Tears and anger as inquiry into doctor hears astonishing allegations
One by one, the four women gave their evidence at the Medical Council's fitness to practise inquiry. There was anger and tears and allegations that, at times, were difficult to comprehend.
But the pain and hurt was all too evident.
The inquiry heard how each had undergone a hysterectomy, a procedure to have their wombs removed, with all four falling seriously ill after the operations performed by gynaecologist Peter Van Geene.
The surgeon, who qualified in the UK and was previously based at the Aut Even private hospital in Kilkenny, is facing 15 separate allegations amounting to poor professional performance following the surgeries he carried out on the four women - all mothers and all aged in their 50s and 60s - between April 2009 and October 2011.
Mr Van Geene will dispute the allegations in the case which adjourned on Monday and resumes in September.
The inquiry heard how two of the women required six units of blood to be transfused after suffering serious post-operative bleeding - an amount described by expert witness Dr Peter McKenna, former master at the Rotunda Hospital, as "exceptional".
In the case of two of the women, Dr McKenna bluntly told the inquiry the hysterectomy procedures should simply have never been performed. Another patient only discovered last week her ovaries had not been removed in an operation that was carried out in 2011.
Patient A, remaining anonymous, was the first to recount her experience. The inquiry heard how she had suffered post-menopausal bleeding and saw Mr Van Geene in 2008. At the time, she was suffering from stress as she cared for her gravely ill husband.
The patient consented to a vaginal hysterectomy. But within 48 hours of the operation, the inquiry heard a "repulsive" brown discharge had developed and it was later found that a fistula, or large hole in the vaginal wall, had formed.
The patient said she is convinced this had been caused by the operation performed by Mr Van Geene - an allegation set to be strongly contested.
Patient A also alleged that the surgeon failed to properly outline the risks to her.
"If I'd known what would've happened, I wouldn't have had it done, as you could imagine," she said.
Dr McKenna, who has reviewed the medical records of each of the four women, said stress was not a reason to perform a vaginal hysterectomy.
"If an undergraduate in their examination told me post-menopausal bleeding was caused by stress I would fail them," he said incredulously.
"That's like saying if you have indigestion because of stress, remove your stomach. It's nonsense."
Later he said he could not "understand the rationale in treating this patient at all. To me it doesn't make a whole lot of sense," he added.
"To me, I feel the patient had the wrong operation."
Perhaps the most shocking allegations were delivered on the second day of the inquiry when patient Helen Cruise (62), from Kilkenny, and the only woman to waive her right to anonymity, complained that Mr Van Geene had blamed her for post-operative bleeding. She also alleged he was rude and became aggressive during a meeting after her operation.
Ms Cruise had her hysterectomy in August 2011 after complaining of severe incontinence. She too suffered bleeding, and needed a laparotomy (an incision of the abdomen) and was subsequently transferred to St Luke's Hospital.
The patient tearfully outlined her difficulties walking around town; her requirement to carry a walking stick; her persistent chronic pain; and the breakdown of a relationship.
She also alleges she did not understand the operation that she signed consent for and said she did so in the operating theatre under anaesthetic after Mr Van Geene handed her the form.
Afterwards, Ms Cruise said the doctor told her he had thrown her womb "into a bucket on the floor".
"I thought that's not a nice thing to say. That womb carried all my children. That wasn't a nice remark to make," the mother-of-seven told the inquiry.
The inquiry also heard of a meeting between Mr Van Geene and Ms Cruise. At this, the patient alleges the surgeon blamed her bleeding on ligatures coming loose because she "coughed" - with reference made to her history of smoking.
The inquiry committee then heard that Mr Van Geene "went berserk", shouted "sue me, sue me, sue me" and struck the patient on the hands and legs. The allegations were repeated by Ms Cruise's daughter, Aneka.
Staff nurse Catriona Kenny, who was also present at the meeting, recalled no "untoward physical touching" but said it was the most extreme case of rudeness she had ever seen and graded it "seven out of 10" under questioning from barrister Neasa Bird, daughter of former RTÉ star Charlie Bird.
Again Dr McKenna was of the view the surgery should not have been performed as it could not solve a urinary problem. It was "no wonder Ms Cruise isn't feeling any better", he commented.
In relation to the womb being thrown in the bucket allegation, he said he could "understand" how such a remark could be made and could be misinterpreted.
But Dr McKenna, now clinical director at the Rotunda, said it was "inexplicable" that any doctor would seek to "spread the blame" to a patient following a medical complication and expressed "concern" at Mr Van Geene's lack of introspection.
Like Ms Cruise, Patient C required six units of blood following her operation in October 2011. The blood loss was described as "massive". Dr McKenna said no one in his hospital had heard of such blood-loss following an elective gynaecological procedure in 10 years "or even more".
Patient C, aged in her 60s, asked in a follow-up meeting with Mr Van Geene if he had removed her ovaries, but she said he was unable to tell her.
"He said he wasn't sure because he didn't have all his records with him," she said, at which point Eugene Gleeson, barrister for Mr Van Geene, confirmed her ovaries had not been removed.
Patient C offered little by way of response.
Patient B gave evidence on Day Three of the inquiry and said she should have been treated with greater "sensitivity".
Dr McKenna later observed: "Looking at the pattern of outcomes and alleged exchanges with patients, I would have concern about the poor professional performance of the individual."
The evidence has been harrowing and hard to listen to at times. The allegations, stretching back over such a long period, have resulted in vast amounts of documentation which Ms Bird and Eugene Gleeson, for Mr Van Geene, have methodically teased through - at times line by line.
On one occasion, a second table was required for a witness, such was the volume of heavy duty ring binders piled in front of him.
The inquiry has thrown the spotlight on various closeted areas of our health system, including some highly-critical observations of the National Treatment Purchase Fund by Dr Ray O'Sullivan, a consultant gynaecologist at St Luke's Hospital.
The public gallery, usually barren at such inquiries, has been close to capacity level at times as the women's family show their support, as well as a large media presence, such is the interest in this case.
But through it all, the patients, in recounting their personal and highly sensitive stories, have been remarkably dignified. Some of the allegations have been contradicted by witnesses, including colleagues of Mr Van Geene's who has also been ever-present throughout.
He will dispute the allegations when he gives evidence in the case of each of his four former patients.
The inquiry continues on September 24 at 9.30am.