The women were from Our Lady of Lourdes Hospital in Drogheda, Co Louth, and had come to discuss a consultant against whom a “minor” complaint had been made.
“At least he’s not as bad as Mr Neary,” remarked the younger midwife, who was herself pregnant with her first child. The woman had only recently started work at the Drogheda hospital following completion of her midwifery training in Belfast. Her senior colleague had worked there for 15 years.
“Who is Mr Neary?” Byrne asked. The young nurse explained that only that week she had secretly retrieved a womb from a surgical bucket after an emergency hysterectomy by Dr Michael Neary, the hospital’s eminent consultant obstetrician.
The older woman hung her head in despair as her colleague told Byrne everything. She explained that a pathologist to whom she had given the womb for analysis was able to prove that it was perfect, that he could find no evidence as to why it was removed.
It would later emerge that Neary had performed the same surgery on as many as 100 women. The young midwife told Byrne that she was distressed over this extraordinarily high rate of caesarean hysterectomies, a procedure that leaves women unable to have children.
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Last week Neary was found guilty of 10 counts of professional misconduct and struck off the medical register for needlessly removing the wombs and ovaries of his patients. The 61-year-old consultant from Mayo, who earned over ¤300,000 a year, now faces over 65 civil cases in the High Court from women who allege that he removed their wombs negligently.
Last month Neary lost his appeal against a High Court award of ¤273,223 damages for negligence towards Alison Gough, a mother from Ardee whose womb he removed after the birth of her only son, Daniel, although the amount was later reduced. Neary may have to face former patients who are intent on pursuing criminal charges of assault or grievous bodily harm.
An anticipated public inquiry is likely to look not only at Neary’s gross negligence, but at the activities of his peers at the obstetric unit who accommodated his radical techniques, and at the roles of at least two professional medical associations that exonerated him in the past.
“I will never, ever forget that meeting,” said Byrne. “It is etched in my mind when that woman turned to me and said, ‘He’s not as bad as Mr Neary.’ She decided to take a chance and deserves enormous credit for her bravery.”
Byrne acted quickly after the midwives’ tales of hysterectomies and distraught mothers. When they left his office, he contacted the health board, who immediately sent an official to the hospital to secure vital paperwork. After a full night’s work — removing and copying patient charts — the weight of evidence against Neary quickly emerged.
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AN OBSTETRIC hysterectomy is performed because of uncontrollable bleeding from the uterus following birth, and is usually associated with a caesarean section. It is a procedure which gynaecologists only resort to in emergencies.
A hospital the size of Our Lady of Lourdes would be expected to have an average of one caesarean hysterectomy a year. But the rate at the hospital between 1996 and 1998 was nine per year. Since that day in 1998, only one caesarean hysterectomy has been performed there.
Senior management were informed the next day and preliminary assessements were carried out. A case that came under close scrutiny was one of Neary’s last patients, a teenage mother who was rushed into theatre in October 1998 for an emergency caesarean section several weeks before she was due to give birth. During the caesarean Neary removed her womb, leaving the 19-year-old sterile for life. Tragically, the baby died six weeks later.
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“Neary called me to the theatre door. He had gloves on and they were bloody,” recalled the woman’s husband. “It was as if he put a gun to my head. He said my wife would die if he didn’t remove her womb.”
After a preliminary examination of his record, the health board asked Neary to stand down immediately. He refused, but agreed to take annual leave as the inquiries continued.
Board officials transferred the files to Michael Maresh, a professor of obstetrics at the University of Manchester, for an independent peer review. Meanwhile Neary also sought validation by his peers, while continuing to treat patients privately. He made contact with the Irish Hospital Consultants Association — the consultant doctors’ trade union — which dispatched a three-man team to Drogheda to review his practice.
The team was given very limited access to files allegedly picked out by Neary himself. A review document, compiled in 36 hours by three leading Dublin consultants — John Murphy, Walter Prendiville and Bernard Stuart — concluded that there was “nothing unusual” about Neary’s management of the nine cases. Neary returned to work at the hospital, armed with the letter from his colleagues that he was fit to practise, as the health board frantically sought ways of removing him.
In December, three months after the board was put on notice of Neary’s conduct, he was placed on paid administrative leave following a report by Maresh. The Manchester consultant, who also reviewed nine of Neary’s cases, informed the board that they had a genuine and serious problem on their hands. He said that in many cases Neary’s decision to perform hysterectomies was taken too quickly and unnecessarily.
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Surgical notes stating that there were uterine or placental abnormalities that warranted the removal of wombs were undermined by subsequent pathological reports, Maresh found. Now dozens of women made complaints to the board about their experiences at Neary’s hands.
In January 1999, Neary was the subject of a second review by his peers. The Institute of Obstetricians and Gynaecologists, of which Neary was a member, carried out the review at the request of the health board. Neary agreed to the terms of reference of the inquiry into 39 of his cases between 1992 and 1998.
The report by the panel of obstetricians, published in late April, questioned almost two-thirds of the hysterectomies performed by Neary. It also stated that it was anxious to preserve Neary’s excellent — and unquestioned — clinical reputation.
The report found that Neary’s clinical practice with regard to caesarean hysterectomies was acceptable in 41% of cases, doubtful in 13% and unacceptable in 46%. The institute report also found that he had a caesarean hysterectomy rate 20 times higher than that of a Dublin maternity hospital.
Despite these findings, the group did not recommend that Neary be removed from practice. Instead it recommended that he take “a supervised postgraduate programme for a continuous period of six months” in another hospital.
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The review also advised that for one year Neary be obliged to consult a colleague any time he wished to carry out a caesarean hysterectomy.
Neary never returned to work. His name was removed from the medical register in 1999 pending the outcome of a three-year inquiry by the Medical Council, the self- regulating body charged with supervising doctors’ fitness to practise medicine.
Following the decision Neary resigned from his position at the hospital. Last week he was finally struck off the medical register by the Medical Council’s fitness-to-practise committee. He has 21 days to lodge an appeal.
WHILE his former patients waited almost five years for the final verdict on Neary’s conduct, supporters rallied to the consultant’s side. When the scandal broke, thousands took to the streets of Drogheda to march in support of him. A deeply religious man, he had successfully delivered generations of children in Louth for almost 30 years.
A small group of friends, including medical colleagues, remain committed to the father of three whose wife, Gabrielle, died of ovarian cancer seven years ago.
“He is an absolute gentleman, a deeply committed family man who was never out of the hospital,” said one confidante who is in daily contact with Neary. “I’ve lost count of the number of times he would leave a meal with friends to race to the hospital to save a woman’s life. People in Drogheda still shake his hand when they meet him in the streets.
“He is a very strong man; he has done nothing wrong. To this day he believes he was right.”
As far as some of his patients are concerned, the treatment Neary sought for his wife — importing medicines from America and securing the best possible surgical care — is in direct and unhappy contrast to the treatment they received.
A decision on whether there should be a full public inquiry into Neary’s actions will be made by Micheal Martin, the health minister, in September. Beforehand he will meet with Patient Focus, an advocacy group for Neary’s patients that has criticised the minister for waiting almost five years for the Medical Council to strike him off. They want compensation, a full public inquiry into the hospital, and Neary behind bars.
Last week Geraldine Feeney, a Fianna Fail senator and lay member of the Medical Council, called for the report to be sent to the Director of Public Prosecutions so that he could consider laying criminal charges against Neary. But the 25-member council, 23 of them doctors, defeated a motion to refer the report to the DPP at a meeting last Tuesday.
The council itself would come under scrutiny in any public inquiry. Notorious for its highly secretive and lengthy reviews into charges of professional misconduct, a report it commissioned has severely criticised these procedures.
Completed last year by Harry Whelehan, a former attorney-general, the report has never been published. But according to the Irish Medical Times, Whelehan found that some complaints against Neary were not recorded, were misfiled, were not acknowledged and, in some cases, were ignored.
For some of Neary’s patients, last week brought just a little closure. “I suppose I should be happy because this should be good news that we are at last being believed. People just thought we were hysterical women,” said one woman who was 20 when Neary performed a caesarean hysterectomy after the birth of her only child in October 1998.
“As far as I was concerned, my life had been saved. I wasn’t prepared to believe anything else. I never planned to have just one child, and I clung on to the hope that it was all a mistake.
“You either crack up or try and get on with it. I’m still trying to come to terms with it all.”