Deadline approaches for symphysiotomy survivors

Many say compensation for women who underwent procedure is inadequate

At the age of 18, and recently married, Ellen Byrne was pregnant with her first child. She says she was exceptionally innocent and knew little about sex or pregnancy. “Even with friends of mine, we never spoke about things.”

As her due date approached, the doctor told her they would have to operate. She assumed she was going to have a Caesarean section. “When you wake up,” she was told, “you’ll have your baby.”

There was no baby when she woke up. Instead she found her hips strapped together, and she was unable to walk. She was in terrible pain. The straps were removed when she went into labour, two days later; her legs were “separated and put up”. Byrne says she was given no pain relief and was told to push. It took hours. The experience, she says, was agony.

After she gave birth Byrne returned to her tenement home. She couldn’t manage the stairs to the third floor, she says. Today, in the kitchen of her home, in Tallaght, she demonstrates how she used to slide one foot slowly in front of the other.

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The pain in the lower part of her body continued for decades and resulted in further operations. Eventually a metal plate was inserted in her pelvis to bridge a gap created, she now believes, by that first operation.

Byrne is one of hundreds of women who may be eligible for compensation under the terms of a redress scheme announced this month for survivors of symphysiotomy operations. She has until December 5th to apply. But the scheme is attracting strong criticism.

Abandoned around the world

Symphysiotomy involves cutting the pelvic bone, ostensibly to facilitate easier childbirth. The procedure was abandoned in many parts of the world by the middle of the 20th century, but it continued to be used into at least the 1980s in Ireland. The reasons have not been formally established, but they seem to have been a mix of religious and cultural factors.

Caesarean sections were considered more dangerous than they are now. It was also thought that a woman who had a Caesarean would require the procedure again but could have only three such operations – meaning a woman with potential for birthing difficulties could not have a large family.

Dr Alexander Spain, master of the National Maternity Hospital from 1942 to 1948, who reintroduced the method to Ireland, wrote in a lecture to the Royal College of Obstetricians and Gynaecologists in November 1948 that “repeat sections . . . will give good results. It will, however, be a long time before such a method of delivery will be accepted by the profession or by the community at large. The results will be contraception, the mutilating operation of sterilisation and marital difficulty, matters often too lightly considered by the medical profession but of immense importance in any community, especially where the great body or any large number of the people subscribe to Catholic rule.”

Our Lady of Lourdes Hospital in Drogheda was particularly associated with the procedure. A 2010 edition of the RTÉ current-affairs programme Prime Time reported that more than 400 of 1,500 symphysiotomies in Ireland took place there, with the last in 1984. Dr Gerard Connolly was its main exponent.

The impact of symphysiotomy could be tragic. In some cases the baby was brain-damaged or died during the procedure – the mortality rate was estimated to be 10 per cent at the Coombe Women & Infants University Hospital by Dr John Kevin Feeney, its master from 1950 to 1956, but “the real harvest of symphysiotomy is reaped in subsequent deliveries”.

For the women, severe pain, incontinence and impaired walking were among the most common effects.

“Catherine” describes living with double incontinence since giving birth in her 20s. Still in constant pain, she has spent decades seeking treatment and explanations from doctors. Several years ago she attempted suicide, unable to “bear it all any longer”.

Operation’s effects

The operation and its effects began to be researched by Dr Jacqueline Morrissey, a historian, in the late 1990s and were pursued in the media by Carl O’Brien, now this newspaper’s Chief Reporter.

In 2002 a new support group, Survivors of Symphysiotomy, started to campaign for redress.

In 2012 Olivia Kearney won €450,000 in damages – reduced on appeal to €325,000 – against Connolly and Our Lady of Lourdes Hospital. This amounted to the first official condemnation of the procedure.

Successive governments refused to launch an inquiry into the procedure, despite recommendations by the UN Human Rights Committee. This summer the committee wrote that the State “should initiate a prompt, independent and thorough investigation into cases of symphysiotomy and provide an effective remedy to the survivors of symphysiotomy for the damage sustained”.

After much criticism of the Government’s approach to the issue, the Department of Health commissioned a report by Prof Oonagh Walsh. Survivors of Symphysiotomy boycotted the second stage of this report after it objected to her methodology. It was completed in May 2013.

In late 2013 Judge Yvonne Murphy was asked by James Reilly, as minister for health, to review the findings of Walsh’s report, alongside other information, and meet insurers, hospital authorities and survivors of symphysiotomies. Her conclusions formed the basis for the redress scheme, whose terms of reference were announced last month.

The scheme offers between €50,000 and €150,000 to women who underwent the procedure; the compensation depends on the severity of their injuries. The former High Court and International Criminal Court judge Maureen Harding Clarke will serve as an independent assessor.

Women have until December 5th to apply (or January 15th in exceptional cases). The scheme will be ex gratia, meaning there will be no admission of wrongdoing. The response to it has been mixed.

“Limiting access to an effective remedy”

On November 11th the new head of the Irish Human Rights and Equality Commission, Emily Logan, wrote to Minister for Justice Frances Fitzgerald to say that “the Government is limiting survivors’ access to an effective remedy for the damage sustained, which would be otherwise available under a scheme established on a statutory footing”.

Logan also expressed concern about the waiver of legal rights under the scheme and called on the Government to launch “an independent investigation into symphysiotomy cases and to establish a process whereby perpetrators (including medical personnel) can be prosecuted and punished”.

Survivors of Symphysiotomy also criticised the scheme; at meetings in Cork and Dublin 83 per cent of attendees voted to reject the €34 million plan. Instead, these women say, they intend to pursue their cases through the courts.

But Survivors of Symphysiotomy is only one stakeholder group. Another associated with the symphysiotomy issue is Patient Focus, which advocated on behalf of women in the Lourdes Hospital Inquiry. Patient Focus, which is State-funded, and according to its website represents 150 women, shares an address with Survivors of Symphysiotomy Ltd. Although its name is almost identical, this group is distinct from Survivors of Symphysiotomy.

Both Survivors of Symphysiotomy Ltd and Patient Focus favour the scheme. Patient Focus’s national co-ordinator, Sheila O’Connor, says that the women “are growing old, and putting them through the courts at this point would be hard on them”.

Survivors of Symphysiotomy is at odds with Survivors of Symphysiotomy Ltd and Patient Focus on the approach women should take to the scheme.

Patient Focus put The Irish Times in touch with a high-profile symphysiotomy survivor who says that many cases might not be strong enough to win in court.

The chairwoman of Survivors of Symphysiotomy, Marie O’Connor – no relation to Sheila O’Connor – says Survivors of Symphysiotomy represents some 400 women, “about 70” of whom came forward after the UN committee’s remarks, in July. “There may be more, but time is running out for them.”

The redress scheme, Marie O’Connor says, has “exceeded the worst possible expectations. Nobody could have imagined the women would only be given 20 days to decide. By choosing to protect itself and the medical profession the Government is placing the women in an extremely difficult position. The irony is that the Government are pushing women into court.”

“Hard to seek independent advice”

Emily Logan is also concerned about the lack of time. In her letter she says this makes it “extremely difficult for the women involved to seek independent advice”.

Other programmes, such as the residential-institutions redress scheme and the Magdalene laundries redress scheme, gave more time. This week two survivors who have suffered lifelong injuries brought a challenge to the constitutionality of the redress scheme to the High Court. They say they lack the capacity to apply for redress within the 20-day window.

The choice now facing the survivors of symphysiotomies is to participate in a scheme that has been heavily criticised or risk emerging from court with nothing.

The issue of whether the women gave consent for the operations is integral, and may be problematic in a court setting for the women’s cases. Judge Murphy wrote as much in her report, citing “the lapse of time, the demise of clinicians involved and the paucity of records in most cases”.

“Might end up with nothing”

The Irish Times

has spoken to three women who intend to fight their cases through the courts. Each realises she may lose. Ellen Byrne says that it would be a lovely surprise if she got something from it but that she has “never had anything” and “might end up with nothing”.

Another of the women, “Mary”, says, “We started with nothing. We may end up with nothing. I’ve probably spent that money on incontinence pads.”

According to Marie O’Connor, of Survivors of Symphysiotomy, about 200 High Court cases are being planned, with the lead cases set down for hearing on January 29th, 2015.

The psychological impact of the process and its aftermath on some of the women has been immense. Mary says she is from a small rural town and couldn’t bear everyone to know that she has been doubly incontinent for most of her adult life. “You’ve no idea what it’s like,” she says, and breaks down in tears.

Catherine says one of the reasons for her suicide attempt was the anxiety she felt about not being believed; she has been “talked down to for years”.

They believe, too, that this scheme is a further show of disrespect to them. “It’s just more of it,” says Catherine.

Byrne’s granddaughter is now 18, the age she was when her nightmare began. Seeing this young relative saddens her. “I cannot believe that anyone could have been so hard on someone so vulnerable. People are different now to each other, though, aren’t they?”