‘Serious spinal surgical incidents’ at Temple Street hospital prompts external review

A UK expert is to review spinal surgeries carried out by a consultant at Temple Street children’s hospital in Dublin after an internal review identified “serious spinal surgical incidents” in the service.

The HSE said it has commissioned the expert from Liverpool to review the surgeries after a number of such incidents were identified.

“The primary focus of this external review will be the clinical care provided by an individual consultant based at CHI at Temple Street, who is currently not conducting surgeries, and in respect of whom a referral has been made to the Medical Council,” it said in a statement on Monday.

“This review arises from very serious concerns identified by CHI since last year relating to poor surgical outcomes in spinal surgery at Temple Street, the use of a certain spinal surgical technique and the use of unauthorised implantable devices.”

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Late last year, patient safety concerns were raised about a small number of children with spina bifida who had spinal surgery in the hospital. These concerns related to poor outcomes from complex spinal surgery, with a high incidence of post-operative complications and infections. Two particularly serious surgical incidents occurred in July and September 2022, according to the HSE.

Following this, CHI commissioned two reviews, one internal and another by experts from Boston children’s hospital. The reviews examined the care provided by the consultant to 17 children.

“Of these 17 children, one child sadly died since, and a number of other children suffered significant post-operative complications,” the HSE said.

“These patients and their families already face enormous challenges due to their condition, and CHI deeply regrets the failings in the care provided to them. CHI is engaged with these families on an ongoing basis and will continue to provide support needed.”

More recently, CHI became aware that “unauthorised devices” were used in a small number of spinal surgery procedures, the HSE added. Officials have met two further families affected by this issue, bringing to 19 the total number of families who CHI have met in recent weeks.

“Each of these patients have now been assigned to a new clinical team in CHI and if they have not already met their new consultant, will be meeting the consultants who will be taking over their care later this week to review and plan their future treatment.”

The external review will be conducted by Selvadurai Nayagam, consultant in orthopaedics and trauma, and head of the limb reconstruction unit at the Royal Liverpool University and Royal Liverpool Children’s Hospitals.

HSE chief clinical officer Dr Colm Henry promised the review will be completed as soon as practicable and before the end of this year. “The review may also make findings and recommendations that apply across all CHI hospitals and to the new children’s hospital and will be published.”

Dr Allan Goldman, chief medical officer of CHI, said it deeply regretted the impact that the issues identified have had on patients and their families. “We welcome the HSE’s external review. We will use the findings, in conjunction with the findings and actions from CHI’S reviews of the spinal surgery service at CHI at Temple Street, to inform our ongoing improvement programme.

“CHI staff are committed and motivated to provide safe, effective, patient-centred and efficient care to spina bifida patients to improve clinical outcomes. We care deeply about the quality of that care. The families involved and the safety of patients remain our priority. We are in the process of putting in place measures to ensure the treatment of our patients is not disrupted or delayed as a result of this review.”

Tánaiste Micheál Martin described the issues surrounding the surgeries as “very, very concerning”.

Speaking to reporters at the United Nations in New York on Monday, he said he could not pre-empt the external review that had been ordered.

However, he said, it was “incumbent on the Health Service Executive and all involved in healthcare to make sure that the highest standards prevail and we are very clear in making sure that optimal standards are always provided in situations such as this where very, very difficult surgeries and procedures are being carried out”.

Taoiseach Leo Varadkar said the review “appears to relate to potential poor performance by one doctor”. He described the issue as “very concerning and very worrying.”

He said he had only found out about it in the last couple of days.

Mr Varadkar said, speaking in New York where he is also attending the UN general assembly alongside the Tánaiste, he could not imagine how the parents of any child affected could be feeling at present.

“I know any family that is affected has been engaged with and open disclosure is happening. So, I do want to reassure any family that if this concerns them, they have been informed already and a full investigation is under way. ”

“I don’t want to prejudge the outcome of that investigation, but it does appear to relate to potential poor performance by one doctor, by one consultant. That’s something that really has to be fully investigated now.”

He said that Ireland had very good outcomes in terms of paediatric healthcare. He said children received very good healthcare.

“But that is not to say that sometimes services don’t fail and sometimes there aren’t difficulties with individual practitioners. What is important now is that there is a full investigation.”

The Scoliosis Advocacy Network, which represents children and their families who have been diagnosed with scoliosis, said in a statement that it is calling for a full review of all scoliosis care across the CHI sites by an international expert.

“This is necessary to ensure that patients with scoliosis receive the highest standard of care and to restore trust in both CHI and the HSE to safeguard our children. Children with scoliosis have been failed by the state for many years now with long wait lists, a lack of access to timely care, broken promises and continued poor communication with patients and their families.”