Updated 16.33
A CONSULTANT GYNAECOLOGIST has defended his actions before a Medical Council Fitness to Practice inquiry today.
Dr Peter van Geene, a consultant at Aut Even Hospital in Kilkenny, faces charges of poor professional performance in carrying out alleged inappropriate hysterectomies on a number of women between 2009 and 2011.
Dr van Geene was first made consultant at Aut Even in 2006.
Since then he has performed more than 2,000 surgeries at the hospital.
Doctor gives testimony
The inquiry first met in July of this year, but today’s hearing is the first time van Geene has himself given testimony.
Before embarking on his questioning Eugene Gleeson, counsel for Dr van Geene, asserted that following van Geene’s testimony he intends to address a ‘certain duplicity’ on behalf of the prosecuting side.
In a gruelling day of cross examination, van Geene was led in great detail through the operational histories of the four women in question.
For the most part the surgeon cut a very composed figure, his tone remaining level and measured at all times. Occasionally however his demeanour became more strained particularly under cross examination by Neasa Bird, representing the Medical Council.
Incident Rate
Ms Bird asked van Geene how he felt about the fact that he had three women over 15 months suffer severe bleeding following “routine surgeries” that he had performed.
“You actually mean three women over five years,” he replied. Ms Bird suggested that that was a matter of semantics.
“I wanted to know what was going wrong of course. I wasn’t doing the wrong operation though, I was doing the right operation,” van Geene said.
He said that an accepted level of bleeding to be seen in such procedures would be 2%, or 6 patients of the 183 he performed vaginal hysterectomies on at Aut Even.
“I had three, not six, so I think that falls under acceptable levels,” he said.
These are the kind of problems that can affect any surgeon at any time.
Helen Cruise
Dr van Geene was asked in detail about the case of Helen Cruise, a 61-year-old woman who waived her anonymity (the only one of the four patients to do so) at the initial hearing in July and made significant accusations against van Geene at that time.
She underwent a hysterectomy carried out by Dr van Geene on 23 August 2011 after presenting with severe incontinence.
Ms Cruise had previously asserted that Dr van Geene told her he had dropped her womb in a bucket following her hysterectomy, and that he slapped her about the legs at a meeting following the operation and claimed that her problem had been caused by her coughing.
She said that her life had been ruined by the procedure carried out by Dr van Geene.
Among the Medical Council’s accusations against Dr van Geene in the case of Ms Cruise is that he had failed to acquire the necessary informed consent from her before performing the operation.
Similarly to two of the other three patients, Ms Cruise suffered significant post-operative bleeding following her hysterectomy. Subsequently her condition worsened significantly, necessitating her transfer to St Luke’s Hospital, Kilkenny.
Dr van Geene denied today absolutely that undue influence had been brought to bear on Ms Cruise prior to her hysterectomy being performed.
He said he saw no particular issue during the initial surgery.
Anaesthetist
Dr van Geene’s then-regular anaesthetist Dr Penugonda Prasad had also in previous testimony contradicted Ms Cruise’s version of events saying that he would never administer an anaesthetic without seeing a patient’s signed consent form.
Ms Cruise said that she had only signed the consent form after being prepped for surgery. Dr Prasad acknowledged that he had not been present when the consent form was signed.
Once it became clear Ms Cruise was suffering a post-operative bleed she was re-admitted to theatre that evening again under Dr van Geene.
“We needed to see what was going on, to see where the bleeding was coming from,” he said.
This lady has lost a lot of blood in a short period of time. The major bleeding was coming from the right ovary, once that was clamped things were ok.
Dr van Geene said that he felt he “needed to talk” to Ms Cruise after her surgery once she awoke.
“I told her she had lost a lot of blood but that we had managed to stem that,” he said.
I told her that she still needed a lot of care but that she was ok now, that the major problems were over.
I think she was quite happy to hear that.
After Ms Cruise was transferred to St Lukes Hospital, van Geene agreed that he had called to visit her.
“All I knew was that she wanted to see me, it was only the second occasion I had ever had a patient transferred to the other hospital,” he said.
It wasn’t my hospital so I stood up, I didn’t think it was appropriate to sit down.
I introduced myself as I couldn’t be sure she’d remember me, and I shook her hand. I explained she had had a bleed after the operation and had had to go back to theatre.
I said my best guess was that this was caused by a coughing episode.
She took particular umbrage to that. She said I would have to prove it. She asked me had I cut her. I thought that strange given I had obviously operated on her.
She got very upset. I found it strange in that I was being accused of being at fault for everything.
I was upset too because it wasn’t how I had wanted the meeting to go.
She got progressively upset with me so I thought it best to take a step back and let her calm down. I told her to come to Aut Even the next day so I could take her stitch out.
She had no means of getting there so I said we would organise a taxi for her. But she never arrived.
When it was put to Dr van Geene that he may have been rude to Ms Cruise he said “if that’s what the staff nurse said then I think that’s correct, and I’m sorry for that”.
Ms Cruise was present at today’s hearing.
Patient A
In the case of Patient A, a woman who had borne four children, van Geene said that the election to carry out a vaginal rather than an abdominal hysterectomy in April 2009 was done so as to hasten her recovery.
Ms Bird focussed intensely on the numerous consultations van Geene had with Patient A prior to her hysterectomy.
She said that when former master of the Rotunda Hospital Dr Peter McKenna said he would fail a student who thought that post-menopausal bleeding could be caused by stress (as surmised by Dr van Geene), Dr van Geene must disagree with that assertion.
Van Geene replied that he did indeed disagree with Dr McKenna.
“I’m just glad he never saw me,” he said.
Patient A’s husband was suffering from a brain tumour at the time and she was his primary carer. Van Geene said that since she bled every time her husband went into hospital he thought it a fair supposition that the two events were related.
When Ms Bird suggested that he had long before made up his mind to perform a hysterectomy on Patient A, van Geene denied that that was the case.
“Performing a hysterectomy is always the last resort,” he said.
That patient had a miserable life – she needed a hysterectomy to stop her bleeding, to give her back her quality of life.
When quizzed by Gleeson, Van Geene asserted that he would not allow a patient to ‘do a wrong thing’.
He said the patient herself elected for a vaginal hysterectomy as the recovery would be quicker, there would be less time spent in hospital and less pain would be involved.
Regarding Patient A the inquiry suggests that the reasons for performing a hysterectomy on her were inappropriate and/or incorrect with regard to determining the correct course of action.
“All factors were in favour of performing the procedure,” said Dr van Geene.
A hysterectomy was absolutely the correct decision in this case.
Dr van Geene acknowledged that the procedure itself performed on 7 April 2009 hadn’t been “entirely standard” and as such he could recall performing it, but that despite a “slightly difficult” procedure there had been nothing particularly untoward occurring in the aftermath of the operation.
Patient B
Regarding Patient B, a 62-year-old former nurse who experienced a significant post-operative bleed following a vaginal hysterectomy performed on 27 July 2010, Dr van Geene could recall nothing untoward in her surgery whatsoever.
It is alleged that the manner in which Dr van Geene carried out Patient B’s hysterectomy led to her significant bleeding, and that he thereafter failed to communicate adequately, or at all, with the patient.
He expressed himself “irked” that he wasn’t made aware by Aut Even staff that the patient had been bleeding significantly overnight and that her blood pressure had dropped.
“Certainly I would have expected to be notified by 4am at the very latest. I am always available for my patients, I wouldn’t have gone home following surgery if I felt that something wasn’t right,” he said.
I couldn’t recall another case like this one, where a patient bled slowly throughout the night following her operation.
Patient B had previously declared herself to be “traumatised” at her treatment at the hands of Dr van Geene in the wake of her operation, saying that “I would say he had a lack of empathy, in that my condition didn’t appear of major significance to him”.
“If she thought that I had no empathy, then who am I to argue with her,” Dr van Geene said when this was put to him.
It makes me unhappy to hear it.
Sometimes calmness and rationality are mistaken for a lack of empathy but I can’t help that.
Dr van Geene insisted that he thought he had communicated adequately with Patient B regarding the post-operative bleed she had experienced.
“There are two sets of persons responsible here, doctors and nurses, and we all have to communicate with each other,” he said.
As far as I’m concerned I communicated properly with the patient.
I think the patient felt there was an overall failure in communication, not just with me.
I’m not sure that anyone knows what this patient was really complaining about, not even her.
When questioned by Ms Bird as to whether or not a patient requiring three units of blood following such an operation, as Patient B did, is common Dr van Geene said that it is.
“That is contrary to Dr McKenna’s evidence doctor,” Bird replied.
Asking whether he could recall the patient objecting to his manner specifically Dr van Geene said “not really”.
Patient C
Finally, Gleeson quizzed Dr van Geene on the case of Patient C, a mother of seven who underwent a hysterectomy at Aut Even on 11 October 2011.
Similarly to Ms Cruise and Patient B, Patient C suffered significant bleeding following her operation which resulted in a laparotomy (a procedure carried out to examine the abdominal organs) on the same day.
Again, Dr van Geene could recall nothing untoward in his patient’s initial surgery.
He said he was unable to honour a follow up meeting with the patient as he had been suspended by Aut Even at that stage and it wasn’t possible.
He said that he felt “rather foolish” at not being able to tell Patient C subsequently what procedure he had performed on her as he couldn’t recall precisely.
“It was around the same time that I had operated on Ms Cruise, and I couldn’t be absolutely certain which patient was which,” he said.
First published 13.30
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