Paul Murphy demands review after Temple Street hip surgery scandal

When Emilia was three, she had osteotomies on both hips at Temple Street. Her mother felt unduly and inappropriately pressured by the surgeon. It started out with the possibility that she might need one hip done, and then it was an absolute necessity to get both done. Emilia was six before she could walk properly. She was the slowest to do a cartwheel, the last to ride a bike. She still has pain when she climbs stairs. Her younger sister, Hannah, was then later in Temple Street with an unrelated eye condition. But the same surgeon spotted her and insisted on checking her for hip dysplasia. The mother said, no, no, that's not necessary. She's been checked at the coom, everything is fine. But the doctor insisted. He logged into the CHI database, he looked at the scan, and he said, no, no, Hannah definitely needs to get both hips done. The mother didn't trust the doctor at this stage. She went back to the coom. The doctor in the coom said, that's a load of nonsense. She doesn't need either hip done, and no hip was done. It's a chilling example of what this scandal looks like to parents. What it looked like inside the hospitals is illustrated by an email sent by the then clinical director in CAPA in November 2023. I quote. Recently, it has become apparent that many children listed for pelvic osteotomies are being cancelled or having their surgery deferred at short notice, thereby causing inefficiencies on surgical lists. Following a meeting today, I have decided that patients listed for pelvic osteotomies will no longer be discussed at the MDT multidisciplinary team. It will be up to the patient's individual consultant to review the x-ray and decide if they wish to proceed. Surgeries were being cancelled because other surgeons thought they were unnecessary. Instead of saying there's something wrong here, the clinical director said, we'll stop discussing them at the MDT, and it'll be fully in the hands of the original surgeon to decide what they would do. What was the motivation for this? If Hannah had been operated on, because they had private health insurance, the surgeon would have made €1,500 for the first hip and another €750 for the second. That's what they would have made for Amelia's two hips. An example of the poisonous role of private profit in what should be a public health system. Three questions for you, Taoiseach. Firstly, why are the surgeons who conducted hundreds of unnecessary surgeries still operating on children? One of them could do an osteotomy tomorrow. Surely they need to be suspended, or at the very least stopped from performing osteotomies until the audit is verified. Secondly, the government and the CHI have publicly committed to independently reviewing all of these osteotomies. But the clinical director of CHI has emailed staff saying, I quote, it is acknowledged that some patients and parents may request a retrospective review of their case to determine the indications for surgery. Taoiseach, do you agree that the onus should not be on parents to request that their cases be reviewed? Finally, Taoiseach, do you agree that the review should not be limited to patients from 2010 onwards, as is clearly indicated by the CHI statement? Thank you. The operation started in 2002, and all of them need to be reviewed. Taoiseach, please. First of all, I thank the deputy for raising the issue, and the case of Amelia and Hannah. Now, can you confirm that Hannah did not get the surgery, I take it? Yeah, okay. I would ask that the parent would refer, and I don't want to put too much burden on the parent, but I think the issue should be formally referred to the Medical Council, for example, or to the authorities in CHI. I think it's important now that the Medical Council takes a role here in terms of the professional regulation of its members. And there's an onus on the Medical Council to be proactive in respect of this issue. Now, I'm conscious that it's a random anonymised sample, although the author says there's a preponderance, I think. I don't want to paraphrase to a smaller number of surgeons in this context. I don't know who the clinical director, by the way, is there, but I don't know who that clinical director was at that time. But that in itself is a serious issue, because that seems to be a shutting down of the multidisciplinary team. And the multidisciplinary approach is a safeguard against wrongdoing or poor practice or ill-informed decisions, because the collective can inform. And I've met many, many consultants who would say it's the collective approach as to whether we'll do surgery or not. And medicine is not an exact science. That's why the collective is important. So I would be very, very worried about that letter in terms of the suspension of the MDT team in respect of assessing the necessity for operations in this area. In terms of, and I think I have to be careful what I said, there's one for the report coming, the Ag report, but we do know on a different case in terms of springs, action was taken in terms of a consultant being put on suspension. And there is an issue for CHI here as well, in terms of it now needs to satisfy itself as an employer and satisfy the patients who, prospective patients, that there's no danger to any future patients or that the environment is safe following the publication of this report. So I would acknowledge what you are saying, by definition, the publication of the report creates issues, and perhaps creates issues in respect of a number, maybe a small number of consultants. And that needs to be bottomed out fairly quickly. Obviously, the follow-through and the onus should not be on parents, you are correct. In my view, we need to do an exhaustive now examination, and the Minister has already said about that, but has to put together an external multidisciplinary team of professionals who would do that review of cases. That would shed more light then on the broader issue in terms of what has already been discovered in the audit in terms of veracity and verifying it. Thanks. I mean, sometimes when people are discussing this issue, they talk about culture in a kind of disembodied sense, that a culture exists that was bad, and clearly it did in this case. But the culture was created by individuals and carried on by individuals, and the top surgeons in question were a really big part of this. And the question has to be asked in terms of what was the motivation. Was the motivation financial? When I heard the figures, this is on top of salaries, €1,500 for a first hip, another €750 for the second hip. These are relatively easy operations for the surgeons to do. You can see that that may have a significant distorting effect on what is happening in our hospitals, and proves the basic point that we need to have a proper public health system. I would make the point that the email which suspended the MDTs, which was incredible, was cc'd to the senior management at CAPA. It should have raised a red flag. Clearly it did not, because then that proceeded to happen. The MDTs were suspended. I would go back to the Taoiseach as to whether you agree that these surgeons should, at the very least, not now be conducting osteotomies. That can be done immediately, I think that needs to be done immediately, and finally, will you confirm, because just when you read the CHI statement, it is clear about from 2010 being reviewed, it needs to go back to 2002, that is when these started. I think the Minister has said already, in response to that last evening, that the Minister is not ruling on going beyond 2010, but that the priority has to be, right now, followed through. And that anyone be, ah, well, no, but I mean, let's be sensible about it. I mean, the Minister has to deal with those where skeletal maturity applies in terms of the cases that have been the subject matter of the external review, which is about 15 years. For those over that, they're in a transitional programme of care already at the transition to adult care. But, the Minister is saying that that can be looked at in the context of, let's get this first phase done initially. I would just make one cautionary note, that private does not mean unethical. And there's many people operate and engage in the private sector generally, who are not unethical. I don't know the reasons as to why this, and I think we do need to inquire further into this aspect of it, the how and the why. And there could be different factors responsible for that. And, but I would equally say, like the fundamentals here, there's an ethical framework that every doctor is meant to adhere to. Thank you, Taoiseach. And that has to be the key issue for us to explore. We now move to other members.