Gynaecologist defends care of four hysterectomy patients

A doctor has defended his care of four hysterectomy patients at a Medical Council inquiry in Dublin.

Dr Peter Van Geene insisted he had obtained a woman’s consent for an operation on her before she entered the operating theatre.

This was in sharp contrast to previous evidence from the patient, Helen Cruise.

Dr Van Geene also claimed he was “ambushed” at a post-operative meeting with Ms Cruise, during which time she “really got stroppy” with him.

The doctor, a consultant gynaecologist who originally trained in the UK, is facing a number of allegations in relation to four women on whom he performed hysterectomies between 2009 and 2011 at Aut Even private hospital in Kilkenny.

Post-operative blood loss

Three of the women suffered post-operative blood loss and required major blood transfusions.

Monday marked the seventh day of the inquiry, which began in July.

Dr Van Geene talked through the care he provided to each of the patients.

Helen Cruise, the only patient involved in the inquiry to waive her right to anonymity, has claimed Dr Van Geene obtained her consent only when she was in the operating theatre.

On Monday, however, Dr Van Geene insisted he obtained her consent in the theatre suite, before she entered theatre.

He did point out that usually he goes over consent forms with patients in his outpatient clinic, before the day of their surgeries.

However, Ms Cruise came to Aut Even Hospital from St Luke’s Hospital under the National Treatment Purchase Fund, and so he did not meet her at his outpatient clinic.

In cases such as this, Dr Van Geene said he would go over the consent forms with patients in the ward. However, on the day of Ms Cruise’s operation, he said someone brought her from the ward to the theatre suite before he knew she was in hospital.

Instead of sending her all the way back to the ward, he decided to get her consent in the theatre suite.

“She was seen by me outside the operating theatre,” Dr Van Geene told the inquiry. “She could not have got into the theatre without consenting.”

Dr Van Geene added that both his anaesthetist, Dr Prasad Penugonda - who previously spoke at the inquiry - and his nurse would have checked to ensure Ms Cruise had given consent before she entered theatre.

Allegations against Dr Van Geene also relate to a conversation he had with Ms Cruise after a second operation on her to stop internal abdominal bleeding.

At the point of this conversation, Ms Cruise had been transferred to St Luke’s Hospital.

Claims of rudeness

Ms Cruise, and a nurse who was present at the time, claim Dr Van Geene was quite rude to Ms Cruise during this conversation.

Describing the conversation, Dr Van Geene told the inquiry on Monday that Ms Cruise asked him what had happened. He told her she had had a post-operative bleed, and he had to take her back to theatre.

He said he told her, “It’s my best guess that this was caused by a coughing episode. She took particular umbrage with this.”

Dr Van Geene said she was very upset and asked him whether he had cut her.

He said he was confused by this because he had operated on her. He said Ms Cruise seemed to be convinced the bleed had started during surgery.

“Everything seemed to be my fault,” Dr Van Geene said. “She got very upset. I was upset too.

“As the meeting went on, she got progressively more irate with me. She really got stroppy with me.”

Dr Van Geene said he decided it would be best to end the meeting, and told her she could come meet him the next day at Aut Even to get her stitches out and discuss anything further.

On the way out, he told the ward nurse he felt like he had been ambushed.

“I didn’t mean to be rude,” the consultant said. “I was stunned, though.”

Dr Van Geene also discussed care he provided to Patients A, B and C, who chose to remain anonymous.

It is alleged Dr Van Geene performed a hysterectomy on Patient A when it was not clear whether one was clinically justified.

Expert witness

Previously, an expert witness criticised Dr Van Geene for indicating that stress was the cause of the bleeding in the case.

However, in his evidence on Monday, Dr Van Geene defended the decision to provide Patient A with a hysterectomy, and the possibility that her bleeding was caused by stress.

Patient B, meanwhile, suffered major blood loss after her vaginal hysterectomy in July 2010. He said she later complained about what she saw as lack of communication about her blood loss.

“We didn’t know reason for blood loss - that was the issue,” said Dr Van Geene, adding he understood her complaints about communication to be general and not directed at him specifically.

In July of this year, Patient C told the inquiry Dr Van Geene was unable to tell her, during their post-operative assessment, whether he had removed her ovaries. She seemingly only found out she still had her ovaries on the day she gave evidence.

‘Rather foolish’

Dr Van Geene said that, because her surgery had been so close to Helen Cruise’s, whose ovaries he did remove, he could not remember whether he had removed Patient A’s ovaries. “I felt rather foolish, to tell you the truth,” he said.

During cross-examination, Neasa Bird, the legal representative for the chief executive of the Medical Council in this inquiry, asked Dr Van Geene whether he had paused to consider whether he was doing anything wrong after three of his patients had suffered major post-operative bleeds within 18 months.

Dr Van Geene said he did want to find out why these women had post-operative bleeding.

In general practice, incidence of bleeding after vaginal hysterectomy is fairly common, Dr Van Geene said, although in his practice it was rare.

“If a patient has a complaint, it’s upsetting,” he added.