Consultant 'believed he had consent' to clip woman's two fallopian tubes during surgery
A consultant gynaecologist has apologised for causing "deep upset" to a patient by clipping both her fallopian tubes, despite only having consent to clip one.
However he claimed that clipping the tubes in this case was "not a sterilisation operation" because "infection had blocked these tubes before I got to them".
Dr Declan Egan, who retired from his practice at University Hospital Galway last month and who runs the private Galway Fertility Unit told a Medical Council Fitness to Practise hearing that medical cutbacks meant that he was under considerable pressure on the day he operated on patient Lorna McKeogh (36), a sales executive from Mountbellew, Co Galway.
Day beds in the hospital had been cut from 10 to just four and this had a knock-on effect on waiting lists.
He had seven C-sections on his theatre list that day in June 2010, one of which involved the delivery of a baby who had inexplicably died at 33 weeks, he said, becoming emotional.
The hearing was momentarily adjourned to allow Dr Egan to regain his composure.
He subsequently told the hearing that he believed the consent form signed by Ms McKeogh "covered" him to clip both tubes and claimed he carried out the procedure in her "best interests".
Ms McKeogh was 32 when she was referred by her GP for gynaecological treatment after suffering a number of miscarriages.
She was first seen by Dr Eithne Lowe at the Bon Secours hospital in Galway and tests showed a probable hydrosalpinx, or water-filled sac, on the right-hand Fallopian tube.
She was told that this might have to be clipped but was unable to have tubal ligation at that hospital because of its Catholic ethos, the inquiry was told and Ms McKeogh was referred to Dr Egan in UHG.
Dr Egan told the hearing that when he examined the patient during surgery, he also found hydrosalpinx on the left-hand side and this left him with "an ethical dilemma".
He believed Ms McKeogh would not be able to get pregnant other than through IVF and explained that clipping the tubes improved her chances of becoming pregnant in this way. He also felt it gave her both options of having tubal surgery at a later date, by having the clips removed, or going ahead with IVF.
Tubal disease is bilateral or involves both sides in "99pc of cases", he subsequently claimed.
Dr Egan claimed that he believed a line in the consent form covered him to carry out an additional procedure if something else was found necessary.
However he yesterday admitted that he has since found out from legal experts that he was not covered.
He said it was only the second time in his career that he had acted "outside consent". The other case had not led to any difficulty.
Dr Egan is before the fitness to practise committee of the council, where he faces an allegation that he performed a clipping of both left and right hydrosalpinges (fluid-filled fallopian tubes) "in circumstances where this was not consistent with the consent form dated June 2, 2010".
Arising from this, he is accused of failing to meet the standards of competence that could reasonably be expected of a consultant obstetrician/gynaecologist.
After the surgery, Dr Egan said he had told Ms McKeogh what had happened in a four-bedded gynaecology ward, with only a curtain screening them, so it was not a setting for a detailed consultation.
Ms McKeogh has told the hearing that she was upset by this conversation.
"I was the messenger and the message was not good," Dr Egan agreed, saying this message was that her tubes were blocked and she would need IVF.
In an explanation for his manner at the time, he told the hearing that he had just come from delivering a baby that had died at 33 weeks, so: "I might not have been as focused on her problem as I would otherwise have been."
He said "women intuitively think hanging onto the tubes is the best answer" but, in fact, tubal surgery "isn't that great" and that was the reason IVF had been invented.
He told his counsel, Eileen Barrington SC ,that Ms McKeogh and her husband had both continued to smoke around 15-20 cigarettes a day, saying this was a very significant feature in her case as smoking caused miscarriage by damaging the DNA in sperm and can bring on the menopause up to four years early.
Coupled with Mr McKeogh's low sperm count, Dr Egan said: "That combination screams IVF to me."
Dr Egan acknowledged his note of the operation was "rather rushed" but said this was due to pressure he was under on the day.
He did not consult with the patient's husband because he would have found it "odd" to consult with "a third party".
Barrister JP McDowell, for the chief executive of the Medical Council, put it to him that other medical experts had subsequently found Ms McKeogh's left tube to be "grossly normal" - but Dr Egan disagreed.
Dr Egan said his decision to clip both tubes had been "well thought-out" to give her both options of subsequent tubal surgery as well as IVF but said: "I think she was deeply upset by this and for that I am truly sorry."
The case is due to resume at the end of March.