Doctor questioned on womb operations

The rate of Caesarean hysterectomies carried out at a Drogheda hospital by a Co Louth consultant gynaecologist was 20 times that of the National Maternity Hospital from 1992 to 1998, according to a report compiled for the North Eastern Health Board, the High Court heard yesterday.

The report showed that Dr Michael Neary performed one hysterectomy for every 20 Caesarean sections he carried out between 1992 and 1998 at Our Lady of Lourdes Hospital, Drogheda.

This rate of hysterectomy was 20 times the rate recorded in the National Maternity Hospital in Dublin over the same period, according to the data available to those who compiled the report, the court was told.

The report stated that on the data available, Dr Neary had performed 708 Caesarean sections from 1992 to 1998 and carried out 39 hysterectomies in the same period, a ratio of one hysterectomy for every 20 Caesareans.

During the same years, Caesarean sections were performed on 38,860 mothers at the National Maternity Hospital, and the ratio of hysterectomies was one in 441, the court was told.

Dr Neary was presented with the report yesterday while being cross-examined in the continuing action in which Ms Alison Gough (37), Market House Lane, Ardee, Co Louth, is suing him and the hospital for negligence. Ms Gough claims Dr Neary wrongly carried out a hysterectomy on her in October 1992 after he had delivered her son, her first and only child, by Caesarean section. The doctor and hospital deny the claims.

Dr Neary told Mr James Nugent SC, for Ms Gough, he had not seen the report in four years. He said the statistics used were informal and compiled over a weekend. He denied he had used hysterectomies as a form of contraception and said his practice in relation to hysterectomies was similar to that of his colleagues in Drogheda.

Dr Neary did not believe he was wrong in what he did regarding Ms Gough in 1992, nor did he believe he would have to do the same thing today because of advances in the meantime.

He said blood transfusions of Caesarean section patients were not done as a matter of course in 1992. He said he stood corrected over his stating on Tuesday that this was a result of the Hepatitis C scare. Mr Nugent said that scare only broke in 1994. Dr Neary said that before 1994, there was concern in relation to HIV.

He agreed some of his evidence in relation to what procedures were carried out on Ms Gough was unsupported by notes. He denied he was "tailoring" his evidence in relation to the times that certain events occurred to suit his case. He agreed a blood supply was ready when the emergency arose in relation to Ms Gough.

Mr Nugent asked why was Ms Gough "left bleeding to death" for some 10 minutes after that. Dr Neary said when the blood supply was ready, the technician would phone the labour ward. He said the ward would be sparsely staffed and it could be a time before the phone was answered. When the call was answered, the person who did so would come to theatre to say the blood was ready and this would take a few minutes.

He said it would take 30 minutes to carry out a reasonably straightforward hysterectomy. Asked whether, with the hysterectomy procedure beginning about 2.25 a.m., that left, "on the kindest interpretation", some 25 minutes to conserve Ms Gough's womb, he said: "That's right."

Earlier, Dr Neary agreed with his counsel, Mr Charles Meenan SC, that when Ms Gough visited him six weeks after the birth of her son, she was upset at what had happened to her and wanted to know what had she done wrong.

Dr Neary denied he had said if he told her what had happened when she had the hysterectomy, she would never sleep again so she was better off not knowing and just to go home and get on with her life. He could well understand Ms Gough would be extremely distressed, angry and confused and that her husband would have similar feelings. These were the kind of feelings one got after any major traumatic event.

Dr Neary said carrying out the hysterectomy on Ms Gough had distressed him greatly. "I have pondered over it in my mind a thousand times as to whether anything different could have been done at the time and I am of the opinion that I could not have acted differently and that if I had waited longer, that the situation would be quite different today and maybe more dreadful."

There was very significant blood loss following the delivery of the placenta and he felt the situation was abnormal. He took measures to stop the bleeding but they had absolutely no effect.

They estimated she had lost between 1,500 and 1,750 ml of blood and was still actively bleeding with an atonic uterus. This was the position before he decided to carry out the hysterectomy. His concern had been that if he delayed too long the patient might end up with bleeding problems. He did not think he had been over-rapid in carrying out the hysterectomy. It was a difficult decision to come to.

The case continues.