Full review ordered of all children’s orthopaedic surgery in Ireland

The independent review of spinal surgeries that have been carried out by a consultant in Temple Street hospital is to be widened to cover all paediatric orthopaedics in the State.

The review ordered into safety concerns arising from the consultant’s work will also examine the way the spinal surgery service has been run and the long delays experienced by children needing orthopaedic operations, Minister for Health Stephen Donnelly has indicated.

Long waiting lists to treat scoliosis and other orthopaedic conditions in children have been a source of embarrassment to successive governments, and have remained high despite substantial investment. There are currently 54 children waiting for spinal surgery at Temple Street, but a total of 261 children on lists across three Children’s Health Ireland (CHI) sites - Temple Street, Crumlin and Cappagh hospital.

“We all know that this service remains far short of where we would all like it to be, despite the very genuine efforts of successive ministers and others over the years,” Mr Donnelly told The Irish Times.

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“There has been a significant increase in activity, but waiting times remain too long and many parents continue to tell me that they do not feel that their children are truly at the centre of this service.”

The Minister said his first priority is for the patient safety concern at Temple Street to be addressed in the external review ordered by the HSE this week. But he added: “The terms of reference very deliberately allow for a wider look at governance and other operational matters across the CHI service and Selvadurai Nayagam [the UK expert conducting the review] will be doing this also. He will be meeting patients, families and advocates as part of this work.”

Mr Donnelly said he would be meeting Mr Nayagam shortly to discuss some of the concerns relayed by parents and patient advocates.

Signalling the Government’s serious concern about this week’s revelations, Taoiseach Leo Varadkar warned serious surgical incidents among children undergoing spinal operations at Temple Street hospital may be the result of failures of clinical governance rather than just the actions of one consultant.

The possibility there was a wider failure of clinical governance in the hospital is “something that will have to be investigated here”, he warned, speaking in New York.

Responding to revelations about high rates of complications among children who were operated on by the Temple Street consultant, Mr Varadkar said: “The more and more I read about it, the more concerned I am and the more bothered I am.”

“I do not want to jump to conclusions and this will have to be investigated thoroughly. And I know there is going to be an examination by the Medical Council as well.

“If you have a child awaiting surgery, you think if they get the surgery that is going to make them better, not worse. It seems that some of these surgeries were performed incorrectly and children suffered and were harmed as a result. That is unbelievably serious.”

[ Temple Street consultant continued surgery for months after concerns emerged ]

[ Spinal surgery at Temple Street hospital a grave situation amid long-standing issues ]

“But the kind of things I am hearing about, and reading about, if true, extend well beyond malpractice. They are very, very serious indeed and children have been harmed as a result.”

Earlier, families of children needing spinal surgery called for the independent review into services at Temple Street to be widened to include other hospitals performing this work.

The families also called for the full publication of information collected for the earlier internal review, including the advice provided by experts from Boston children’s hospital.

The CHI review published this week identified a higher than expected complication rate among spina bifida patients undergoing complex surgery, with many requiring unplanned further surgery and the removal of metal implants, and suffering high post-operative infection rates.

A helpline has been opened for affected patients on spinal surgery lists, but only at Temple Street. Children’s Health Ireland (CHI) says staff are not in a position “at this time” to answer questions about dates for surgeries.

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In a statement, CHI said three patients received surgery “with metalwork involved” and their families have been contacted, it said. This refers to the use by the surgeon at the centre of the review of non-medical implants - compression springs - in these operations; two of these have so far required removal.

“In the unlikely event that any further issues arise relating to surgical implants, these patients will be contacted directly and urgently,” a spokeswoman added.

The Scoliosis Advocacy Network said it was shocked, upset and appalled by the revelations of failings at CHI, the hospital group providing paediatric services nationally.

The internal review does not go far enough in its scope to give parents and patients assurances around clinical practices across the hospital group, according to the network.

Raymond Bradley of Malcolmson Law solicitors, which provides legal advice to scoliosis and spina bifida support groups, described the internal review published this week by CHI as “very limited”.

He said affected parents were “reeling” at the revelations about high rates of complications after surgery, and in particular over the admission that non EU-certified springs were inserted into the backs of three children.