1998 reports:The reports which three eminent obstetricians prepared in 1998 exonerating the practice of Dr Michael Neary were published in full for the first time yesterday by the Medical Council.
Prepared by Dr John Murphy, Prof Walter Prendiville and Dr Bernard Stuart in November 1998 at the urgent request of the Irish Hospital Consultants Association (IHCA), the reports found that Dr Neary had no case to answer, even though it emerged later that he was unnecessarily removing patients' wombs.
The IHCA, which was concerned that the North Eastern Health Board was going to take action against Dr Neary, forwarded the reports to the health board.
In his report Dr Murphy, a consultant obstetrician and gynaecologist at the National Maternity Hospital, Holles Street, Dublin, and now president of the Royal College of Physicians of Ireland, said that it was his conclusion that Dr Neary should continue to work in Our Lady of Lourdes Hospital pending any formal investigation.
"It would be wrong to put restrictions on his practice and it is my view that the mothers of the North Eastern Health Board are fortunate in having the service of such an experienced and caring obstetrician," he wrote.
He and the other two doctors reviewed nine cases of patients who had undergone emergency Caesarean hysterectomies at the hands of Dr Neary. The cases were selected for them by Neary.
Dr Murphy wrote: "It is my conclusion that Dr Neary has no case to answer concerning his management of any of the patients in question."
The report prepared by Prof Prendiville and Dr Stuart said that, on the evidence, they had found no grounds to suspend Dr Neary or place any restrictions on his practice, public or private.
They wrote: "We find no evidence of questionable clinical judgment, poor operative ability or faulty decision-making.
"Quite the contrary, we find that Dr Neary, in the exercise of his clinical judgement, has under difficult circumstances probably saved the lives of several mothers," they said.
On the basis of their reports, the three obstetricians were recently found guilty of professional misconduct by the Medical Council. But no sanctions were imposed on them.
The three stated they interviewed Dr Neary before preparing their reports. All said their reports were preliminary ones.
And they noted that a complaint about Dr Neary to his health board appeared to be from a non-medical person.
Even prior to Dr Neary's appointment to the Lourdes Hospital in 1974, they said there was a relatively high rate of Caesarean hysterectomy at the hospital.
Dr Murphy said there was a requirement for "an immediate" report from him.
He noted that the Lourdes Hospital had a code of ethics that forbade tubal ligation [sterilisation by tying tubes]. This led to more Caesarean hysterectomies being carried out.
Furthermore, he noted that during Caesarean section, blood loss of a significant amount is not uncommon and a resistance to blood transfusion had built up as a result of the anti-D blood contamination scandal. This may have influenced Dr Neary.
He said: "Severe obstetric haemorrhage is dramatic, like a blazing out-of-control fire. It has to be controlled immediately by dramatic measures.
"What one does with copious haemorrhage can only be decided on at the time.
"Retrospection by others as to how an acute haemorrhage might have been managed is a futile and unrewarding exercise."
The Lourdes Hospital inquiry found Dr Neary had a low tolerance for haemorrhage, proceeding rapidly to hysterectomies.
Having examined the notes of nine patients, Dr Murphy concluded most of the Caesarean hysterectomies were life-saving. And he said that from data provided by Dr Neary "his rate of Caesarean hysterectomies is not dramatically different from that of his colleagues".
In their report, Prof Prendiville and Dr Stuart said they had insufficient time to prepare a comprehensive report.
They too referred to the hospital's ethical code, and the fact that the Caesarean hysterectomy rate in the unit as a whole was high.
They said that compared with his consultant colleagues Dr Neary's rate of Caesarean hysterectomies was not excessive.