The warning was made in an internal report by senior Temple Street managers, obtained by The Irish Times, that called on CHI to address Mr Green’s “personality, behaviour and surgical competence” and warned of risks to patient safety.
The unpublished report, which recommended CHI “hold people to account” and consider an external review, was compiled in August 2021 following repeated, unsuccessful efforts to sort out issues in the hospital’s orthopaedic unit.
These worsened after it was submitted to the CHI executive as the number of surgeries increased. In July and September 2022 two serious surgical incidents occurred. Staff raised their concerns directly with management from September.
It was at this point – more than a year after the internal report suggested an external review – that CHI commissioned two reviews of Mr Green’s work. An internal review started in November 2022 and an external one in March 2023.
Published last September, these showed that of 17 children with spina bifida who underwent spinal surgery, a significant number suffered complications. Thirteen needed additional unplanned surgery and one child died, in September 2022. Mr Green ceased carrying out spinal surgery last November and has been referred to the Medical Council.
In 2019, Temple Street management set up an “intervention” to deal with issues around service delivery and team dynamics in the orthopaedics unit, according to the report by Temple Street clinical director Dr Adrienne Foran, former chief executive Mona Baker and clinical adviser Dr Charles Bruce.
“Some of these team dynamics had displayed unacceptable behaviours both within the consultant team and to other staff groups including nursing and administrative staff,” it noted.
CHI, it said, should address Mr Green’s “personality, [and] behavioural and surgical competence in working on [a]) significantly difficult case-mix in a multi-professional environment”.
The report warned of a “real risk to patient safety and staff” if issues at the service were not addressed, highlighting in particular “poor interpersonal issues” and a “very fractured team”.
“Behaviour is episodic and totally unacceptable, unprofessional and could in future lead to a significant never event given the poor communication and cavalier approach of one consultant,” the report stated.
This consultant – Mr Green – when contacted this weekend, said he was unable to talk about the matters under review. CHI told The Irish Times “these matters are the subject of an external review, with which CHI are fully co-operating”.
According to the report, interviews with individual medical, nursing and administrative staff revealed a “lack of trust” between some consultants, “no transparency or openness” in discussing service delivery issues and “signs of embitterment and fatalism” among the consultant group.
“The corridor conversations and rumours led to a non-cohesive team dynamic fostering a silo mentality and destructive alliances.”
The report documents the efforts made to deal with the problems in the unit over many years. The regular consultant meetings begun in 2019 had some success until the Covid-19 pandemic intervened, after which relationships worsened again. In April 2021, CHI chief executive Eilish Hardiman and other senior staff attended a group meeting to review the current position and arrange “an urgent management intervention”.
A lack of operating theatre capacity led Mr Green to bring in elective patients as emergencies at weekends, impacting on the work of other doctors and leading to “abusive conversations” and exchanges between consultants “which have festered”.
A further round of meetings with consultants followed at which various grievances around theatre access, behaviours and other issues were aired. Based on these meetings, the report was drawn up and submitted to the CHI executive, warning of a “myriad of unacceptable behaviours and lack of professionalism expected as a consultant and as part of a team”.