Anyone going into hospital to have a baby these days could be forgiven for being seriously scared. What has emerged over the past year of the obstetric practices of Dr Michael Neary would cause even the most stoical of parents to blanch, writes Mary Raftery.
But it is more how the medical profession has dealt with the issues raised by Dr Neary's practices which would so seriously shake the confidence of not just prospective parents, but of everyone who has any dealings with doctors in this country.
Dr Neary was last year found to be negligent by the High Court for having performed an unnecessary Caesarean hysterectomy (or womb removal) on Alison Gough in Our Lady of Lourdes Hospital in Drogheda. Another 65 similar cases have yet to be heard by the courts.
Ten complaints against Dr Neary have this week been upheld by the Medical Council, the body charged with supervising a doctor's fitness to practise medicine, and the council has struck him off the medical register.
So far, so good, you might think. However, it has taken the Medical Council 4½ years to reach this point. This is hardly the kind of prompt action which might allay the entirely justified fears of patients and attempt to repair the damage to doctor/patient relationships. It is difficult to escape the conclusion that the Medical Council, made up almost entirely of doctors, simply doesn't take very seriously the business of complaints against the profession.
It is instructive to look at some of the council's complaints statistics. Since 1999, when the current council was appointed, it has received an average of 235 complaints a year. Over 90 per cent of these were dismissed without even a hearing. Of the cases considered in 2002 (405, which included a backlog), the council decided that only 14 warranted even further consideration.
In just one area, that of doctors' failure to communicate and rudeness, the council received 117 complaints during the past five years. In only a single case was even further inquiry deemed appropriate.
All of this is against a background of high levels of medical litigation in this country. We are constantly admonished by the medical profession that we as a nation are far too eager to go to court if anything goes wrong with our treatment.
But a startling study by the St Paul insurance company has indicated a radically different picture. It surveyed reported incidents of potential malpractice over the past five years and discovered that patients sued in only one-third of the cases examined.
A fair and somewhat alarming conclusion from this is that medical negligence in Ireland is in reality a far more serious problem than we had previously thought. So rather than being overly litigious and compo-crazy, as the medical profession would have it, patients actually don't sue doctors nearly enough.
Doubtless doctors would prefer that we should instead all go to the Medical Council, to have our cases adjudicated by other doctors and most likely summarily dismissed.
Even the Medical Council itself had a vague unease about its own procedures in the Neary cases. Last summer, in response to scathing criticism from Patient Focus and several of Neary's victims, the council commissioned former attorney general Harry Whelehan to review those procedures.
He produced his full report to the council last June, which has so far refused to publish it. According to a report in the Irish Medical Times earlier this month, Whelehan was highly critical of the council.
He stated that some complaints against Neary were not recorded, were misfiled, were not acknowledged and were ignored. Reasonable standards are not being met and inquiries are fragmented, according to his review. He talks of a "sense of disillusionment" among those complainants whose files he reviewed. He felt it understandable that people would feel that there was "a general lack of interest in pursuing complaints", and that they were not being taken seriously.
In this context, it is not surprising that so many people who are the victims of medical negligence choose to ignore the only body in the State charged with the regulation of doctors, and instead go to court. Doctors complain that high levels of litigation can lead to the practice of defensive medicine to the detriment of patients. However, it is now clear that the responsibility for this vicious circle lies fairly and squarely with the medical profession, which clings firmly to the principle that it should continue to be allowed to regulate itself through a Medical Council structure.
Trust is a word often quoted by the medical profession - it is what we, the patients, are expected to confer on them. The Medical Council is supposed to ensure that we can be confident that our trust is justified. It is palpably obvious that the Medical Council is failing in this most fundamental task. Professional self-regulation by doctors is simply not working.
It is now incumbent on the Minister for Health and Children, Micheál Martin, to intervene urgently to create transparent and fully independent mechanisms for the hearing of complaints against doctors. What is at stake here is literally life and death.