Heart Beat: Sir William Blackstone, the noted jurist in his epic Commentaries on the laws of England, wrote "Mala Praxis is a great misdemeanour and offence at common law, whether it be for curiosity and experiment, or by neglect; because it breaks the trust which the party had placed in his physician, and tends to the patient's destruction". This was written 250 years ago but its relevance to Judge Harding Clarke's profound report is obvious. I am, like many others, perplexed, not alone as to how this debacle came about, but also as to what was going on in Dr Neary's mind.
Shakespeare wrote "a terrible childbed that thou had". That is exactly what these unfortunate women experienced. Apologies and compensation cannot ever fully reverse the harm done, such harm apparently without any rational explanation.
This was a bad thing, but such happen in all walks of life, all callings and professions. We are seeing other examples in the Church and in politics. It is important to see such crises in perspective and to resist the temptation to leap from the particular to the general, in order to promote one's own agenda.
Dr Neary's lapse, or whatever you want to call it, was just that; an aberration and is not something with which to seek to chastise the entire medical profession, which I can assure you is alive and well and doing its best in difficult circumstances to look after us.
It is ironic that this problem should have arisen in an obstetrics unit, given Ireland's century's old pre-eminence in this discipline. Indeed for the past 50 years or more, the Dublin maternity hospitals' masters' reports detailing morbidity and mortality of mothers and neonates have provided a beacon of peer review and audit. These reports are presented at a conjoint, no holds barred meeting, comparing hospital to hospital. It is all about accountability and such is not forgotten in these institutions or among the doctors trained therein.
It is not alone among the maternity hospitals, but also in almost every aspect and specialty in medicine here, that audit and continuing medical education assume a major and growing part. It would not be possible otherwise for the profession at all levels to meet modern requirements and thus serve their patients. Sadly, however, the service has increasingly failed to meet the needs of the patients or those looking after them.
I have had a wide experience of hospital life, and continuing medical education has always been part of my life. Medical journals, scientific papers, meetings, here and abroad, were an accepted part of life, as was the imparting of knowledge so acquired to colleagues and students. It was in hospital to hospital, specialty to specialty, an effort necessary so that our patients and service would not be left behind in the rapidly unfolding panorama of world medicine. Much of the expense of this was borne by the doctors as it is only relatively recently that payment for postgraduate education has been available. Ask any non-consultant hospital doctor, how easy it is to access same!
Drogheda therefore came as a shock to doctors as well as the public and, like everybody else, we wondered how this came about, and what could be done to prevent any similar occurrence. I was taken by a suggestion from the Taoiseach that a hospital inspectorate be established. It would be charged with reviewing established, continuing medical education (CME) and audit programmes, and instituting peer review, where appropriate and necessary. It would also, hopefully, comment on facilities and requirements, and suggest a rational deployment of hospital services. It would point to gaps in any of the above and suggest means of filling them. It would be wholly positive, seeking only to move matters forward. Yes, this is a way to go; but an important caveat, it must be staffed by new people. We must not have another game of blind man's bluff, with the same old faces blundering around again.
I have listened to Dr John Hillery and his plans for the Medical Council. I would like to hear him tell us where the gaps in provision of service are perceived to be and by whom. I would like to hear this in detail. I do not share his worries about the state of medicine in Ireland and I have nothing but respect for those who try to deliver high quality practice in very difficult times. I would like to suggest to him that his plans for periodic assessment of his colleagues will not prove to be as simple as he postulates, nor will they be as well received as he appears to think.
There is something sinister and unacceptable about writing to a doctor's patients and colleagues as to the doctor's capabilities. This is quite apart from the little matter at the core of medical practice, that of confidentiality. I would have none of it, and of the large number of doctors to whom I have spoken in the past week, a majority were of the same mind. Perhaps instead of the sententious claptrap about 360-degree audit, the council could look at the problems entertained by the unfortunate patients lying on hospital trolleys and the difficulties faced by the staff endeavouring to look after them. The doctors are not responsible for the shambles of our health service, Dr Hillery; let us not make matters even worse. It is no fun out there for those in the front line and they need this further intrusion like a hole in the head.
Lastly, I note the new heights scaled by the Minister for Trolleys. What was that about a 10-point plan, to bring about improvement in three months? It doesn't seem to have worked.
Maurice Neligan is a cardiac surgeon.