The judge who chaired the inquiry into the hysterectomies carried out by Dr Michael Neary has sharply criticised the Health Service Executive for failing to implement her report's recommendations.
Judge Maureen Harding Clark, who inquired into the high rate of Caesarean hysterectomies at Our Lady of Lourdes Hospital, Drogheda, said there had been "no follow through" by HSE regional management on her report which was published two months ago.
Judge Harding Clark, who is a judge at the International Criminal Court, told a conference in Dublin dealing with the regulation of healthcare professionals yesterday that she had returned to the hospital recently to see how things were progressing.
She found many of her recommendations were "embraced" by senior midwives and by consultants. They had set in place plans for an executive management board so that there would be more involvement of medical staff in management, in the ordering of equipment and so on "only to find there has been no follow through from the HSE regional management".
While doctors, nurses and others were trained to the highest standard, she questioned "the quality, education and leadership qualities of the people who are in the health board, or the executive arm, the money-spending people.
"If they don't have to have anything more than a very basic education, work their way up through the clerical ranks and find that they have the right to stop a brilliant idea which actually advances the health of the large group of people in the community because the idea has to go to this person sideways, to that person, up to a cost accountant, back to the clerical officer and so on and the idea is buried," she said.
"What happened in Lourdes hospital before could be replicated in many other hospitals if the circle isn't closed," she added.
She said one of the most shocking findings of her report was that consultants working with Dr Neary, who carried out most of the hysterectomies, had not seen anything wrong with his practice.
She had also found during her inquiry, she said, severe management deficits, personality problems, internal conflicts, no transparency at any level, no discussions, no analysis, no audit, no handover meetings, no questioning of outcomes, no agreed protocols, gross undermanning, great underresourcing, gross overworking, questionable training of some consultants, and flawed judgments in one consultant in particular at the hospital.
Judge Harding Clark went on to criticise the lack of a "central statistical collection point" for all kinds of information in the Republic, which could cover everything from Caesarean hysterectomy rates in different hospitals to the types of cars most often involved in road crashes. This could be done quickly, she said.
The chairman of the Lourdes hospital's medical board, Dr Alf Nicholson, supported Judge Harding Clark's comments. "We haven't seen much action from the HSE end of things yet," he said.
Dr Shane Higgins, clinical director of the hospital's department of obstetrics and gynaecology, said one of the judge's main recommendations was the setting up of an executive management board. "The hope was among clinicians that it would happen urgently," he said.
"There just seems to be a tardiness in terms of it being set up. . . it is happening but slowly," he said.
A spokesman for the HSE claimed, however, that most of the recommendations in the Lourdes inquiry report were implemented even before the report was published.
He said the HSE would be happy to meet Judge Harding Clark to update her on the progress made.