Temple Street hospital spinal surgery review widened to 17 more ‘cases of concern’

Completion of an independent review into spinal surgeries at Temple Street children’s hospital has been delayed after 17 additional “cases of concern” were identified.

The decision by the UK expert carrying out the review to include further cases in Children’s Health Ireland (CHI) and the National Orthopaedic Hospital Cappagh means the number of children’s surgeries under investigation has effectively doubled.

Last September, the HSE commissioned Selvadurai Nayagam, a consultant in orthopaedics and trauma at Royal Liverpool children’s hospital, to review surgeries carried out by a Temple Street surgeon. This came after internal reviews identified serious spinal surgical incidents, including the death of one child and others with serious post-operative complications. It then emerged that unauthorised springs had been used in three patients.

All of the additional cases, which were identified by CHI as of concern and are now being reviewed by Mr Nayagam, “relate to the practice of the consultant whose work is being reviewed”, the Department of Health confirmed on Tuesday.

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“These additional patients/families have already been informed. Advocacy groups were advised that the report would now be delayed and of the necessity to review cases from additional patient cohorts on Friday, February 2nd,” a spokesman said.

The surgeon ceased doing the most complex form of spinal surgery in August 2022 and ceased all surgeries last July. He went on voluntary leave last September when the HSE published the internal reviews.

Nineteen cases of concern were originally identified last year.

Minister for Health Stephen Donnelly has asked CHI to establish a dedicated paediatric spinal surgery unit, according to his spokesman. This followed meetings with orthopaedic surgeons who pointed to the success internationally of units with a dedicated focus.

David Moore, head of orthopaedics and a consultant at Crumlin children’s hospital and Tallaght University Hospital, has been appointed to head the unit.

Mr Donnelly has also asked the HSE to appoint a full-time project lead to work on issues relating to orthopaedic waiting lists for children.

Mr Donnelly intends to convene a taskforce on spinal surgery waiting lists for children, where delays have been a source of political embarrassment for years. The new body will include patient representatives and doctors, and will be modelled on the approach used to resolve issues around the CervicalCheck screening programme.

A number of advocacy groups have called for the establishment of a taskforce. The Minister has written to groups seeking to meet them and get their views on possible terms of reference for the taskforce.

Children with spinal conditions need to be operated on promptly, and often repeatedly, because their curvature can worsen quickly as they grow, causing acute pain and other conditions. At the end of last year, 78 children were waiting over four months for a spinal procedure, 13 per cent down on 2022.

Overall, 231 children were waiting for spinal procedures, down 5 per cent. The department says a “substantial” number of procedures were undertaken over the past two years, but this was offset by significant increases in referrals.

There was a 30 per cent increase in addition to the spinal fusions surgery list in 2022 compared with 2018, rising to 42 per cent last year.

“While waiting lists have fallen, they remain unacceptably long,” the spokesman told The Irish Times.

Mr Nayagam was originally due to produce an initial report by the end of last year. A HSE spokeswoman said the terms of reference of his review were amended to include Cappagh. “This and the comprehensive robust methodological approach by the reviewer has necessitated the timelines for the risk assessment have been extended.”

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