LAST UPDATE | 26 Sep 2023
THE MINISTER FOR Health has said he will meet with patient advocacy groups and families of children impacted by the crisis in paediatric orthopaedic surgery at Temple Street Children’s hospital.
Stephen Donnelly told the Dáil this evening that the meeting will be held this week alongside Taoiseach Leo Varadkar.
The HSE has commissioned an external review into elements of paediatric care at Children’s Health Ireland (CHI) at Temple Street following revelations that one child died and others suffered serious complications following spinal surgery there.
The review, which will be led by Liverpool-based orthopaedics expert Selvadurai Nayagam, arises from very serious concerns identified by CHI since last year in relation to poor surgical outcomes in spinal surgery at Temple Street.
Among the concerns were the use of a certain spinal surgical technique and a significant number of negative post-surgery outcomes, which led to serious complications and in one case the death of a child.
The Health Minister was criticised last week while he was in New York attending UN and World Health Organisation meetings, with some questioning why he did not return to Ireland when the controversy first emerged.
Addressing the Dáil this evening, Donnelly said there is “full scope” for the terms of reference of an external review into children’s spinal surgeries to be expanded, following input from affected families.
He also said that the families and advocacy groups will “absolutely” be included in the drafting of the terms of reference for the review.
“I want to start by acknowledging the distress and anxiety that this whole episode is causing to the patients themselves involved in these reviews. These are girls and boys, young women and young men and, of course, their parents and their families,” he said.
The minister said he was “absolutely determined” to fully answer legitimate questions of families waiting on services at Temple Street hospital.
The Health Minister also offered his “deepest condolences” to the parents and family of 10-year-old Dollceanna Carter who died last year. Her case file was among 19 examined in the reviews.
Donnelly said no one can be in any doubt of the “incredible loss suffered by all those who loved this beautiful child”.
He said the use of non-CE marked springs as implants has caused great concern, but added that this was among issues which have not yet been fully clarified and investigated in the initial reviews.
Providing a timeline to deputies, Donnelly said his department was notified of two serious patient safety incidents at the hospital in November and that an internal review into surgical outcomes had been initiated.
An external review was also commissioned and this was completed in July.
Both the internal and the external review found that the rates of complication were higher than internationally expected.
Since then, Nayagam has been appointed to lead a further, wider external review which will also consider the use of the springs in three surgeries which were reported by CHI in August.
During a session on the patient-safety concerns, Donnelly was told that “this is one of the most tragic scandals” that politicians had seen.
Sinn Féin health spokesman David Cullinane said: “At the heart of this scandal are 19 children and their families who have been traumatised, who have been harmed, who have been wronged and sadly in one case, a child who has passed away.
“A family which will not be whole again, and many other families who will carry the harm and trauma of what happened to their kids with them for many years to come.”
Cullinane said these families need to be placed at the centre of the State’s response, criticising the minister for “excluding patient advocates and the parents of children” from the drafting of terms of reference into the review.
He also called for the initial reviews to be published in full.
“The failure of the State to properly care for and meet the needs of these children includes pre and after-care, follow-up care and extremely long waiting lists, which allow conditions to get worse and further complications to arise,” he said.
“I do not use the word failure lightly, Minister, but you have to accept that the State has failed those children and their families.
“The acceptance of failure of an unfit system should be your and their starting point. The exclusion of patient advocates from the drafting of the terms of reference of the independent review is a sad indication that this fundamental failure has not been accepted.”
Social Democrats TD Roisín Shortall said it was a “national scandal”.
“It’s a huge issue that needs to be dealt with and we need a timely response to it, not yet another example of putting something into a review and kicking it down the road and my fear is that that’s what’s going to happen,” she said.
Labour TD Duncan Smith said the crisis was one part of “a select few scandals as some of the worst in the history of the State”.
Responding to questions on a range of issues including waiting lists and aftercare for child orthopaedic services, Donnelly said: “The State has failed these children and the State has been failing these children for years.”
Speaking about the surgeon involved in the cases, Donnelly said: “A specific complex procedure known as kyphectomy was paused by the surgeon and indeed CHI last November, the November of 2022.
“Patient safety protective measures were put in place by CHI in line with consultant contract. This includes measures such as working under additional supervision and restricting certain clinical duties.
“The surgeon involved in all of these incidences and concerns raised to date has now stopped all clinical practice and has been referred to the Medical Council.”
The surgeon has not been suspended. Donnelly said: “There has been no findings made against this doctor.”
The minister said all patients affected by the concerns raised, as well as all those awaiting surgery with the surgeon, have had their care transferred to other clinicians.
He said he is open to meeting patients and families directly, adding his first would be on Wednesday.
The minister said the new external review is “intended to go as deep and as wide as necessary” including examining if there is a wider group of patients that may have been affected.
Donnelly said: “The reviews also raise further questions about aspects of culture and governance that require a deeper examination.”
He said the drafted terms of reference for Nayagam’s review are intended to be further defined by him as he “engages fully in the work”, including meeting patients and families.
“The first and most urgent objective is to look at the practice of the surgeon concerned and determine if any wider review is required in order to provide a risk assessment and assurance on core patient safety issues.
“The other objectives of the review relate to wider issues including culture and governance within the paediatric orthopaedic service and to review the current and future delivery of the service and make any recommendations as he sees fit.”
During Leaders’ Questions earlier today, the Taoiseach confirmed that he had invited the “four or possibly five” advocacy group to meet with him and the Health Minister together.
He said he was keen to meet them and that what they said would be taken on board before any decisions were made in relation to the review.
“I want to once again take this opportunity to acknowledge that this is a cause of great anxiety for a lot of parents, a lot of families and indeed very vulnerable children attending these services,” Varadkar said.
Asked by People Before Profit-Solidarity TD Paul Murphy about extending the review to include other children’s surgery, Varadkar said he was not sure that that was the best approach as it would take “a very long time to do”.
“This is about spinal surgery… I think if we expand that out to every surgery done by every surgeon in all three major paediatric hospitals, we wouldn’t be coming back here with an answer for perhaps years and I’m not sure that’d be the best approach, but of course, I’m not going to rule it out at this point,” he said.
With additional reporting from PA
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