A Galway fertility doctor who clipped both of a woman's fallopian tubes when he had consent to clip one has said he faced an "ethical dilemma" when working under pressure on the day of the operation.
Declan Egan told a Medical Council hearing clipping both of the patient's tubes, rather than just one, represented the least threat to her "life and limb" by preventing fluid from blocked tubes going into the uterus and causing damage.
Dr Egan, a consultant gynaecologist who retired from University Hospital Galway last month but still runs the private Galway Fertility Unit, acknowledged he did not seek the explicit consent of patient Lorna McKeogh beforehand, but said his action was medically justified.
“I simply tried to save here from further surgery that would have been a threat to her life,” Dr Egan told the hearing before the fitness to practise committee of the council.
Dr Egan faces an allegation that he performed a clipping of both left and right hydrosalpinges (fluid-filled fallopian tubes) “in circumstances where this was not consistent with the consent form dated June 2nd, 2010”.
Arising from this, he is accused of failing to meet the standards of competence that could reasonably be expected of a consultant obstetrician/gynaecologist.
At a previous hearing, Ms McKeogh, a sales executive from Mountbellew, Co Galway, claimed Mr Egan made her sterile by clipping both of her tubes at UHG.
In his evidence, Mr Egan maintained the clipping of the tubes was not a sterilisation procedure as infection had blocked both tubes before he operated. He said there was very little chance of Ms McKeogh and her husband Darragh conceiving after tubal surgery and she would require IVF to get pregnant.
Clipping the tubes left open the possibility of further tubal surgery to reverse the procedure. Ms McKeogh later pursued this option, he pointed out.
Dr Egan said he understood the signed patient consent allowed him to carry out a procedure if during surgery he found something different, and this is what occurred. He believed at the time he had consent “outside explicit consent” but had since been legally advised he was not covered.
He said his decision was influenced by the reduced resources available for elective gynaecological surgery in Galway. The number of beds had been reduced and patients’ operations were being cancelled up to three times. The waiting list had increased from six to eight weeks to six months.
Having regard to the totality of Ms McKeogh’s clinical history, her best interests would be served by clipping the tubes and trying IVF. His action “optimised” her chances of getting pregnant by IVF.
Ms McKeogh was transferred to Mr Egan's list in UHG by Dr Eithne Lowe in Bon Secours hospital as she was unable to carry out the procedure there because of its ethos.
He said he had not seen Ms McKeogh before the day of the procedure but if he had, he would have discussed the clipping of both hydrosalpinges. It “wasn’t ideal” that he had not seen the patient beforehand and there was poor communication with Dr Lowe.
He told his counsel, Eileen Barrington SC, the fact Ms McKeogh and her husband both continued to smoke was a significant feature in her case. Miscarriage was largely due to lifestyle factors, he said, and in this case there was “a lot of smoking and a lot of drinking” on both sides. This caused DNA fragmentation and could bring on the menopause up to four years early.
Waiting would use up whatever eggs she had left, and Mr McKeogh had a low sperm count. “That combination screams IVF to me.”
Mr Egan acknowledged his note of the operation was “rather rushed” but said this was due to pressure of work and understaffing. He was unable to consult with colleagues during the operation as there was none in the vicinity with reproductive experience. He would have found it “odd” to consult with Mr McKeogh, who was in legal terms a third party.
Mr Egan said there were a lot of “misconceptions” about the removal of fallopian tubes. “Women instinctively think hanging on to their tubes is the best option whereas we know tubal surgery is not the answer. That’s why IVF was invented.”
Ms McKeogh suffered distress when she later received invitations to attend a number of meetings about IVF at Mr Egan’s private clinic. Mr Egan said this was not his intention and he said the fact that she received the invitations was due to the efficiency of secretaries in spotting she hadn’t attended the meeting.
Ms McKeogh has also spoken of the stress and expense in undertaking IVF, but Mr Egan claimed most of the stress she experienced arose from the fact she “turned her back” on his clinic to undertake treatment in Dublin. As for the cost, he said his clinic charged €4,500 but frequently cut a deal with “Travellers, refugees, poor people”.
The hearing continues next month.
