Missing records 'highly suspicious'

Missing files, altered registers, suspicious removal and returns of charts. All were part of a conspiracy of obstruction encountered during an inquiry into Our Lady of Lourdes Hospital in Drogheda. Gardaí may open a new criminal investigation based on the findings. Sara Burke reports

It is a long, large, heavy register recording all births at Our Lady of Lourdes Hospital between 1957 and 1991. It was kept in a press at the main hospital in the office of the superintendent of the labour ward. The keys to the press were kept in a cupboard at the ward's nurses' station. It was the best record of pre-1991 hysterectomies in the hospital. Shortly after the official inquiry was launched into the scandal of the Lourdes Hospital hysterectomies, the register went missing.

"The disappearance of the pre-1991 register is highly suspicious and the inquiry believes it was deliberately taken from the hospital shortly after October 1998," the official report of the inquiry stated. "Whoever removed the register was familiar with the hospital records and well aware that this register was the best record of pre-1991 hysterectomies."

A Garda investigation into the missing register took place in 2004. It was unsuccessful. Contrary to recent media reports, a Garda spokesperson said there was "no new investigation as a result of the report, but gardaí are examining it, in detail, to establish if anything requires criminal investigation."

The disappearance of this register is not the only reasons for suspecting there was a conspiracy of obstruction among some of the Lourdes hospital staff to disguise the scale of the scandal. The same register for the years 1991 to 2004 seemed complete when first examined by the inquiry. However, alterations to the register were found by accident when one of the inquiry's first witnesses, a woman who had had a hysterectomy in 1993, was not recorded in the register. Closer examination found that the register had been altered in three different places. Inquiry chairperson Maureen Harding Clarke notes, "Some very alarming alterations were detected in this register [indicating] deliberate attempts to prevent the full determination of the numbers of peripartum hysterectomies carried out." A handwriting specialist verified that changes were made and that the character of the writing and alterations was very similar.

Other records for the three cases altered are also missing. In two cases the entire patient charts are missing, in the other case the obstetric chart is missing. In all three cases the birth registers are also missing. "The selective nature of the type of missing documents is strongly supportive of a deliberate culling of the records," according to the inquiry.

During the course of the inquiry, Michael Neary gave evidence which implied he possessed an unauthorised photocopy of the 1991 maternity-theatre register. The copy contains all cases from 1991 to the end of 1998. The register looks similar to the one that went missing. The inquiry has established that it was copied by at least two women, as two sets of hands were clearly visible on a number of pages – one wore nail varnish making it unlikely to be a nurse or a midwife.

The inquiry sought to find out how and why Michael Neary had obtained such a copy. Staff in the hosptial denied any knowledge of the photocopying of the register and "expressed shock that such a procedure could be carried out without their knowledge or permission". Neary says he received the copy from a colleague in 2001, but he says he is unable to recall the circumstances. The inquiry is suspicious, as Neary did not follow official procedures. The fact that the register was removed, copied and returned without anyone noticing, and at a time when the previous maternity-theatre register had gone missing, was of grave concern to the inquiry. It was copied after the alterations had been made as they are in the photocopy. Maureen Harding Clarke concludes that someone with sympathies to Neary assisted him without informing the appropriate parties.

In August 2004, when the inquiry team resorted to secondary sources to verify the number of hysterectomies, another register was missing. These gynaecology-theatre registers from 1981 to 1988 were stored in a locked room close to the nurses' station and the chance of their removal was considered remote by staff. However, when the hospital staff went looking for them, seven years of records were missing. In October 2004, the missing register was found – in the same store room. It recorded two peripartum hysterectomies. The inquiry believes the registers were removed and returned when suspicions were aroused.

Forty of the hospital's 266 birth registers were missing. Each book contains 250 births.

• Only registers containing peripartum hysterectomies are missing.

• There are no missing birth registers since 1998, when the first reports about Neary were made.

• The birth registers for three cases altered on the maternity theatre register are missing. They are also the only missing registers for the 1990s.

• For 41 of the 44 patients who had hysterectomies and whose patient charts are missing, the corresponding birth register is also missing.

Evidence given to the inquiry indicates that the registers went missing between October 1998 and February 1999. It concludes that some person or persons deliberately, systematically and carefully removed birth registers where obstetric hysterectomies were recorded – in particular for the period prior to October 1991 when the maternity register is missing – and in each case the corresponding patient charts are also missing. The inquiry believes the person responsible must have been a staff member who "had intimate knowledge of the recording and filing system and whose presence with files would not cause query or surprise".

Michael Neary denies any knowledge of the disappearance or alteration of files. He told the inquiry "that someone may have been trying to blacken his character by removing so many records relating to patients". The removal of all records of patients' details obliterates all traces of those present or assisting operations. It also means that some women will never know whether their hysterectomy was necessary or not.

The whereabouts of the missing registers and records remains unknown. It is the opinion of the inquiry that no files will be found. It concludes that they "were intentionally identified, traced and removed from the hospital... with the object of protecting those involved in the hysterectomies or in protecting the reputation of the hospital".p

Hospital Enquiry

Maureen Harding Clarke was appointed to investigate the number of peripartum hysterectomies carried out at Our Lady of Lourdes Hospital since 1960, and to determine why so many occurred. Investigations into the practices of the consultant obstetrician Michael Neary (right) began in October 1998 after two midwives reported unusual numbers of caesarean hysterectomies and out-of-date clinical practices. Between 1974 and 1998, 188 peripartum hysterectomies were carried out, of which 129 were carried out by Michael Neary. Peripartum hysterectomies are carried out within six weeks of birth, an uncommon procedure usually reserved for emergencies. In September 2003, Neary was stuck off the medical register.