Taoiseach ‘very worried’ about email from clinical director at National Orthopaedic Hospital

By Cillian Sherlock, PA

The Taoiseach has told the Dáil he is “very worried” about the suspension of a multidisciplinary team’s oversight of hip surgery decisions at a Dublin hospital.

Micheál Martin said there needs to be an “exhaustive” review of unnecessary hip surgeries at two Dublin hospitals.

He was responding to People Before Profit-Solidarity TD Paul Murphy during Leaders’ Questions in the Dáil on Wednesday.

It comes after a clinical audit of surgeries for dysplasia of the hips in children found that a lower threshold for operations was used at CHI Temple Street hospital and the National Orthopaedic Hospital Cappagh (NOHC) than the threshold used at CHI Crumlin.

The review discovered that in the period 2021 to 2023 almost 80 per cent of children operated on at the NOHC, and 60 per cent of those at Temple Street, did not meet the threshold for surgery.

The 2,259 children who underwent hip surgeries in the three hospitals (NOHC, CHI Temple Street and CHI Crumlin) from as far back as 2010 will now be subject to clinical reviews.

Mr Murphy told Mr Martin about an email from a clinical director at Cappagh which ordered an end to multidisciplinary teams considering the cases of patients listed for pelvic osteotomies, instead deferring to the decision of the individual consultant involved.

He said the senior management team at the hospital was also CCd (carbon copied) on the email in November 2023.

He quoted: “Recently, it has become apparent that many children listed for pelvic osteotomies are being cancelled or are having their surgery deferred at short notice thereby causing inefficiencies on surgical lists.

“Following a meeting today, I have decided that patients listed for pelvic osteotomies will no longer be discussed at the MDT

“It will be up to the patient’s individual consultant to review the X-ray and decide if they wish to proceed.”

 

Mr Murphy said surgeries were being cancelled because other surgeons on the MDT thought they were unnecessary, adding: “Instead of saying there was something wrong here, the clinical director said ‘we’ll stop discussing them at the MDT and it’ll be fully in the hands of the original surgeon to decide’.”

Mr Murphy also told the Dáil about the experiences of a a mother of two daughters, Amelia and Hannah, and a surgeon at Temple Street.

He said the mother felt “unduly and inappropriately” pressured by the surgeon ahead of two osteotomies on Amelia’s hips.

Later, her younger sister Hannah was spotted by the same surgeon while she was in the hospital for an eye issue.

Mr Murphy said the surgeon insisted that she also needed two osteotomies despite the family being told by a doctor at the Coombe that this was not necessary. The surgeries on Hannah did not proceed.

He said this was a “chilling example” of the experiences of parents.

He questioned whether there was financial motivation as if the operations had been carried out under private health insurance, the surgeon would have made €1,500 for the first hip and €750 for the second.

He said this may have had a “significant distorting effect” and was an “example of the poisonous role of private profit in what should be a public health system”.

In response, the Taoiseach said he did not know the reasons behind the decisions which were taken and cautioned that “private does not mean unethical”.

On the email read out by Mr Murphy, Mr Martin said he was not aware of who the clinical director was but described it as a “serious issue”.

“That seems to be a shutting down of the multidisciplinary team and the multi-disciplinary approach is a safeguard against wrongdoing or poor practice or ill-informed decisions – because the collective can inform.

“And I’ve met many, many consultants who will say it’s the collective approach as to whether we do surgery or not.

“Medicine is not an exact science, that’s why the collective is important.

He added: “So I would be very, very worried about the suspension of the MDT team in respect of assessing the necessity for operations in this area.”

Mr Murphy also asked the Taoiseach if he believed the surgeons who performed unnecessary operations should be suspended or at least prevented from carrying out osteotomies until an audit into the matter is verified.

Mr Martin said Amelia and Hannah’s mother should formally refer the matter to the Medical Council or the authorities in CHI.

He said there was an onus on the Medical Council to be proactive on the issue as the professional regulator.

He said the CHI also needs to satisfy itself that there is no danger to future patients and that the working environment is safe.

Asked if there should not be an onus on parents to request a review, Mr Martin agreed and said there should be an exhaustive examination of cases.