Martin Daly critiques DDH management after Thomas Audit
Martin Daly spoke in the House about the Thomas Audit into the management of developmental dysplasia of the hip (DDH) at CHI Temple Street and the National Orthopaedic Hospital Kappa. He described the audit as deeply disappointing, raised concerns about governance, consent and clinical judgment, and called for independent review, accountability and proper follow-up for affected children.
The speech summarised the Thomas Audit's findings on DDH care at CHI Temple Street in Crumlin and the National Orthopaedic Hospital Kappa, describing the results as unsettling and deeply disappointing. Martin Daly emphasised the human cost, saying his primary concern is for the children who, the audit notes, should not have been operated upon, and for their families whose trust in the medical profession has been harmed.
Daly highlighted inexplicable variation in pelvic osteotomy rates across CHI Crumlin, Temple Street and Kappa - in the order of 60 to 80 per cent - and said some surgeons strayed far from evidence-based practice and internationally accepted protocols. He warned that these were not marginal decisions and that a small subgroup of surgeons appeared to have carried out a significant number of (including bilateral) pelvic osteotomies.
The statement raised broader questions about CHI's managerial and clinical culture, governance and its relationship with the HSE, pointing to an internal CHI report alleging unethical and irregular referral practices and a toxic workplace environment for junior staff. Daly criticised non-action by management on that internal report and called for the Health Committee to examine the management culture and governance of CHI and Kappa and the practices of individual surgeons.
Martin Daly acknowledged the minister's prompt response to the audit, including the appointment of two HSE board members to the CHI board, an enhanced service level agreement for greater operational oversight, a cross-hospital interdepartmental peer review group for any further surgeries, and commitments by the minister and the Taoiseach to an independent external review process.
Daly demanded proper follow-up to skeletal maturity for affected children, independent review of every case back to 2010, better informed consent and improved record keeping supported by hospital digitalisation. He urged professional reflection, remediation and accountability by the appropriate bodies, stressing that the failures revealed by the Thomas report must be learned from to protect children, families and the medical profession.
Audit findings and patient impact
The speech summarised the Thomas Audit's findings on DDH care at CHI Temple Street in Crumlin and the National Orthopaedic Hospital Kappa, describing the results as unsettling and deeply disappointing. Martin Daly emphasised the human cost, saying his primary concern is for the children who, the audit notes, should not have been operated upon, and for their families whose trust in the medical profession has been harmed.
Variations in surgical practice and rates
Daly highlighted inexplicable variation in pelvic osteotomy rates across CHI Crumlin, Temple Street and Kappa - in the order of 60 to 80 per cent - and said some surgeons strayed far from evidence-based practice and internationally accepted protocols. He warned that these were not marginal decisions and that a small subgroup of surgeons appeared to have carried out a significant number of (including bilateral) pelvic osteotomies.
Governance, ethics and workplace culture
The statement raised broader questions about CHI's managerial and clinical culture, governance and its relationship with the HSE, pointing to an internal CHI report alleging unethical and irregular referral practices and a toxic workplace environment for junior staff. Daly criticised non-action by management on that internal report and called for the Health Committee to examine the management culture and governance of CHI and Kappa and the practices of individual surgeons.
Acknowledgement of Government response
Martin Daly acknowledged the minister's prompt response to the audit, including the appointment of two HSE board members to the CHI board, an enhanced service level agreement for greater operational oversight, a cross-hospital interdepartmental peer review group for any further surgeries, and commitments by the minister and the Taoiseach to an independent external review process.
Calls for review, follow-up and accountability
Daly demanded proper follow-up to skeletal maturity for affected children, independent review of every case back to 2010, better informed consent and improved record keeping supported by hospital digitalisation. He urged professional reflection, remediation and accountability by the appropriate bodies, stressing that the failures revealed by the Thomas report must be learned from to protect children, families and the medical profession.
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Transcript
Minister, it is with significant regret that I have to speak today. I am a member of the medical profession, not an orthopaedic specialist but a doctor of nearly 40 years standing. The Thomas Audit of the management of developmental dysplasia of hips in children in CHI Temple Street in Crumlin and the National Orthopaedic Hospital Kappa is deeply disappointing and unsettling, most especially as it follows on from the use of non-medical grade springs in spinal surgery in CHI. My thoughts are primarily with the children that Mr Simon Thomas states clearly should not have been operated upon and their families. The trust patients and families place in doctors is the bedrock of our profession. That trust has been ruptured in Temple Street and Kappa by some surgeons who must now explain their actions. These were not marginal decisions. Another hospital, namely Crumlin, in the same group of hospitals, in the same small city, followed a starkly different standard of practice and have been vindicated in the Thomas Audit. The Thomas Audit into the management of DDH in CHI has brought clarity within the limitations of its terms of reference. However, it raises many new questions about governance, ethics, consent, clinical judgment and decision making. This is more than clinical misjudgment. It shows some surgeons strayed far from evidence-based practice, ignoring internationally accepted protocols. While Thomas notes that some variants in DDH management could be expected, the variants of pelvic osteotomy rates across CHI Crumlin, Temple Street and Kappa are inexplicable, in the order of 60 to 80 per cent. No plausible explanation was offered. Minister, I acknowledge your swift response to the official audit report and welcomed the appointment of two HSE board members to the CHI board. The increased operational oversight of CHI by way of an enhanced service level agreement. The cross-hospital interdepartmental peer review group for consideration of any further surgeries. And the commitment by you and the Taoiseach to an independent external review process. However, broader questions remain around CHI's culture and governance and its relationship with the HSE. This is especially urgent in light of reports alleging unethical and irregular referral practices by a consultant in an internal CHI report and the alleged toxic workplace environment for junior staff. The non-action by management in response to that report is simply incredible. However, our immediate concern must be the care of affected children and families. Proper follow-up to skeletal maturity must be carried out – standard best practice that was lacking in Temple Street and Kappa. Every case must now be independently reviewed back to 2010. This is a major undertaking but essential, and we must ensure it does not further delay care for children awaiting surgery. It is incumbent upon Government and this House to tease out the systemic failures this DDH debacle has revealed. The key issues are managerial culture and governance, clinical culture and governance, and the process of clinical decision making at Temple Street and Kappa. In many hospitals critical, robust collegial peer review of cases is standard before any treatments are carried out. We need to understand why some surgeons deviated so sharply from accepted practice. Thomas suggests a small subgroup of surgeons carried out a significant number of pelvic osteotomies, especially an unusual number of bilateral pelvic osteotomies. These must prompt professional reflection, remediation and accountability by the appropriate bodies. Informed consent must also be addressed. Thomas details what adequate consent looks like and highlights poor record keeping, underlining the urgency of hospital digitalisation. The Health Committee should explore these matters to clarify the management culture and governance of CHI and Kappa and the practices of individual surgeons. As I have said, it gives me no pleasure to make this statement, but we are obliged to act. The failures highlighted in the Thomas report, the apparent governance vacuum at Temple Street and Kappa serves no one well. Not the children, not their families, not the medical profession and certainly not the state. We must learn from those mistakes.