Doctor under ‘considerable pressure’ prior to clipping patient's Fallopian tubes, hearing told
A consultant gynaecologist told a medical fitness to practise hearing that despite clipping a patient's Fallopian tubes, this was not a sterilisation operation because "infection had blocked these tubes before I got to them."
Dr Declan Egan told a Medical Council Fitness to Practise hearing that medical cutbacks meant that he was under considerable pressure on the day he operated patient Lorna McKeogh (36), clipping both of her fallopian tubes though he only had consent to clip one.
The consultant gynecologist, who recently retired from his practise at UHG and runs a private Galway Fertility Unit at Rahoon in the city, said day beds in the hospital had been cut from ten to just four and this had a knock on effect on waiting lists.
He believed the consent form "covered" him to clip both tubes and claimed he carried out the procedure on patient Lorna McKeogh (36) in her "best interests", in a bid to improve her chances of getting pregnant through IVF.
Finding a problem with both Fallopian tubes rather than just one as suspected, had left him with "a dilemma", he told a Medical Council Fitness to Practise hearing today.
He believed she 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 claimed that he believed a line in the consent form covered him to carry out an additional procedure if something else was found necessary.
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 2nd, 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.
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 a doctor, Dr Eithne Lowe at the Bon Secours hospital in Galway but it was unable to carry out a tubal ligation because of its Catholic ethos, the inquiry was told.
Ms McKeogh was referred to Dr Egan in UHG, who performed the bilateral tubal ligation under total anaesthetic.
Doctors had suspected hydrosalpinx or water filled sacs on the right hand Fallopian tube.
However Dr Egan told a Medical Council Fitness to Practise hearing today that when he examined the patient during surgery found hydrosalpinx also on the left hand side and so had taken the decision to clip both..
After the surgery, Dr Egan said he had told Mrs McKeogh that he had informed her 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.
Mrs McKeogh has told the hearing that she was upset by this conversation.
"I was the messenger and the message was not good," he agreed today.
However he told the hearing that he had just come from another patient and had delivered her baby that had died at 33 weeks, so: "I might be been not as focused on her problem as I would otherwise have been."
And Dr Egan said he would have assumed that the patients' own doctor, Dr Lowe would have covered all the scenarios in clipping Fallopian tubes because "women will intuitively think hanging onto the tubes is the best answer" when in fact it is not, in the case of IVF, he claimed.
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, can bring on the menopause up to four years early.
He also claimed there was “a lot of smoking and a lot of drinking” on both sides.
Coupled with Mr McKeogh’s low sperm count, Dr Egan said: “That combination screams IVF to me,” he said.
Dr Egan acknowledged his note of the operation was “rather rushed” but said this was due to pressure he was under on the day, with seven c-sections on the list. He was unable to consult with colleagues during the operation as none nearby had reproductive experience. He would have found it “odd” to consult with Mr McKeogh, who was in legal terms a third party.
He said consent forms for tubal ligation in Galway Hospital used to provide for the husband’s signature but this practise ceased in 2009.
When it was put to him that Ms McKeogh suffered distress when she received invitations to attend IVF meetings at Dr Egan’s private clinic, Dr Egan said was due to the “efficiency”of secretaries in noticing that she hadn’t attended an initial meeting on IVF.
Meanwhile Dr Egan claimed most of the stress Ms MsKeogh said she experienced over the IVF process arose from the fact she had “turned her back” on the local clinic to undertake treatment “miles away” in Dublin.
Questioned by the panel from the medical council, Dr Egan explained that he had clipped the tubes because “free oxygen radicals” within infected fluid can damage sperm and eggs and prevent a pregnancy.
He said his clinic had the best IVF success rate in the country and deals with approximately 1,000 patients a year, with around 350 in his public practise, from which he retired last month, and 670 between three consultants at the private clinic.
He said that in “99pc of cases” tubal disease is bilateral, or on both side.
He also said the reason IVF was invented is because tubal surgery “isn’t that great.”
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.