The obstetrician and gynaecologist at the centre of Ireland’s worst case of medical misconduct may have harmed more patients than previously thought, a new report by two leading British experts has found.
Michael Neary of County Louth was struck off by the Irish Medical Council in 2003 and became the subject of an Irish government inquiry in 2004.
That inquiry, led by Judge Maureen Harding-Clarke, concluded that Dr Neary had carried out 188 peripartum hysterectomies at Our Lady of Lourdes Hospital, Drogheda, over 25 years until his suspension in 1999. An average consultant obstetrician would perform about five or six such operations in an entire career.
The new report, commissioned by the Dublin based support group Patient Focus, was authored by Roger Clements, a private gynaecologist, and Richard Porter, a gynaecologist at the Royal United Hospital, Bath. They found that Dr Neary carried out dozens of unnecessary oophorectomies, often on the basis of a diagnosis of endometriosis that was little more than a clinical “hunch.”
In many cases, the report found, postoperative examination of the tissue proved that that diagnosis was false or exaggerated. Oophorectomy is justified “only in the most severe cases” of endometriosis, the British doctors note, adding that Dr Neary misled many patients into believing that endometriosis is a premalignant condition.
The two authors dispute a central finding of the Harding-Clarke inquiry: that Dr Neary was a well meaning doctor who practised excessively defensive medicine, motivated by a fear of blood loss that approached “phobic dimensions.”
“Even in most of the caesarean cases studied by the inquiry, the records show there was no unusual blood loss,” said Mr Clements. “And the blood loss argument is a non-starter in these cases, because these were unnecessary elective operations.”
Dr Neary has never faced criminal prosecution, in part because of the difficulty of showing intent to harm. But the new report raises fresh questions about his motivation. “Dr Neary appears not to have been a technically incompetent surgeon,” the report finds. His incorrect diagnoses must have become apparent at the operation, the British doctors conclude, “yet faced with the facts at the time of surgery he continued in very many cases to deprive women of their reproductive organs and their own sex hormones.”
The report is currently being studied by Ireland’s National Bureau of Criminal Investigations, which will make a recommendation on possible prosecution.
Dr Neary has been successfully sued by one patient but has since lost his indemnity coverage and has transferred his property to his children.
About 200 women have been found eligible for government compensation under the Lourdes Hospital redress scheme, and €45m (£34m; $66m) has been made available so far. The current report says that 39 more women merit redress, and about 60 more cases of women who have contacted Patient Focus are to be investigated.