When Marie Kelly read her copy of The Irish Times last Monday morning she could not believe her eyes. There among the case studies of the women whose wombs, and in some cases ovaries, were removed, she recognised her own case. It was a huge shock, she said. It was even more of a shock, however, to discover subsequently that the case featured was not hers but one involving a different woman in another part of the country.
"It was all so familiar, especially the language used by the doctor to explain what happened and why she should not complain. I was told [by my consultant] I should be in a coffin, that I seemed to have trouble comprehending what dead meant.
"I was told it was the single most difficult night of his life. `Blame me, if you want a scapegoat,' he said. `Any other obstetrician would have done to same thing and if he did not he would have been negligent. I saved your life.' I asked him what the pathology had shown and he said pathology was not done in cases like mine."
In fact, there was a pathology report, which was to prove vital in the case.
At 28, Marie lost her baby (it was born prematurely), her womb and both her ovaries. After suing the consultant obstetrician she received a "significant" six-figure sum in damages in an out-of-court settlement.
At home this week she was surrounded by a mountain of files related to the case. Among the letters, case notes and medical reports was a colour photograph of her two-day-old daughter, Caroline, who had been born prematurely, just hours before she died.
At that time Marie and her husband, Michael, had been told that her womb had been removed following the delivery. What they did not know was that both ovaries were also gone. It was to take another four months before she found out. During this time she went into what doctors describe as "crash" menopause, without even realising it, experiencing hot flushes and night sweats, and another consultant, after much prompting, performed a blood test.
Her consultant had not included this fact on her hospital chart, nor had he told her of his action. He did, however, bill the VHI for carrying out the procedure. It took three years before the VHI would tell Marie what Code 2257 meant on the doctor's bill: total abdominal hysterectomy with unilateral or bilateral salpingo oophorectomy, removal of womb and one or both ovaries.
Marie had delivered her two previous children, a boy and a girl, naturally and without any complications. She began bleeding during her third pregnancy and attended her GP. He referred her to her obstetrician and as the pregnancy advanced she was scanned regularly and he said "everything was fine".
She began to have reservations about her obstetrician, about his manner and about an increasing number of stories she was hearing from other women that he was "very fond of carrying out hysterectomies".
"At one stage he asked me if my family would be complete, and I said absolutely not."
The bleeding continued, and her consultant carried out an internal examination one day at the hospital and then a scan. He told her to go home even though one of the nurses had asked him if she should have been discharged when she was still bleeding. She had made an appointment with another consultant, but never made it - she went into premature labour at 26 weeks.
Marie went to hospital, where another consultant administered a drug in an attempt to stop labour. This worked, but the following night it began again. Marie says her doctor arrived at 3 a.m. and told her a Caesarean section was necessary as the baby was in distress. She remembers walking to the operating theatre and climbing on the bed. After being "put under" she remembers waking up in the theatre and someone putting a form in front of her, asking her to sign it. "I asked if they were going to do a D&C [a procedure to clean out the interior of the womb] or what, and the response I heard was `or what'."
It is unclear exactly what happened in the operating theatre that night. The consultant subsequently made a number of claims to explain his actions, including that there were fibroids present, and that the placenta was in front of the baby, causing the complications. There was massive bleeding. Afterwards the notes of the surgery were incomplete. There were no notes on the Caesarean section which had been performed. Marie believes she may have been operated on three times in all.
As it turned out the pathology report showed he had left some of the placenta behind, and Marie believes that one of her arteries was cut because of the large amount of blood lost. Documents given to the couple by the hospital show there was a lot of confusion among members of the surgical team as to what was going on that night.
The consultant's claims were not backed up by the pathology report, which the couple received from the hospital only when their solicitor requested the handing over of the actual specimens removed so they could get them independently analysed. "That seemed to work all right," Michael said.
A report by a respected British expert found that the Caesarean section had been performed incompletely, "a significant part of the placenta was left behind and haematosis was not secure (he had not stopped the bleeding); the surgeon left the operating theatre before he was certain of his patient's well-being." It said the removal of ovaries was "not justified".
"There may be a conflict between what Dr S told Mrs K, or tried to tell Mrs K, and what Mrs K learned. Nevertheless, it is difficult to escape the conclusion that Dr S withheld the information that he removed Mrs K's ovaries, not only from Mrs K, but also from her GP. That, in my opinion, was quite unacceptable. It is unacceptable as a principle that a surgeon should withhold such information."
A second report said the performance of Dr S "fell below an acceptable standard of care and skill, with very serious consequences for the patient and injury to her baby".
When the first attempts were made to settle the case, Marie said, she was far too angry to even contemplate it. As the figure rose their barrister advised them it would be better for them to accept it.
At 32 Marie has been on HRT for four years and worries about the side-effects. She attends regularly for bone scans. "It was very hard in the beginning, and I still get upset. Maybe I was naive, but I had no idea what having my womb and ovaries out involved. I had no idea I would never have a period again. It was very hard looking at pregnant women."
Marie says taking the case helped her healing process a lot. "We did a lot of research, and I felt I was taking control of it. I know a lot of other women with similar stories, and the solicitor won't even let them see their reports, only to read them out. We found all the work we put in ourselves very important."
Michael nods his head as if he still can't believe it all happened: "Our first mistake was to trust them. God, we had no idea." The consultant is listed in the current medical directory as a practising obstetrician, but the couple say they have heard that his colleagues have finally "ring-fenced" him.
"Who knows how many other women he treated like this? How many wombs and ovaries he removed? I also blame the hospital. They tried to contribute to the cover-up and even though they knew what went on did nothing about it."
