'Don't do a hysterectomy on me'

Patient "D" was herself a midwife, who had worked in Our Lady of Lourdes Hospital with Michael Neary. On going into the maternity unit to give birth to her first child (an earlier pregnancy had resulted in a still birth) she pleaded with her husband not to allow Michael Neary do a hysterectomy on her. She was aware of the high rate of hysterectomies in the hospital.

In other hospitals obstetricians spend up to 12 hours massaging the uterus and trying to stem the flow of blood before finally resorting to a hysterectomy. In this case Michael Neary waited only a few minutes.

The following is a transcript of evidence given by Patient "D" to the Fitness to Practice Committee of Irish Medical Council that was inquiring into the conduct of Michael Neary. She was being examined by counsel for the Fitness to Practice Committee, Mary Irvine SC.

Q: Had you any concerns at that stage (just after her son had been born)?

A: I had not heard him crying for a couple of seconds. Then Dr. Neary reassured me everything was fine.

Q: How long do you think it took for Dr. Neary to take the baby away and come back to you? He took him to a resuscitating table?

A: It was in the corner, only a minute and a half.

Q: How were you physically feeling?

A: Fine, delighted to have my son.

Q: Tell the Committee what your next recollection was?

A: Dr. Neary came back over to the table and said that I was bleeding quite heavily. I remember him ordering a repeat of the Syntocin.

Q: Syntocin is something to stop bleeding?

A: Yes.

Q: Do you remember him ordering that?

A: Yes

Q: At what stage did he order it, can you remember?

A: As soon as he realised I was bleeding he ordered it straight away and ordered hot packs as well.

Q: Can you remember, again if you cannot it doesn't matter, how long do you thing it was between (her son's) delivery and you heard Dr. Neary ordering the repeat Syntocin and hot packs?

A: That would have been fairly shortly after the delivery. He would have just come back. He came back from the table and within a matter of one minute would have ordered both together and said to me he was massaging my uterus as well at that time.

Q: Again how were you feeling when he was massaging your uterus?

A: Under tremendous stress. Everything was going through my head at the time. I had realised there was a lot of hysterectomies being carried out in the hospital over the previous year and was beginning to panic.

Q: Did you have any discussion with Dr. Neary what was going on at the time he was calling for the additional Syntocin and hot packs?

A: Not so much discussion as he told me I was bleeding very heavily and he was having trouble stopping it. He turned around a couple of minutes later and said "I have to carry out a hysterectomy". I said "No, you cannot".

Q: Can you describe the atmosphere between the staff in the Theatre at that time?

A: I know one of the midwives was crying. She was looking down at me with tears in her eyes. Everybody was very stressed at the time. I believe a Ward Sister came in through the doors of the Theatre, Colette McGinn. She said "Dr. Neary, we will get Dr. Lynch in. We will see if we can do anything". He said there wasn't time, he would carry out a hysterectomy.

Q: That discussion between the Sister and Dr. Neary, how long after (her son's) birth do you think that conversation took place?

A: Six or seven minutes after. I really cannot recollect from a time perspective. It seems like a short enough time, not extremely long.

Q: In terms of your discussion with Dr. Neary, did he tell you what he intended to do, or did he intend to do anything?

A: He said I will have to do this.

Q: Did you express any view?

A: I said "Don't do a hysterectomy on me".

Q: At what stage did you tell him not to do it.

A: When he told me first he was going to do it I said "Don't do it".

Q: Why did you say that?

A: Because I was aware of the fact that he was carrying out a large number of hysterectomies at the time. I was sure there must have been something he could do to help me out. I did not feel as if I, as if my life was in danger..

Q: Would it have been any assistance, as far as within the hospital, to Dr. Neary if he had additional assistance in Theatre?

A: I don't know, I don't think Dr. Lynch was in the hospital. Dr. Neary might have felt he was in the hospital at that time – I am not 100 percent sure he was or wasn't.

Q: Again, in terms of how you felt yourself, physically, can you describe that to the Committee, when he told you he was doing a hysterectomy, how did you feel physically first?

A: I had a bit of chest pain and said it to the anaesthetist. Looking back I think it was pure stress at the time. I was obviously very upset.

Q: I think Dr. Neary convinced you needed the hysterectomy and he proceeded?

A: He never convinced me. I needed it. I wasn't in a position to suggest – I did but I could not do anything more than that.

Q: Are you saying you never gave your consent to him performing a hysterectomy.

A: I didn't, no.

Q: In terms then of the period of time that you were in surgery, can you remember whether any blood was administered to you during that period of time?

A: They started one unit in Theatre and the other in the Recovery room.

Q: Can you remember was the blood started before Dr. Neary started the hysterectomy or after the surgery commenced?

A: I think it was after the surgery.

Q: Have you any recollection of how long it was before you were back in the Recovery Room?

A: I was back in the Recovery Room about a quarter past one.

Q: Having delivered (her son) about midday?

A: Yes

Q: In the aftermath of this particular surgery did you see Dr. Neary again?

A: Dr. Neary came in to the Recovery Room and I think he might have said he did all he could, and that he was sorry.

Q: After seeing Dr. Neary in the Recovery Rooms did you see him on any subsequent dates?

A: I know he came up to my room that evening to see how I was getting on, but I could not talk to him. He came in the following day and told me he had – (witness upset)

Ms. Irvine: Take your time. Would you like a break?

Chairman: We were going to take a break anyway. Would you like to continue or take a break?

A: Continue

Chairman: Pull the microphone a bit towards you.

A: The following day Dr. Neary came into the room and told me I had a large fault in my uterus, the fundal area of my uterus had no muscle, practically no muscle. So there was nothing to contract and stop the bleeding...

He said that the surgery was necessary and it was six weeks later when I went for my check up he discussed it again. I said "How could I have no muscle in my fundus?". He said it might have something to do with a drug my mother might have take after one of her pregnancies, called Stilboestrol.

Sometimes it causes reproductive defects in women, in the children of women who take them maybe to prevent lactation or whatever, obviously he said it could affect other members of the family.

My sister, he said my other sisters might have some kind of reproductive fault, not necessarily in the fundus of the uterus, but there could be other faults. He also told me the day after my surgery I was very lucky, that Dr. Gebard wanted to take my ovaries, and that I was lucky.

Q: Did you yourself understand the type of defect that Dr. Neary was describing to you?

A: I understood the point, if I had no muscle in the uterus obviously it could not contract, it would bleed and continue to bleed. I know what the fault would have meant, but all I could do was believe him there was a fault in my uterus.

Q: Did you ever find out subsequently whether that fault or lack of muscle was established on testing?

A: Two years later in the Irish Times I read my case and it gave my age, and it said I was told I had a fundal fault, but the pathology was normal. I followed up by getting my pathology and he said it was normal.

Q: Could you assist us regarding the procedures in hospitals post hysterectomy. Does the uterus get send to the pathology lab. Can you assist us in relation to that?

A: Yes, I think nearly all uteruses go down for histology.

Q: Is that what you understood happened in your case?

A: Yes

Q: You have had the opportunity of seeing your own report and it showed no defect.

A: Yes. p