Report finds rate of hysterectomies ‘truly shocking’

THE cautionary tale of what happened at Our Lady of Lourdes Hospital in Drogheda, where an inordinately high number of women had their wombs removed, was, we are told, “set in a time of unquestioning submission to authority, whether religious or civil, when nurses and doctors were in abundant supply and permanent jobs were few and treasured.”

To put what happened in context, we are told: “It is a story of a relatively small but very busy hospital which operated by a separate and unique set of rules, and was accountable to a religious community (Medical Missionaries of Mary/MMM) rather than to objective medical standards.”

These are the words of Judge Maureen Harding Clark in the report of the Lourdes Inquiry, set up to investigate the high rate of peripartum hysterectomies (womb removal within six weeks of delivery) at “The Lourdes” over a 25-year period from 1974 to 1998, during which time consultant obstetrician Michael Neary worked at the hospital.

Published yesterday, the report’s findings included:

* A total of 188 peripartum hysterectomies were carried out at Drogheda between 1974-1998, described in the report as “truly shocking.” Neary carried out 129, Dr Finian Lynch carried out 40 over a 16-year period.

* The rate of Caesarean hysterectomies for the same period was one for every 37 Caesarean sections compared to one in 300 for other hospitals of a similar Catholic ethos.

* Neary’s Caesarean hysterectomy patients were younger and had a lower number of pregnancies than other consultants’ patients. However, he did have a higher proportion of problem pregnancies.

* No one died as a result of the hysterectomies.

* The number of Caesarean hysterectomies carried out by Neary in 1978/1979 caused the then matron some concern. Her concerns were not heeded.

nNo person raised any issues until October 1998: not the obstetricians who worked in the maternity unit and who knew of the operations; not the anaesthetists who wrote up the operation notes and were always present at the operations; not the surgical nurses who were frequently midwives, and always women; not the midwives who cared for the women after their operations and who recorded the fact that they had had a peripartum hysterectomy; not the pathologists and technicians who received the wombs and specimens from the maternity theatre. It was only in October 1998 that two midwives, consulting the then North Eastern Health Board solicitor on an unrelated matter, sought his advice on serious concerns which one of the midwives had about Neary’s practices.

* Reasons given by management and staff for failure to raise the alarm included: they were not informed; all the hysterectomies were carried out for a very good reason; there was no audit; no one knew what was an acceptable rate.

* The unit was passed for training by the Royal College of Obstetricians and Gynaecologists in 1987 and 1992 with some reservations. The unit was also passed by the Royal College of Surgeons in Ireland for undergraduate training and by An Bord Altranais for midwifery training.

* The maternity unit was caught in a time warp and there was lukewarm application of risk management.

* Obstetric hysterectomy records in 44 cases for the period 1974-1998 are missing and were intentionally and unlawfully removed from the hospital with the object of protecting those involved in the hysterectomies or of protecting the reputation of the hospital.

* In 40 of the 44 cases, the birth registers are also missing.

* A person or persons unidentified, who had knowledge of where records were stored and who had easy access to those records, was responsible for a deliberate, careful and systematic removal of key historical records, together with master cards and patient charts.

* The culture of hysterectomy was associated with a lack of understanding, knowledge or faith in methods of managing blood loss and preserving the uterus.

* The isolation of the unit from the general hospital played a large part in the lack of awareness of what was going on.

* Any isolated institution which fails to have in place a process of outcome review by peers and benchmark comparators can produce a similar outcome to that which occurred in the Lourdes Hospital.

Examining current practices at “The Lourdes”, the inquiry found:

* The possibility of the unit falling behind in current practice is now remote thanks to major changes in practices.

* All hysterectomies carried out now involve teamwork.

* Tubal ligations - an operation to tie the fallopian tubes - were introduced at the end of September/October 1999. The report had found not permitting direct sterilisation, prohibited by the hospital’s Catholic ethos, may have driven up the rate of hysterectomies, a finding hotly disputed by the Medical Missionaries of Mary, the sisters who ran the hospital at the time.