Neary's defence: Dr Michael Neary, who has been struck off the medical register, strongly defended his decisions to carry out Caesarean hysterectomies on 10 women when he was cross-examined before the Medical Council's Fitness to Practise Committee, it has emerged in the transcripts of his evidence to the committee.
In no case did Dr Neary say he had made an incorrect decision to perform a hysterectomy, and he was also critical of the alleged lack of expertise and training of some staff at Our Lady of Lourdes Hospital, Drogheda, and lack of resources, including blood supplies and scanning machines, at the hospital.
The transcripts of Dr Neary's evidence to the committee have become available following Tuesday's decision by the High Court to confirm the Medical Council's decision to strike him off the medical register.
The committee's inquiry into allegations of professional misconduct by Dr Neary opened on June 6th, 2000, and was adjourned on several occasions. It was alleged that Dr Neary had performed unnecessary Caesarean hysterectomy operations on several patients.
Dr Neary began his evidence to the committee on September 9th 2002, which was the 22nd day of the hearing. His evidence and cross-examination lasted 10 days spread over several months.
The committee delivered its report to the Medical Council on July 14th last, and on July 29th the Medical Council decided Dr Neary should be struck from the medical register. That decision was confirmed by the High Court this week.
According to transcripts of the committee hearings put before the High Court, Dr Neary, a consultant obstetrician, was asked to explain, in detail, his actions in the case of each of the 10 women whom he operated on at Our Lady of Lourdes Hospital, Drogheda, between 1992 and 1998.
He was questioned about the absence of hospital notes to support some of the medical decisions he had made and denied he had a habit in his reports of exaggerating the severity of what had happened to patients prior to his deciding to proceed with hysterectomies.
On behalf of the registrar of the Medical Council, it was suggested to the committee that the average blood loss sustained by the patients on whom Dr Neary had performed hysterectomies was some 1,500 mls prior to the operations and that no explanation had been advanced by Dr Neary as to why there was such a wide discrepancy between the blood loss in his cases before he proceeded to hysterectomy and an average of 3,500 mls in another similar and comparable hospital before the same operations were carried out.
It was also submitted that the time lapse between delivery of babies and the decision to proceed to hysterectomies was "frighteningly short".
Dr Neary was critical of the levels of expertise of other staff, and lack of resources at the hospital, including the operator of an ultra-sound scanning machine.
He agreed he was concerned about the adequacy of blood supplies at the hospital and said this affected the way he dealt with his patients.
He said there were several occasions when doctors had to "bail out" of operations because the hospital ran out of blood. He said he could present a case where lack of blood had caused a severe problem and the patient had died.
He said the most complicated patients were generally channelled to his clinics, particularly cases where it was thought likely there would be a major bleeding problem. When compared with others, this would make his statistics unfavourable, he said. The committee heard Dr Neary had performed 55 per cent of births at the hospital between 1992 and 1998.
He performed 31 hysterectomies out of some 1,841 deliveries he carried out between 1992 and 1998.
During cross-examination, he agreed he had not tried to ligate any of the arteries of the women involved in order to stop bleeding. He agreed another doctor who gave evidence to the inquiry had said this was something that could be considered but added that Dr Peter Boylan, former master of the National Maternity Hospital, who also gave evidence, had said he would not have ligated the arteries. In general in Ireland, 99 per cent of obstetricians would not have ligated the internal iliac arteries, he said.
In the case of Patient C, he denied the 28-year-old woman had not lost anything like 1,200 ccs of blood and also denied he had moved far too quickly to hysterectomy. He argued the woman was at risk of death at the time he carried out the hysterectomy.
Dealing with Patient D, a 26-year-old woman who had had two healthy children, he said she had a placenta previa (where the placenta is in front of the baby and the woman does not have vaginal delivery without a significant amount of bleeding) and was identified to be at risk of bleeding. Asked about the evidence of another doctor at the hospital to the effect there was no crisis in relation to the same patient, Dr Neary said a crisis occurred in theatre when the woman lost a considerable amount of blood.
He denied that this case, like all the other cases before the committee, showed that it was his anticipation of some future crisis which drove him to carry out yet another hysterectomy.
In Patient D's case, Dr Boylan told the committee he had a doubt whether a hysterectomy at any stage would have been required had Dr Neary persisted long enough with conservative measures to tackle the problems. Dr Neary said he and other doctors had persisted with conservative measures for about one hour in D's case and Dr Boylan and another doctor had said 30-40 minutes attempting to tackle haemostasis was an adequate length of time. He said he spent 20 minutes longer than that before starting the hysterectomy.
Dealing with Patient E, a 33-year-old woman who was admitted at 33 weeks pregnant with placenta previa, he denied he had moved with excessive speed towards a hysterectomy after the woman's second baby was delivered by Caesarean section. The committee was told the baby was born at 11.55 p.m. and the woman's uterus was removed by 16.12 p.m. and it was suggested to Dr Neary he began the hysterectomy 12 minutes after the baby was born. Dr Neary said he would have compressed the uterus but had not made notes to that effect.
At the outset of his evidence, according to the transcripts, Dr Neary told the inquiry his wife died in 1996 and they had three grown-up children. After qualifying in medicine in 1965, he held positions in hospitals in Ireland and England before taking up a post as consultant obstetrician gynaecologist in Drogheda on April 1st, 1974.
Dr Neary said the hospital was founded by the Medical Missionaries of Mary (MMM) order through Mother Mary Martin in 1941. When he began practice there, he was shocked at the conditions and his initial reaction was "the quicker I get out of this place the better". For 15 years, no soap was supplied for surgeons to scrub up with and he brought in his own soap for doing operations. There were no blood pressure or pulse monitors in the maternity hospital until 1991. There was also gross overcrowding. The first scanning machine came in 1980. They relied on charity totally for the funding of the machines. A condition of getting the first machine was that it would be operated by an elderly nun, he said. The hospital was acquired by the North Eastern Health Board in 1998.
The board had become involved in the funding of the hospital from 1992 but between then and 1998, when the board acquired the hospital, the MMMs continued to direct hospital policy, he said.
Dr Neary wrote letters in 1994 complaining that the absence of a foetal assessment unit resulted in patients having a sub-standard service.
There were also complaints about the lack of scanning experience by some operators. He said there were problems about the limited availability of blood and the fact it was quite old and therefore did not have the same clotting ability as fresh blood.
He referred to a letter of 1998 in which the scanner operator said she was withdrawing the Aloka 610 ultra-sound machine because it was unsafe to use. Dr Neary said he had also written to the NEHB in 1998 expressing the total frustration of the obstetricians in Drogheda regarding the scanning situation and saying they urgently needed new ultra-sound scanners.
He also referred to being asked for sterilisations about three times weekly in 1974. However, the MMMs did not allow sterilisations to be done in the hospital. It had a very Catholic ethos and even as the number of nuns reduced, staff were made aware that relatives of nuns in theatres in the hospital were there as observers.
Dr Neary said he and other doctors told the board that, as a result of the policy of no sterilisation, some women's uteruses were badly damaged when Caesarean sections were carried out.
