Fertility doctor’s decision ‘lacked sensitivity’

The decision of a Galway fertility doctor to clip both of a woman's fallopian tubes without consent has been described as "quite extraordinary" at a Medical Council disciplinary hearing.

Expert witness Prof Anthony Smith said the decision to clip both of the woman's tubes when consent had been given to clip only one, lacked sensitivity given the effect the operation had on her ability to conceive naturally. He said there was a "total failure to consider the patient as an individual".

Prof Smith, a consultant gynaecologist at Central Manchester University Hospitals, was also critical of Dr Declan Egan’s failure to provide more detail of his action, or to seek corroborative support from colleagues at University Hospital Galway (UHG).

Dr Egan, a consultant gynaecologist who practises at UHG and runs the private Galway Fertility Unit in Rahoon, acknowledges he should have sought the consent of patient Lorna McKeogh beforehand, but argues his action was medically justified.

Dr Egan is before the fitness to practise committee of the council, where he faces an allegation that he performed a clipping of both left and right hydrosalpinges (fluid-filled fallopian tubes) “in circumstances where this was not consistent with the consent form dated June 2nd, 2010”.

Arising from this, he is accused of failing to meet the standards of competence that could reasonably be expected of a consultant obstetrician/gynaecologist.

Ms McKeogh was 32 when she was referred by her GP for gynaecological treatment after suffering a number of miscarriages. She was first seen by a doctor at the Bon Secours hospital in Galway but it was unable to carry out a tubal ligation because of its Catholic ethos, the inquiry was told. Ms McKeogh was referred to Dr Egan in UHG, who performed the bilateral tubal ligation under total anaesthetic.

Prof Smith said he would have expected consent to be provided before this procedure was carried out, as well as a detailed explanation or justification of what was done. He expressed surprise that such an important decision was not accompanied by more detail, such as pictures or videos.

This was a big decision, “not just another thing to do,” because of the change it involved for Ms McKeogh’s subsequent approach to her fertility. In mitigation, he said Dr Egan did not know the patient and how important a natural ability to conceive was to her.

“It’s not just about buying babies off the shelf through IVF,” he said. “For a lot of women, this is a fundamental part of their feelings.”

Prof Smith told JP McDowell, for the chief executive of the Medical Council, he was surprised Dr Egan didn’t seem to have grasped the gravity of the situation.

Ms McKeogh (36), a sales executive from Mountbellew, Co Galway, has said the decision by Dr Egan to clip both of the tubes, rather than just one, rendered her infertile. Describing his bedside manner as "horrendous," she has also accused Dr Egan of failing to consult her husband Darragh, who was waiting nearby during the procedure.

Prof Smith said this was a “tricky issue” and he didn’t think a doctor could ask a husband for consent in these circumstances.

The failure to obtain consent was a “serious omission” because doctors rely heavily on the trust of patients for what they do.

Dr Egan will give evidence when the hearing resumes at a later date.