematology, oncology, operating theatres, laboratories and so on. Vaccination is offered free of charge to all staff considered to be at risk.

As regards the recent case of a doctor infected with hepatitis B, I have asked the appropriate authorities of the hospitals in which this doctor is alleged to have worked to confirm whether he worked in that hospital; to indicate the date on which the hospital commenced hepatitis B vaccination of health care workers and if this doctor's hepatitis B status was known; to identify the capacity in which the doctor worked in the hospital and if his work has been likely to put patients at risk of contracting hepatitis B, that is, would he personally have been involved in surgical procedures or mostly have been an observer? I also asked if the records of patients who may have undergone surgical procedures, including minor surgery, by the doctor concerned would be identifiable through the hospital records system. My department's chief medical officer has also contacted his colleagues in the United Kingdom for information on the nature of the person's illness and if it is known when he contracted the disease.

I presume the Deputy will be aware of the reply I gave earlier today to a parliamentary question setting out the measures which have been taken in this matter. My Department is according priority to establishing full information to enable patients who may have been exposed to the infection arising out of contact with this doctor to be identified. Any such patient will be contacted for testing and other follow-up procedures which may be deemed necessary.