The statistical evidence put before the Fitness to Practise Committee (FTPC) of the Medical Council as part of its investigation of Dr Michael Neary suggests that the frequency of hysterectomy following Caesarean section by at least one other doctor at Our Lady of Lourdes Hospital may have been excessive.
Between the years 1993 and 1998, when Caesarean hysterectomy is considered as a proportion of all Caesarean sections, the rate in the Coombe Women's Hospital was one per 600.
While Dr Neary's personal rate was one per 20, the rate for Drogheda obstetrics unit as a whole was one per 42.
The statistics indicate that the Caesarean hysterectomy rate for the unit as a whole was at least a factor of 10 above what could be considered to be a national norm (see table).
A similar disparity was noted when Caesarean hysterectomies as a proportion of total births were analysed.
Calculating the annualised rate for all births between 1993 and 1998, the Fitness to Practise Committee noted a rate of one per 3,847 for Caesarean hysterectomy as a proportion of total births in the National Maternity Hospital and a rate of one per 4,373 in the Coombe Women's Hospital.
However, when the Drogheda rate was calculated it was found to be one per 179 (see table).
Commenting on these findings the report of the FTPC states: "Hysterectomies in association with pregnancy were carried out over 20 times as frequently in Drogheda in the period 1993 to 1998 as they were in the Coombe or in the National Maternity Hospital. Clearly such a substantial deviation from the norm must be a source of very serious concern."
It goes on to note that "the committee considers that the practice in Drogheda, as demonstrated by these figures, fell very substantially outside the range of what might be accepted.
"From these figures, the committee can only conclude that it is highly probable that the procedures carried out in Drogheda were largely unnecessary."
Dr Neary, in evidence, stated that the culture in Drogheda was one of carrying out Caesarean hysterectomies and that he was not out of line with his colleagues.
In response, the FTPC noted: "In fact, the evidence would appear to show that allegedly another colleague carried out Caesarean hysterectomies at a similar rate.
"This colleague did not testify and the committee, as a matter of fairness, cannot and will not reach any conclusion on the practice of that colleague."
However, it went on to state that an allegation that a colleague engages in an allegedly similar practice could not be used as a "justification for any practitioner to adopt that practice and thereby avoid criticism".
The committee made specific reference to a lack of internal and external peer review and consultation within Our Lady Of Lourdes Hospital.
"There appears to have been little evidence of peer review, consultation with colleagues or consultation with practitioners in other disciplines, such as pathologists, in order to preserve and maintain acceptable medical standards."
Referring to the importance of effective communication and peer review for the good practice of medicine, the committee said: "There is regrettably substantial evidence that these ingredients were absent both within the hospital and between Our Lady of Lourdes Hospital and other units elsewhere. It is deeply regrettable that it was not until this inquiry that the statistic referred to earlier came to light fully."
The full Medical Council considered the Fitness to Practise Committee report on Dr Neary on July 29th last and agreed that he was guilty of professional misconduct in relation to complaints from 10 patients.
Its decision was formally ratified by the High Court on Tuesday.
In a statement the Medical Council said it would "immediately submit a copy of the inquiry report to the Minister for Health and Children with a request that the very serious issue which it raised about the Drogheda obstetric unit be explored".
Following a meeting with the Minister for Health, Mr Martin, this week, the president of the Medical Council, Prof Gerard Bury, said he believed the council was "pushing an open door" in terms of a further exploration of the events at Our Lady's Hospital by the Department of Health.
