Leading obstetrician criticises way surgery organised

A ruling on the Medical Council inquiry into consultant gynaecologist Peter van Geene is not expected until the end of this month after the inquiry was adjourned yesterday.

Evidence by witnesses concluded yesterday and legal teams will make their closing arguments in writing to the inquiry committee before October 21st.

As the inquiry entered its ninth day, expert witness Dr Peter Boylan expressed concern that Mr Van Geene had met patient Helen Cruise only just before going into the operating theatre. The former master of the National Maternity Hospital in Dublin argued that this unsatisfactory situation was partly due to the way in which the National Treatment Purchase Fund (NTPF), of which he was highly critical, operated.

Dr Boylan, who works at Holles Street as a consultant obstetrician, also stressed yesterday the importance of professional communication with patients on the part of doctors.

Mr Van Geene faces an allegation of poor professional performance in relation to a number of cases involving four women on whom he performed hysterectomies between 2009 and 2011 at Aut Even Hospital in Kilkenny.

Dr Boylan told the inquiry his main concerns related to the timing and manner in which consent had been obtained from Ms Cruise. He said the failure to obtain proper informed consent in this situation amounted to poor professional performance.

Relationship Dr Boylan said the fact

Helen Cruise was a patient on the NTPF hugely affected her relationship with Mr Van Geene, and how things played out on the day of her surgery.

The NTPF was designed to assist public patients who required non-urgent surgeries to be treated at private hospitals. Ms Cruise was such a patient – although she was originally referred to St Luke’s hospital by her GP, she was able to have her surgery at Aut Even.

Dr Boylan was highly critical of the NTPF, adding that because the public waiting lists were so long, there could be a lengthy time between when a patient is examined and put on the list for surgery, and the actual date of the surgery, even if one is transferred to a private hospital through the NTPF.

Dr Boylan said the fact that Mr Van Geene saw Ms Cruise for the first time just outside the operating theatre was a “highly unsatisfactory” situation. He pointed out that the surgery would have been discussed with Ms Cruise at St Luke’s hospital. He insisted it was important a woman understood the planned procedure before surgery. “The problem with the NTPF is that there’s no context for the procedure,” said Dr Boylan. “They just turn up for a procedure. It’s a highly unsatisfactory system.”

Dr Boylan also spoke about the claims that Mr Van Geene was rude to Ms Cruise during at least one post-operative conversation.

Both Ms Cruise and a nurse have claimed that Mr Van Geene was rude to Ms Cruise during a post-operative discussion at St Luke’s Hospital.

‘Suck it up’

Speaking generally, Dr Boylan said it was unacceptable for doctors to be rude to patients, adding that it would be reasonable for a patient to want an explanation for post-operative complications.

“You should never be rude to a patient,” said Dr Boylan. “A patient can be rude to you [but] we’re the doctors, so we just have to suck it up sometimes.

Consultant obstetrician Peter Lenehan, who works at St Vincent's Private Hospital and the Blackrock Clinic in Dublin, also spoke at the inquiry yesterday. He agreed with Dr Boylan that the decision to carry out a hysterectomy on another one of the four women, Patient A, was clinically justified.

It is alleged that Mr Van Geene made a decision to carry out a hysterectomy on Patient A without carrying out the necessary investigations to establish whether this was clinically justified.

“I think the necessary investigations had been carried out,” said Dr Lenehan.

Dr Lenehan did not agree with Dr Boylan regarding the significance of the way consent had been obtained from Ms Cruise. “It was less than ideal to have the consent done just outside the operating theatre . . . but I don’t think it’s poor professional performance,” said Dr Lenehan.

He added that informed consent is a continuous process, which begins with the first meeting with a GP.