Doctors' reports could have 'put safety of future patients at risk'

UK expert's report: A UK-based expert who examined the conduct of the three obstetricians who exonerated Dr Michael Neary in 1998 concluded that their reports into the Drogheda-based obstetrician could have put the safety of future patients at risk.

Dr Michael Maresh, consultant obstetrician and gynaecologist at St Mary's hospital, Manchester, was asked last year by the Medical Council to produce a report considering whether there was professional misconduct by the three obstetricians into their reviews of Dr Neary.

The three doctors were approached by the Irish Hospital Consultants Association to conduct a report into Dr Neary's work after concerns were initially raised about his high rate of hysterectomies, many of which it later transpired were unnecessary.

They reviewed nine cases of Caesarean hysterectomies selected for them by Dr Neary in November 1998 over the course of four hours. In their subsequent reports, they found that he could continue working.

Following the receipt of their reports, Dr Neary was permitted by health authorities to work with restrictions until he was asked to take administrative leave in December 1998.

The three obstetricians are Prof Walter Prendiville, consultant obstetrician and gynaecologist at the Coombe Women's Hospital; Dr Bernard Stuart, also of the Coombe; and Dr John Murphy, consultant obstetrician and gynaecologist at the National Maternity Hospital, Holles Street, and president of the Royal College of Physicians of Ireland.

Extracts from their reviews show Prof Prendiville and Dr Stuart found no evidence of "questionable clinical judgement, poor operative ability or faulty decision-making" in Dr Neary's cases.

They also considered that Dr Neary, "in the exercise of his clinical judgement, has under difficult circumstances probably saved the lives of some mothers".

In his separate review of Dr Neary's practice, Dr Murphy concluded that five of the nine cases were "life-saving" and that Dr Neary had no case to answer for any of the cases.

Dr Maresh stated that the three doctors were placed in a "difficult position" by being asked to assist in defending Dr Neary's position. However, he said that while they were being asked to act on Dr Neary's behalf, their first duty of care was to the pregnant women.

Dr Maresh found that they did not study evidence scattered through Dr Neary's notes, such as anaesthetic records, haemoglobin estimations, histology reports, and nursing and midwifery notes.

The three doctors appeared to have relied heavily on Dr Neary's operating notes rather than looking for evidence which may have been present to confirm or refute Dr Neary's observations.

Dr Maresh found that the three doctors did not make any comment about the overall rate of hysterectomy at the hospital. However, he said, they would have known that even excluding women who had a hysterectomy for sterilisation purposes, the rate was "very much higher" at Our Lady of Lourdes compared to their own hospitals.

The Manchester-based expert's report also states that the three doctors said that if Dr Neary was to continue working, he would not be able to perform another hysterectomy without obtaining a second consultant opinion.

However, there appeared to be no mention of this point in the doctors' conclusions.

Overall, Dr Maresh agreed with all bar one of the 11 allegations of misconduct against the three doctors.

These allegations include the assertion that the three doctors prepared their report in circumstances where they ought to have known that, if the contents were accepted, the safety of future patients of Dr Neary would be put at risk.

Dr Maresh also agreed with misconduct allegations asserting that they had stated that Dr Neary had no case no answer, when it was clear there should have been serious reservations about some or all of the nine cases.