The Michael Neary case: Arrogance, power and the Catholic ethos

How an obstetrician could rip the wombs from 129 women and how nobody – not the nuns who owned the hospital, the midwives, the fellow consultants nor the nursing staff – shouted stop. By Sara Burke

Our Lady of Lourdes Hospital, Drogheda, was a bleak place back in 1974, when Michael Neary first arrived there as a partially trained obstetrician. It was located in an old, large building away from the convent of the hospital's owners, the Medical Missionaries of Mary (MMM). It had basic services, very basic and a serious shortage of professional staff.

The cruel and disfiguring practice of symphysiotomy was common (this is a surgical procedure, which involves cracking the pelvis, to permanently widen the pelvis of a woman who might normally require repeat caesarean sections). Also little pain relief was available for child birth and only contraception sanctioned by the Catholic Church was promoted, such as the Billings method.

And it was a Catholic maternity hospital, run by the Medical Missionaries of Mary strictly in accordance with a Catholic ethos.

The maternity hospital had been set up in 1939 to serve the people of the area and to train missionaries for Africa. Gerard Connolly, the first obstetrician appointed to the hospital in 1944, was much liked by the nuns. Liam O'Brien, the other consultant in the hospital when Neary arrived, did not get on so well with the nuns.

Michael Neary's arrival was welcomed by his colleagues. He was a junior consultant and although he had a heavy work load, he immersed himself fully in the role.

The maternity unit of the hospital operated in its premises away from the rest of the general hospital and it maintained its independence.

There was a severe and hierarchical regime in place. The MMMs were the owners and management, but the consultants held positions of high status and their work practices were not questioned. They were respected, often feared, sometimes adored by patients and staff. Nurses, midwives and all other staff were there to "serve" the consultants. What the doctors said and did was unchallenged.

Michael Neary assumed the senior consultant position shortly after his arrival as Gerard Connolly resigned and Liam O'Brien was in poor health.

During the late 1970s, high rates of caesarean sections were prevalent in Lourdes. The high rate was brought to the matron's attention and she had a meeting with the obstetricians. Liam O'Brien remembers that prior to Michael Neary's arrival there were maternal deaths in the unit but after his arrival and through the 1970s these dropped significantly and none of the maternal deaths were caused by haemorrhage. The number of peripartum hysterectomies increased but this was considered "natural" as the number of caesarean sections was up. Peripartum hysterectomy is the term used for the removal of a woman's womb immediately after giving birth or up to six weeks after delivery. The matron said she spoke several times to Gerard Connolly about Michael Neary's high rates of peripartum hysterectomies and that Connolly said Neary was "afraid of haemorrhage".

Doctors and nurses who worked there at the time describe how "indirect sterilisations" were carried out in the form of peripartum hysterectomies. These were allowed by the hospital's "Catholic ethos", if considered medically necessary. One common medical reason for this procedure was when, during a caesarean section, a women's uterus (womb) was considered at risk of rupture in a future pregnancy. This could be the case if women were older and had had many children, a regular condition in the Ireland in the 1970s where contraception was largely unavailable. The Medical Missionaries of Mary strongly contest the notion that indirect sterilisations were a reason for hysterectomies.

In 1990, a new maternity hospital, linked to the main hospital was built. Although Lourdes, like most medical facilities in Ireland at the time, was under funded and under staffed, the numbers working in the hospital increased. Jobs in the unit were highly sought after.

The incidence of peripartum hysterectomies went up in the early 1990s. In fact, the years 1993, 1994 and 1995 saw some of its highest figures. No one seemed to notice. No questions were asked. As peripartum hysterectomies were used as an acceptable form of secondary sterilisation, it was accepted despite the unusually high levels and increasingly young age and lower parity (the number of births) of the mother.

While most of these procedures were being carried out by Michael Neary, some of them were not. Between 1974 and 1998, there were 188 peripartum hysterectomies, 129 of which were carried out by Michael Neary. Forty were carried by Finian Lynch. As the inquiry headed by Judge Maureen Harding Clarke noted, these were far in excess of the number of hysterectomies carried out in other hospitals, including a Waterford hospital also run by the Medical Missionaries of Mary. Many obstreticians said they carried out no more than two or three hysterectomies in their entire careers.

Michael Neary's explanation was that he continued to carry out hysterectomies to prevent what he perceived as possible maternal death or severe problems in later pregnancy.

Neary also carried out larger than average numbers of episiotomies (this is cutting the area beween the vagina and anus to allow for child birth). Women on whom he carried these out spoke about how Neary would joke about stitching them up tightly and "providing a play pen" for their husbands. Other women who were his patients said they pleaded with him not to carry out a hysterectomy on them but he went ahead and did it anyway.

The unit was visited by the Royal College of Obstetricians and An Bord Altranis in the 1980s and 1990s. Both authorities considered the unit of a sufficient standard for training nurses and doctors.

In May 1997, the North Eastern Health Board took over the ownership and the management of the hospital from the Medical Missionaries of Mary. It is now the biggest hospital in the region.

In 1998, two midwives meeting with the health board solicitor on other issues sought the solicitor's advice on their concern over levels of hysterectomies. In particular they were worried about high rates of caesarian hysterectomies in the hospital, especially where these activities involved young women.

On 28 October 1998, a meeting was held between senior health board (NEHB) management and Michael Neary. Michael Neary was put on two weeks administrative leave. His cases were examined by colleagues on the basis of whose findings he was reinstated. (See the accompanying article by Mary Raftery.) On 8 December 1998, the health board received a report back from another external obstetrician, Michael Maresh, a UK consultant. His report was very critical of Neary's record as the number of hysterectomies carried out was beyond all international norms and the cause of extreme concern. The health board solicitor and CEO at the time instructed Neary to take immediate leave from 11 December 1998.

On 14 December 1998, details of the nine cases reviewed were published in the Irish Times. For many of the women who had undergone hysterectomies performed by Michael Neary, this was the first information they had that their hysterectomies were unnecessary. Each of the nine women was able to recognise her own case although their identities and that of Michael Neary and even the hospital were not revealed.

On 5 February 1999, Neary was suspended from practice by a High Court order and in June of that year he resigned from practicing medicine. He has not practiced since.

In June 2000, the Irish Medical Council (IMC) began its inquiry through its "Fitness to Practice Committee", which took three years to complete. On 2 September 2003, IMC secured a high court order to erase Neary's name from register of medical practitioners.

Supporters of Michael Neary including midwives marched to Lourdes and the Dail demanding his reinstatement.

On the 6 April 2004, a non statutory private inquiry was set up to inquire into the nature and extent of perirpartum hysterectomies in Our Lady of Lourdes Hospital in Drogheda from 1960 to the present day. Judge Maureen Harding Clarke was appointed Chairman. She found that key files had gone missing, obviously removed by people sympathetic to Michael Neary. In the course of her investigation her own office was broken into three times.

Main issues

? Neary was not sufficiently trained and his training ended when he arrived at the hospital. By today's standards, aged 31, he was young to be appointed a consultant. Training should continue through out one's medical career.

? In the maternity unit, there was no training structure in place, no supervision, no audit of activity, no checks and balances. Some of this is still true today.

? The Catholic ethos of the hospital influenced its way of working. No contraception was available and sterilisations were prohibited.

? Ironically, as a part of the Catholic ethos, "secondary sterisilsations" were carried out in the form of hysterectomies when women's uteri (wombs) were considered at risk of rupture in a future pregnancy. This was the case if women were older and had had many children, which was common in Ireland in the 1970s.

? There was a culture of respect and fear in the unit so that even when questions were raised in the unit, people did not have the opportunity or the courage to speak out.

? Many of Neary's women patients were treated very badly, they gave no consent for the surgery. They were told they had had a "lucky escape" and that they had had a close run, that they were lucky not to have died.

? Complaints were made to the Irish Medical Council in the 1980s but no action was taken. They had received 215 complaints between 1986 and 1998, ten of which were in relation to peripartum hysterectomies.

? An Bord Altranis and the Royal College of Physicians in Ireland's Institute of Obstetricians and Gynaecologists visited the hospital and while necessary improvements were identified the unit was considered suitable for training of nurses and doctors.

? Files were removed from the hospital which obstructed the Inquiry and means that to this day some women are unsure as to the actual reason for their hysterectomy. p