Monday 23 April 2018

Expert claims two of gynaecologist's patients did not need to have wombs removed

Consultant obstetrician and gynaecologist Dr Peter Van Geene during the The Medical Council fitness-to-practise inquiry at Kingram House, Dublin. Photo: Gareth Chaney Collins
Consultant obstetrician and gynaecologist Dr Peter Van Geene during the The Medical Council fitness-to-practise inquiry at Kingram House, Dublin. Photo: Gareth Chaney Collins

Sam Griffin

An expert witness at the inquiry into allegations against a gynaecologist has claimed two of the surgeon's patients did not need to have their wombs removed and that other procedures would have been more appropriate.

Rotunda Hospital clinical director Peter McKenna said it was also his view that the pattern of patients suffering postoperative bleeding following surgeries carried out by Peter Van Geene in the Aut Even Hospital in Kilkenny amounts to “poor professional performance”.

He said he was also concerned by the surgeon's inability to be “introspective” and said to “spread the blame” to his patients for surgical complications was “inexplicable”.

The tribunal heard evidence from Dr McKenna, the former master of the Rotunda Hospital, on the fifth day of the Medical Council’s fitness to practise inquiry.

The allegations are by four patients of Mr Van Geene who underwent hysterectomies carried out by him at the private hospital between 2009 and 2011.

“Looking at the pattern of outcomes and alleged exchanges with patients, I would have concern about the poor professional performance of the individual,” Dr McKenna told the inquiry.

Later he said: “When you have poor outcome such as these and they are very poor outcomes, you would have to question the ability of the person to pick the right patient for the procedure and the ability of the person to do that operation.”

Dr McKenna addressed the allegations in respect of each of the four patients who gave evidence this week.

In relation to Patient A,  the inquiry heard she had presented with post menopausal bleeding and had complained of suffering from stress.

Mr Van Geene agreed to perform the hysterectomy in April 2009. Dr McKenna said he “did not see what could be achieved” by performing the procedure if the patient’s problems were stress-related.

“That’s like saying if you have indigestion because of stress remove your stomach,” he said. “It’s nonsense.”

“I cannot understand the rationale in treating this patient at all. To me it doesn’t it make a whole lot of sense,” he added. “To me I feel the patient had the wrong operation.”

Similarly in the case of another patient, Helen Cruise who waiver her anonymity, he said he could not understand why a hysterectomy was carried out as she was suffering with incontinence.

“I do not see how a vaginal hysterectomy can fix a urinary problem,” he said and added “It was no wonder Ms Cruise isn’t feeling any better”.

Ms Cruise subsequently required six units of blood during a laparotomy when she suffered haemorrhaging, an amount he described as “massive”.

Ms Cruise had also alleged Mr Van Geene had shouted at her at a meeting after her operation and said her postoperative bleeding was because she had coughed and caused ligatures to come out.

“If you have caused a complication you don’t have a leg to stand on,” Dr McKenna said adding he would expect someone working under him to inform the patient of the problem, apologise accept responsibility and not “walk away from it”.

“I can’t understand why you would exacerbate your problem by being rude to the patient,” he said.

In relation to the allegation that he had said he had thrown Ms Cruise’s womb into a bucket, he said he understood “how something like that could be said and it could be misinterpreted”.

In relation to Patient C who also needed six units of blood after her operation, he said no one in his hospital could recall a patient getting that much blood in ten years.

He did also state in relation to some of the allegations, that as ‘stand alone’ problems they would not in his view amount to poor professional performance.

Mr Van Geene is expected to dispute the allegations when he gives evidence to the inquiry.

In earlier evidence, a consultant anaesthetist said the surgeon facing allegations of poor professional performance is a “good communicator” and always courteous around patients and other doctors, a fitness to practise inquiry has heard.

Dr Prasad was giving evidence in relation to one patient, Helen Cruise, who has waived her right to anonymity and who has alleged the surgeon shouted at her, physically touched her and told her he had thrown her womb into a bucket.

Dr Prasad told the inquiry he administered an anaesthetic prior to Ms Cruise’s hysterectomy after discussing this with the patient. He said he saw the consent form had already been signed prior to Ms Cruise entering the theatre, but said he did not witness Ms Cruise signing it.

He said he would not have proceeded if the form had not been signed.

He disputed the evidence given by Ms Cruise where she had told the inquiry she received an epidural and said he administered a spinal anaesthetic.

Under cross examination he said he didn’t recall any conversation during the operation about the disposal of the patient’s uterus and said this practice normally “goes without saying”.

He said the procedure went very smoothly and was uneventful.

The inquiry heard he was then called back to the hospital later that night when the patient started to bleed. He said he wasn’t the on-call anaesthetist but wanted to return as he had been involved in the earlier operation.

He said Ms Cruise received six units of blood which he described as a “significant” amount but added that he has come across such a situation following previous hysterectomies.

He said he wasn’t surprised to hear Ms Cruise was later transferred to St Luke’s. This was because he was aware of the “limitations” of Aut Even, he added under question from the inquiry committee. Aut Even does not have an intensive care unit or a coronary care unit.

Asked by barrister Eugene Gleeson, representing Mr Van Geene, if he had worked with his client for “many, many operations” he said he had and agreed Mr Van Geene was a good communicator and courteous to patients and other doctors.

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