Whistle-blowing should be seen as a human rights issue

After weeks of dithering and obfuscation, the fixed penalty points Garda whistle-blowers got their well-deserved apology. The mismanagement of their complaints highlights the ham-fisted and usually, wholly inadequate management response to public sector workers who say something is just plain wrong. Remember what happened nearly 20 years ago in Our Lady of Lourdes Hospital (OLOL), Drogheda? In October 1998 two midwives working in the maternity unit complained about the very high rates of caesarean hysterectomies and other bad practices at the unit. Between 1974 and 1998 Dr Michael Neary carried out 188 of these hysterectomies. At that time the Coombe Hospital had a caesarean hysterectomy rate of one in 600 caesarean sections. Dr Neary had a rate of one in 20.

The Lourdes Hospital Inquiry: Report of Judge Maureen Harding Clark published in 2006 noted "If it were in the power of the Inquiry to make an award of bravery to any person it would be to the midwife who we shall call Ann who made the first complaint to the North Eastern Health Board (NEHB) solicitor." Ann was supported by staff midwife Bridget. They had to complain to an authority outside the maternity unit, because no one in the hospital was listening to their concerns or prepared to do anything about them. Ann painted a picture of a very inward-looking unit. She described outdated practices such as rectal examinations, women forced to give birth in the lithotomy (stranded beetle, legs in stirrups) position, and midline incisions for caesarean sections. A few midwives, including a matron who had spent 25 years in the unit, were also concerned about the caesarean hysterectomy rates. When they tried to raise the issue within the unit they were either, ignored, reprimanded, or victimised.

Need for whistle blowers
The Inquiry found that a majority of midwives were "deeply shocked at the extent of the hysterectomies . . . and blamed themselves for not suspecting that anything was amiss". Midwives worked in "fear and dread" of the consultants, were "disempowered" and mere "handmaidens". One matron was "a submissive nurse with no confidence to take her concerns to a higher level, or to follow through on them". While there is no comparison between losing your womb and losing your penalty points both scandals needed whistle-blowers to bring about justice. The difference between what happened to the Garda whistle-blowers and the midwives is that the NEHB senior managers acted swiftly. Following an investigation Dr Neary was put on administrative leave in December 1998 and struck off the Medical Register in 2003.

Ireland needs more whistle-blowers. No one blew the whistle on the 1,500 symphysiotomies and pubiotomies (deliberately breaking the pelvis) carried out in 24 Irish maternity hospitals from 1949 to 1987. Survivors of Symphysiotomy (SOS), has recently taken its case to the United Nations Committee Against Torture because of the government’s refusal to acknowledge that these operations and their aftermath were actually torture. There has been no independent inquiry and no fair or adequate redress scheme. When SOS wins the case, which I have no doubt it will, Irish taxpayers will have to pay out more millions in compensation.

Whistle-blowing is difficult. Workers dislike whistle-blowing colleagues because they don’t want to accept that whistle-blowers might be more courageous, better people, than they are themselves. Denial is a major problem. Even when confronted with the facts Dr Neary’s colleagues continued to support him. One Dublin obstetrician said “the mothers of the NEHB are fortunate”. Former patients marched to the gates of OLOL and demanded he be reinstated. Whistle-blowers fear retaliation and victimisation because that is what usually happens. A human rights-based approach to the delivery of public services would reduce the need for whistle-blowing and help develop organisation cultures that actively encourage whistle-blowers.

Ireland ratified the Universal Declaration of Human Rights in 1955. If Article 5 – "No one shall be subjected to torture or to cruel, inhuman or degrading treatment or punishment" – underpinned healthcare practice, symphysiotomies would never have been allowed in Irish hospitals. If Article 7 – "All are equal before the law and are entitled without any discrimination to equal protection of the law" – was followed, the two gardaí would not have had to blow the whistle on fixed penalty points. Retired Garda Commissioner, Martin Callinan, would not have used the word "disgusting" if he had remembered Article 12 – "No one shall be subjected to . . . attacks upon their honour and reputation." A rights-based approach might mean whistle-blowers would be seen as protecting human rights instead of criticising their colleagues.