Temple Street consultant continued surgery for months after concerns emerged

The consultant whose work at Temple Street children’s hospital is to be externally reviewed continued to carry out operations for months after concerns about their work first emerged.

The Health Service Executive has commissioned a UK expert to review surgeries carried out by the consultant after an internal review identified “serious spinal surgical incidents” in the service, it said on Monday. One child died following multiple procedures and others suffered serious postoperative complications.

Patient safety concerns were first raised following a “particularly serious” surgical incident in July 2022, according to a report by Children’s Health Ireland (CHI) – the hospital group responsible for paediatric care nationally – with another following in September that year. From that month, staff began raising concerns about outcomes for patients who were operated on by the consultant.

The consultant ceased doing complex spinal surgery on children with spina bifida in November 2022, a HSE spokesman said.

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The consultant ceased doing kyphectomies – the most complex form of spinal surgery – in mid-August 2022, ceased all spinal surgeries last May and ceased all surgeries in July, CHI clinical director Dr Ike Okafor told The Irish Times.

Asked whether the doctor has been suspended, the HSE spokesman replied: “This surgeon is currently not conducting surgeries, is part of a HR process and a referral has been made to the Irish Medical Council. We cannot comment further.”

The HSE, which has apologised to affected patients and their families, said the single consultant at Temple Street is the “primary focus” of the external review. The consultant was given a copy of the report, it said.

[ Analysis: Spinal surgery at Temple Street hospital a grave situation  ]

“This review arises from very serious concerns identified by CHI since last year relating to poor surgical outcomes in spinal surgery at Temple Street, the use of a certain spinal surgical technique and the use of unauthorised implantable devices.”

An analysis of 16 case files showed 13 patients – more than 80 per cent – required further unplanned surgery after being operated on by the consultant. One of these patients died after multiple procedures.

About three-quarters of the patients suffered infection or wound complications, and more than half had to have metal implants removed.

The CHI report says the adverse outcomes from kyphectomies in Temple Street are higher than those indicated in the literature internationally, though it cautions that the number of cases is too small to make detailed comparison.

The internal review begun last year looked at 17 patients of the consultant but more recently, CHI says, it became aware that “unauthorised devices” had been used in a small number of spinal surgery procedures. Officials have met two further families affected by this issue, bringing to 19 the total number of families CHI has met in recent weeks.

Dr Okafor said the devices – compression springs – appear to have been “procured by unusual means”. Their use is being separately reviewed by the HSE.

Future complex spinal surgeries will be carried out in Crumlin children’s hospital, Dr Okafor said, but it was possible they could resume in Temple Street at some point. A clinic is being held this weekend to assess the postoperative needs of the worst-affected children.

Taoiseach Leo Varadkar said the review of spinal surgeries at Temple Street “appears to relate to potential poor performance by one doctor”.

Speaking in New York where he is attending the United Nations general assembly, he described the issue as “very concerning and very worrying”.

He said a full investigation was under way and this was important. “I don’t want to prejudge the outcome of that investigation, but it does appear to relate to potential poor performance by one doctor, by one consultant. That’s something that really has to be fully investigated now.”

The external review, to be completed by the end of the year, will be conducted by Selvadurai Nayagam, a consultant in orthopaedics and trauma at Royal Liverpool children’s hospital.