Friday 24 May 2019

The motives of Dr Neary remain to be unmasked

A TV drama into the Neary scandal gives little insight into the mind of the notorious doctor, writes Maeve Sheehan

THERE is a moment in Whistleblower, the dramatisation of the Michael Neary scandal, when a Manchester consultant spots immediately what his highly qualified, colleagues had missed for years.

This was, of course, the obstetrician's alarming propensity to remove the wombs of mothers in childbirth that made him a risk to women at Our Lady of Lourdes Hospital.

"If he sees it so clearly, how come nobody else has seen it in the 25 years of Neary's practice," asks a North Eastern Health Board official. "That's the question," replies the hero, a fictional hospital administrator played by Adrian Dunbar.

Unfortunately, the question is never answered. Given the scale of destruction Neary inflicted on the bodies of 129 women and scores of others whose ovaries he removed during gynaecological procedures, the "why" of it all remains staggeringly absent in inquiries into Ireland's biggest medical scandals.

What was his motivation? Why did his colleagues, the pathologists and anaesthetists, the senior nurses, not raise complaints? Was Micheal Neary so charismatic that he blinded his colleagues, dazzling them his brilliant surgical techniques when in fact he was butchering many of the expectant mothers unfortunate enough to lay on his operating table?

The story of Michael Neary's devastating predilection for removing the wombs of women over two decades has been rehearsed many times, by the Medical Council which took three years and 37 days to strike him off the medical register, and a damning inquiry report by Judge Maureen Harding Clarke in 2006.

But there has been little enlightenment as to the sinister impulses of this notorious consultant from Mayo who lost his wife to ovarian cancer.

Such insight is also in short supply in Whistleblower, which is broadcast tonight on RTE.

Rather than speculate on the darkness that spurred such acts of medical brutality, the film instead weaves a steady narrative path through a complex medical scandal.

In real life, Neary was exposed in 1998, after 24 years of practice.

Times were changing at Our Lady of Lourdes. In 1997 the hospital was taken over from the Medical Missionaries of Mary by the North Eastern Health Board. The new regime brought in younger nurses. Practices were reviewed. A small number of nurses began to question Neary's rate of caesarean hysterectomies, mostly among themselves.

In October 1998, two young midwives met the North Eastern Health Board's lawyer, Gary Byrne. They were being interviewed about a separate personnel matter when one of the midwives -- whom Justice Harding Clarke later called Ann -- dropped the bombshell about Neary.

The nurse spelt out her concerns and those of others about the dubious practices of the hospital's senior obstetrician. When the meeting ended at 6.30pm, Mr Byrne called Jackie Crinnion, the human resources director of the North Eastern Health Board. She in turn called Finbar Lennon, its clinical director, and Ambrose McLoughlin, then chief executive of the North Eastern Health Board.

A preliminary check of the medical record confirmed their suspicions. Neary, who was in Spain at the time, was telephoned and informed of the complaints.

The rest is history. The hospital wanted to suspend Neary but the obstetrician persuaded three Dublin colleagues to review his work -- which they did favourably -- winning him a reprieve. To stop him returning to work, the health board had to engage an English consultant to review his work, in order to get evidence to suspend him.

Whistleblower tells that story through fictional three characters -- young English midwife Louise; Karen, a 21-year-old once feisty mother who was rendered barren by him; and the detective-like hospital administrator, played by Dunbar.

The facts in this horrendous drama need little embellishment. The most haunting scenes depict with aching clarity the human toll of a needless hysterectomy on a 21-year-old woman following the birth of her first child, all based on first-hand interviews with some of Dr Neary's victims.

Even its most harrowing and dramatic scene -- in which a midwife who worked at the hospital pleads with Neary not to remove her womb -- is based on fact.

That midwife existed. She was one of Neary's "favourites". She gave birth to her baby in 1996, the year that his wife died of ovarian cancer. The anaesthetist and other staff witnessed her begging Neary not to perform the hysterectomy, as she lay in theatre. Despite her pleas and their misgivings, they did not question Neary's clinical judgement, believing the operation necessary because of supposedly heavy blood loss.

Afterwards, one or two nurses complained. Nothing was done, probably because of Neary's bereavement.

In all of this Neary -- played with almost benign and impenetrable reserve by Stanley Townsend -- features as an elusive and reserved figure who is calm in the operating theatre, casually remarking over a bleeding mother, "Ah no, it's no use. Open the hysterectomy kit."

He is patronising to patients, nice enough to the nurses, admired by colleagues, no more gruff or condescending than some of the old school consultants that many of us encountered. There are rare insights into his personal life. Does he prefer Donegal or Spain for Christmas, he is asked. Spain, he replies.

Only one scene attempts to address his motivation. When administrators pore over patient charts to find out how many of these needless hysterectomies they might be dealing with, they notice an inordinately high number in 1996. "Neary's wife died of ovarian cancer in 1996," remarks a hospital executive.

That view was certainly put forward to Judge Maureen Harding Clarke in the Lourdes inquiry but she did not pay it much heed. She noted all the rumours that Neary's unusual propensity for removing wombs was connected to his wife's premature death. The thinking was that he was inspired by vengeance or filled with an irrational terror of uterine and ovarian cancer.

Ultimately, Judge Harding Clarke said that Neary was neither an evil man nor a bad doctor. After interviewing hundreds of staff, patients and Neary himself, she appeared to summarise him as a skilled doctor who rushed to hasty decisions at the onset of danger. "The inquiry postulates that Dr Neary had an acutely heightened sense of danger and a morbid sensitivity to haemorrhage when carrying out surgery, especially at caesarean section," it said.

"It is highly probable that fear of losing a patient approached phobic dimensions and led him to practise defensive medicine in its most extreme forms."

One group of women fell outside the scope of her inquiry, however. They were 62 women whose ovaries -- and in some cases wombs -- had been removed during routine gynaecological procedures performed by Neary.

Mostly women of childbearing age, many had gone to him with minor problems such as cysts or fibroids. They emerged from supposedly routine appointments having gone through major surgery to remove their ovaries.

Knowing the fate that befell these women, Dr Roger Clements, one of two British consultants who reviewed those cases, does not agree with the more benign assessment of Neary's supposed phobias and fear of blood loss. His findings cast the obstetrician's supposed blunders in a far more sinister light.

Neary had explained the hysterectomies to Judge Maureen Clarke by saying that he had been trying to stem the blood loss. How could he explain the gynaecological procedures that resulted in missing ovaries in 62 women?

These patients were not bleeding from childbirth. They were not at death's door, as he claimed so many of his victims were. These patients were told that they had endometriosis or cancer, in order to justify removing their ovaries. In most cases they did not.

"These weren't mistakes, they weren't carelessness. He, for some reason, had to do these operations and I can't understand the motivation," said Roger Clements last year.

"Neary was not a bad doctor. He wasn't bad at his job. He was perfectly competent and the staff around him thought he was a wonderful doctor. I think there can't be any doubt that this was a will to do something, rather than slipshod medicine."

The Garda's National Bureau of Criminal Investigation was given a copy of the reports by Patient Focus last year. That investigation is ongoing and may come to nothing. Medical inquiries are notoriously difficult, because prosecutors must be able to prove an intent to harm.

For now, Micheal Neary's intentions remain a chilling enigma.

A Survivor's Tale, Living Page 4

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