Culture had been established in which too ready recourse was made to hysterectomy
Eithne Donnellan,
Health Correspondent
An independent British expert who reviewed the care of 10 women who recently complained about their treatment some years ago at the maternity unit of Our Lady of Lourdes Hospital, Drogheda, has severely criticised the regime at the hospital.
London obstetrician Dr Roger Clements found that one woman, who had already had four Caesarean sections when she presented at the hospital for her fifth in 1995, was operated on by a junior doctor.
The doctor, proceeded after the section to remove her womb, and also her left ovary and Fallopian tube because they were "stucked" to the uterus. However, the uterus was not fully removed and she continued to menstruate afterwards.
Dr Clements, whose reviews of a number of patients' complaints have been obtained by The Irish Times, said there seemed to be no good reason why the junior doctor should not have completed the hysterectomy and removed the cervix, unless it was beyond his technical ability to do so.
In his opinion it was "quite inappropriate to delegate that potentially dangerous surgery (a fifth Caesarean section) to a junior doctor.
"Many Caesarean sections can properly be delegated to junior doctors in training, but this was one of those rare ones which might call for special expertise," he added. The woman's case notes showed her fourth section had also been performed by a junior doctor.
Dr Clements believed, while the hysterectomy was necessary, a more senior surgeon would have had a better chance of separating her womb from her Fallopian tube and ovary. Their removal amounted to "a gratuitous surgical encore and one which had no justification", he found.
In another case, it took 15 minutes to get a medical team to the labour ward when a woman was haemorrhaging during labour. "In my opinion a system of care which fails to get medical staff to the labour ward within 10 minutes of a request is unsafe," Dr Clements said.
"My understanding is that Our Lady of Lourdes Hospital is a major district hospital with three tiers of medical staff (house officers, registrars and consultants). It takes on high risk obstetrics. "If it purports to deal with women at high risk, it must provide a service which is commensurate with that. The standard normally applied is that there should be a doctor capable of conducting operative vaginal delivery available within 10 minutes.
"The senior house officer (who may not be capable of such deliveries) should be on the labour ward throughout his working time. At night time he should sleep on the labour ward. Those conditions were clearly not in place in 1993 and it is a matter of serious criticism that they were not."
In two other cases Dr Clements found patients wombs had been removed unnecessarily. "With some knowledge of the background of practice at Our Lady of Lourdes Hospital in the early 1990s, it is impossible to escape the conclusion that a culture had been established in which too ready recourse was made to hysterectomy during and immediately after delivery," he said.
These four complaints were among 10 made to the North Eastern Health Board in 2002 and 2003 by women treated at the Drogheda obstetrics unit. The 10 cases were referred for outside evaluation to Dr Clements by the health board, which then got its external risk advisors to examine what he found.
The report from its risk advisors has recently been received and is currently being considered, the board said yesterday.
It added that the complaints relate to events between three and 15 years ago.
"The CEO has an obligation to be fair to all parties concerned and cannot make any further comment on these matters at this time," it added.