Judging Consultants

Maureen Harding Clarke, chairperson of the Inquiry into Lourdes Hospital is lucid, coherent and efficient. Her superb report was delivered in less than two years. By John Byrne.

She must be the most literate judge in the jurisdiction. Her report on the Lourdes Hospital Inquiry, on which she was the sole member, is a model of lucidity and coherence.

The Inquiry itself, without the powers to compel witnesses and documents, was conducted in less than two years and addressed all of its terms of reference comprehensively. The Inquiry received full co-operation from virtually everyone it wanted to examine, aside from a consultant obstetrician at Our Lady of Lourdes Hospital in Drogheda, Finian Lynch.

The report recounts how a culture of deference at Our Lady of Lourdes Hospital in Drogheda permitted the consultant obstetrician there, Michael Neary, to conduct 129 "peripartum hysterectomies" (that is hysterectomonies carried out either immediately after giving birth by caesarean section or within six weeks of giving birth) at a time when most obstetricians would have conducted no more than eight to ten such procedures in their entire careers. She makes the point eloquently that while this despoliation of women's bodies was taking place, no consultant, no registrar, no junior doctor, no midwife, no nurse, no pathologist, nobody in the Medical Missionaries of Mary (the order which owned and controlled the hospital), complained or even questioned.

Eventually the whistle was blown by a midwife who had been trained in Northern Ireland and who was so shocked by the scale of hysterectomies that she made a statement to the solicitor for the Northern Eastern Health Board, which had taken over the hospital from the Medical Missionaries of Mary.

She is evenhanded in her evaluation of Michael Neary, acknowledging how respected he was by his colleagues, the staff of the hospital in general and, especially, by most of his patients. She records: "This is not a simple story of an evil man or a bad doctor, nor is it a story of wholesale suppression of facts. The facts were there for all to see. Here was no attempt to hide the procedures or pretend they were something else."

She highlights the very Catholic culture of the hospital and writes: "There is a very strong suspicion that a number of hysterectomy procedures were carried out because of the ethos of the hospital." Tubal ligations and other sterilisation procedures were forbidden, as was information on family planning methods other than the billings method. She records how the Medical Missionaries sought advice on the moral issue of sterilisation from a Catholic theologian, who gave a liberal interpretation of Catholic teaching and then from other theologians and the late Cardinal O'Fiach, who laid down the law along traditional lines.

She reports how her team started by getting suitable premises and she records, almost incidentally, how the premises were subject to three criminal forced entries. Clearly her suspicion was that the forced entries were part of the enterprise whereby files relevant to her enquiry went missing from the archive at the Lourdes Hospital. On those missing files she writes: "We are satisfied that a person or persons unidentified, who had knowledge of where the records were stored and who had easy access to those records, was responsible for a deliberate, careful and systematic removal of key historical records, which are missing, together with master cards and patients charts. Three alterations to the maternity theatre register detected by the Inquiry appear to be made in the same hand and apparently were made against complaints were made against Dr Neary. Most of the missing records refer to Dr Neary's patients. Someone with a misplaced sense of loyalty to Dr Neary or the unit is probably responsible."

She hammers home how three reputable Dublin obstetricians, on examining files of Michael Neary's patients on whom he conducted hysterectomies, found he had no case to answer, and yet how a distinguished British obstetrician found on examining some of the same files that there were reasons for grave disquiet. She notes for the Royal College of Obstetricians and Gynecologists found the maternity unit at Lourdes Hospital to be "suitable for training obstetric registrars"; and how the medical school at the Royal College of Surgeons in Ireland approved the maternity unit for undergraduate training.

Born in Scotland of a Scottish Presbyterian father and an Irish Catholic mother, Maureen Harding Clark moved to Malaya with her family at the age of two, where her father worked as an engineer. She schooled in an English-speaking convent, where she and her sister were the only Europeans, and it was here that she acquired her colonial accent. The family moved to Ireland when she was 12. After secondary school, she headed off the the University of Lyons before returning to study law at UCD. Here she met her husband, an American, and after finishing in UCD she moved to the United States with him. But the marriage did not work out, and she soon came back to Ireland with two small children, Kate and John.

She was faced with two significant obstacles upon her return: Ireland in the early 1970s was not tolerant of single mothers, and she found being a lone parent "ghastly". Professionally, there was also a problem: she wanted to be a barrister at a time when women barristers found the going rough.

"It was challenging [being a woman barrister in the 1970s]," says Carol O'Kennedy, who was called to the bar in 1969. "It was almost all men in the library then. A lot of them were very helpful, because some of them had daughters who were studying and they would have liked them to become barristers. But some of the older men in the library thought women barristers were just looking for a husband."

"But when Maureen Harding Clark came on the scene, there was a group of women who arrived at the same time – Mary Laffoy [now a High Court judge], Susan Denham [now a Supreme Court judge] and some others," says Carol O'Kennedy. "There was camaraderie among them, and Maureen would have certainly have helped to elevate the profile of women in the profession at the time.

She joined the South Eastern circuit shortly after being called, the only women there at the time, which involved a lot of travel. Colleagues knew a small, good-looking and formidable operator who was not afraid to take on established male figures. "She was very precise, logical and lucid, and was not afraid to tackle senior male barristers. She was very well respected," says Carol O'Kennedy.

She admired Mary Robinson. "Mary Robinson was a role model," she told Carol Coulter of the the Irish Times in 2001. "She had young children and she was working as a barrister, and she lectured me in Trinity. She said, 'If you want to be a real barrister you have to do what the men do. You have to go on circuit.' So I did."

She was on the circuit for about 15 years. She built up a criminal law practice, which was not an area where many women worked at that time, while her children were in boarding school. She became a senior council in 1991, and by that stage had added medical negligence to her areas of expertise.

In 2001 she became one of the first Judges at the International Criminal Tribunal for the Former Yugoslavia at The Hague. She was described by the Government when presenting her nomination as "Ireland's leading woman criminal lawyer". After intense diplomatic efforts, she was elected by the UN as a judge of the International Criminal Court and was sworn in on March 11 2003. She is also a commissioner of the Irish Human Rights Commission.

Since there seems little prospect of official Inquiries being redundant here, Maureen Harding Clarke is likely to be in considerable demand, that is when she is not at the International Criminal Court. Certainly the thoroughness of her report and the speed of its delivery are likely to recommend her for such, all the more so since two current enquires are now close to their tenth year and one of these has produced no report at all in that time.