No reasons to believe Lourdes hospital horrors not going on elsewhere

There are a few startling observations in Maureen Harding Clarke's superb report on her inquiry in peripartum hysterectomy at Our Lady of Lourdes Hospital, Drogheda. On page 23 of her report she quotes a sister of the Medical Missionaries of Mary (“Sr B”) as saying: “Let me say that I was aware that hysterectomies were done in Ireland more often than was necessary because sterilisation was ethically not acceptable”.

It was generally accepted by the staff in the maternity section of the hospitals that sterilisations were being done to prevent future pregnancies, where, it was thought, the woman's health would be endangered by such pregnancy.

The hypocrisy involved in this practice is astounding: it was OK to rip out a woman's womb and perhaps bring on menopause by maybe 20 years but it was ethically unacceptable to engage in tubal ligation. In one case everyone could pretend the objective was other than sterilisation, in the other it would be obvious it was just sterilisation.

She continues in her report to state: “There was an abundance of evidence from obstetricians, midwives and professionals in the hospital, theologians, articles and text books, which led me to the inescapable inference that compassionate hysterectomies and planned hysterectomies were carried out as obstetric operations in the Lourdes Hospital Maternity Unit and in other Maternity Units in the country and in other Catholic hospitals.”

Isn't this astonishing? The judge believes this barbarous practice is going on in other hospitals. Shouldn't we know about this? Shouldn't there be an inquiry into this?

There is the revelation that the Royal College of Obstetricians and Gynaecologists inspected the maternity unit in 1987 and 1992 and found it “suitable for training obstetric registrars”. What does this say about the Royal College of Obstetricians and Gynecologists?

She goes on to note: “The Royal College of Surgeons in Ireland approved the Maternity Unit for undergraduate training”. What does this say about the Royal College of Surgeons?

In a commentary on present conditions in Our Lady of Lourdes Hospital, she writes:
“Management's role and actions in addressing the major structural, operational and personal deficits in the Maternity Unit and the hospital since 1998 have been slow and unsatisfactory. The overall plan and strategy has merit but the implementation has been compromised by a lack of management continuity and consistency and by failures in leadership and direction. The magnitude of the task of effecting root and branch change did not seem to have been appreciated at the very highest levels of management in the Health Board and perhaps the Department of Health. As a result, the necessary operational and structural changes in the Maternity Unit have taken much longer to realise and only now in 2006 are most of the elements in place. Audit is still not seen as an immediate imperative by management. The tools for audit are not available. No protected time is set aside for hospital wide monthly audit. It is not recognised that audit requires time and space and an audit coordinator.

“Not everything in the Maternity Unit has improved. Statistics are kept but are not easily accessed. There is a lukewarm application of risk management amongst some consultants. Many do not understand what clinical governance means. Not all consultants share the burden of teaching and conducting audit. Private patient care still takes up a lot of consultant time. Two consultants have been absent over extended periods with no sign of replacement. There is still no computerised data collection system in place."

“No elective major gynaecology operations are carried out although theatres, staff and clinicians are in place with the requisite skills and equipment as there are no dedicated gynaecology beds available for elective operations”.

So after years of knowing that there was something catastrophically amiss at Our Lady of Lourdes Hospital in Drogheda, there still remain major problems there. What has the Department of Health and Children been doing about this for eight years now? How can it be that the Department remains indifferent, apparently (and of course they will protest otherwise) after all we have come to know.

There is a further devastating comment in the introduction to the report:
“The facts we uncovered revealed that any isolated institution which fails to have in place a process of outcome review by peers and benchmark comparators can produce similar scandals as those which occurred in the Lourdes Hospital. Support systems must be in place to conduct regular obligatory audit. There must be mandatory continuing professional development and skills assessment at all levels of healthcare. Senior ward sisters ought to attend updating of skills and methods programmes and should be able to recognise that procedures change in accordance with evidence based research. Outmoded and unnecessary practices ought to be recognised as such and changed as soon as information is available. Hospital management should have more authority and training and should have medical input. Clinical independence should no longer be interpreted as a licence for arrogance, disregard for patient choice, dignity and need, or freedom from accountability”.

It would be nice to be assured that procedures have been put in place to ensure this could not happen again but what reason have we to believe that?

Vincent Browne