Wednesday, September 3, 2008
Unsafe practice and medical experimentation on women's bodies
Image: Heroine from Erik Vanden's photos on Flickr.com
The Irish Times has published a story discussing a dramatisation of events which occurred in the late 1990s in a hospital in Ireland. This dramatisation portrays the events where a senior Obstetrician was performing classical incision ceasarean sections which were resulting in haemorrage for which he then continued to full intrapartum hysterectomy. This was happening on a regular basis to a significant number of women in the care of this doctor. The medical, nursing and midwifery staff were all aware of the shortcomings of his practice however no one did anything to challenge or to stop him, such was his godlike status. A midwife came to work in Drogheda, where this occurred, from outside the area and was so concerned she eventually managed to speak with the Health Board management and the concerns about Dr Neary's practice came to light.
An inquiry was held and Dr Neary was stuck off the register. During this inquiry concerns were expressed, not only about the doctors practice, but how he was able to continue unchecked with the knowledge of so many people. Following the publication of its decision, the Medical Council advised the Minister for Health and Children that a broad inquiry was needed to explore the context of the tragic events at Drogheda and this was initiated in 2004. The findings of this inquiry can be seen here.
What happened to the midwife who "blew the whistle" on this situation? She has maintained her anonymity but the Irish Times suggest that she had to leave Drogheda and perhaps the country in order to practice. I can understand her desire for anonymity however I find it shocking and concerning that she was not able to continue to practice. By bringing this matter to the fore she has saved the lives and contributed to the well being of the community and should be applauded and rewarded.
The reason I am commenting is because it is so similar to the events which took place in National Womens Hospital in Auckland New Zealand from the 1960s to the 80s. It was two journalists, Philida Bunkle and Sandra Coney who raised the initial concerns about treatment at National Women's hospital. A woman who had concerns about the treatment she had been receiving brought the matter to their attention. As was the case in Ireland, medical, nursing and midwifery staff were aware that Dr Green was placing the lives of women at risk and did nothing to stop him. The findings of the inquiry into these events, conducted by Dame Sylvia Cartwright, were released in August 1988, 20 years ago. This lead to major changes in the health services in New Zealand. Ethics committees and the health and disability commissioner were appointed and the code of patient rights was developed. The importance of informed consent to any medical procedure and the patients right to refuse treatment were embedded in New Zealand legislation. The Cartwright Report emphasised the need for the focus of health services to shift from the doctor to the patient and was the beginning of the move towards women centered care in childbirth also coinciding with the start of the New Zealand College of midwives and the push towards midwifery autonomy in New Zealand. There have been profound changes in the health services in New Zealand subsequent to the Cartwright Inquiry and, hopefully, the events which lead to it cannot happen again in this country. We do need to understand the importance of Dame Sylvia's findings. We are all responsible for our own practice and, if we are aware of practice in others which is clearly unsafe or unsound we have a professional responsibility to act, to do nothing is to be complicit in the actions of the person providing unsafe care, and we are equally responsible for the outcomes.
As is evidenced by the Irish inquiry these circumstances are not unique. It is very concerning that this could be happening now in some other place. If you are aware of unsafe practice you do have a duty to find someone to tell who can act. There should be proper channels which you can follow to bring your concerns to light. If this is not the case or if the problem is not being addressed then perhaps you need to look at other ways to do this. In New Zealand it was two feminist journalists who were able to arouse concern initially. In Ireland it was a Health Board solicitor who recognised the problem. If you are aware of a similar situation I urge you to find someone who is willing to listen and take the steps necessary for questions to be asked.