PATIENT ADVOCATES AND a lawyer working with a number of families of children who suffered adverse outcomes following spinal surgery at Temple Street Children’s Hospital have called for the terms of a review of its surgical service to be extended.
On Monday, the HSE announced it had commissioned an external review into elements of paediatric care at Children’s Health Ireland (CHI) at Temple Street after one child died and others suffered serious complications following spinal surgery there.
The review – which follows internal and external reviews commissioned by CHI itself – has a “primary focus” on one consultant, who has been referred to the Medical Council.
However, patient advocates and a lawyer working with a number of families whose children suffered adverse outcomes have called for the scope of this review to be extended to cover other branches of CHI, including Crumlin, and other elements of care for patients with spina bifida including the impact of long delays in treatment on surgical outcomes.
Although the surgeon in question did not operate in Crumlin – or any other CHI facility – over the past three years, the affected groups want a full review into how spinal surgery patients have been treated across paediatric services.
Speaking to The Journal in New York this evening, Taoiseach Leo Varadkar said that while the consultant’s other places of work should be checked to see if he carried out complex surgeries in those hospitals, a wider review would be premature.
“So I’m not sure if that’s warranted at this stage,” he explained. “You know, because then you’re putting more and more resources in to try to find a problem that might be there, rather than putting resources into dealing with a problem that we know is there.”
Varadkar also confirmed he has asked for a full briefing from the Department of Health, adding that he will be discussing the matter with the Minister for Health Stephen Donnelly this week.
“We have to start with all the facts… I think this could be very serious,” he said. “I don’t want to go too far… but the more and more I learn, the more concerned [I am] that operations were not done properly.”
Four reviews
A fresh review, commissioned by the HSE from an external expert in the UK, has been commissioned and was announced on Monday.
On Tuesday, CHI clarified that three children had been affected by one of the issues this review will examine, namely the implantation of unauthorised metal devices in patients.
The Journal understands that one child still has such a device fitted.
CHI has itself commissioned a fourth review, to be conducted by an “external team”, examining the three cases of unauthorised devices being implanted in children. The hospital group said on Tuesday that this investigation began on Friday 15 September. This was the same day The Ditch published a story on the matter.
The first and second reviews – internal and external reviews commissioned by CHI – have been completed but have not been published or shared with the families affected or with patient advocates who cooperated with the inquiries.
CHI has published a summary of the reviews’ findings but patient advocates say many questions remain unanswered, including the full list of recommendations made by the external review.
Raymond Bradley, a solicitor representing several of the families affected, said the synopsis of the two reviews to date published by the HSE on Monday was “lacking in the specificity parents deserve associated with their children”.
“Their view is they have a right to see what findings relate to their children. Some of them have made the point as well, they participated on the basis that they believed they would receive that information.”
Bradley said parents’ immediate concerns were to find out what happened, given the information provided so far was incomplete, and to ensure the necessary care was available given long waiting lists.
“The lists are ever lengthening and delays in terms of this type of spinal surgery result in additional curvature of the spine that impinges upon the lungs and causes respiratory issues. So these children can’t sit on a waiting list and some of them sat on the waiting list for four years,” Bradley said.
He added that the issue was likely to be larger in scale than the 19 children whose cases were referred to by the HSE on Monday, given the many children who had waited for spinal surgery in the past six years. He said any further review should take this into account, and added that spina bifida care was also provided at Crumlin.
There has also been a separate issue with devices fitted to children to correct spinal curvature which have broken. Bradley said he knew of one child with such a device whose problem was “current” and “had not been addressed” as of now.
“You have to look at the totality of the service, you can’t just isolate one hospital. And what the [patient] groups are seeking is a full review, a full investigation,” he said.
He said there were about 600 families of children with spina bifida or scoliosis potentially affected due to surgery delays, problems with products, or other issues in Temple Street and Crumlin.
People Before Profit-Solidarity TD Paul Murphy, who has raised the issues at Temple Street several times with Minister for Health Stephen Donnelly and with the Taoiseach this year, said it was “crazy” that the already completed reviews had not yet been published and shared with the families concerned.
He called on the minister to ensure the reviews were published.
Murphy raised the issue of unregistered implants with the minister in August, over a month before CHI commissioned its external review of this issue. These parliamentary questions were forwarded to CHI, which said at the time that it was not in a position to provide answers.
Patient advocates’ concerns
The HSE said on Monday that “in late 2022, senior management in CHI were made aware of patient safety concerns in relation to the treatment of a small number of patients with spina bifida who had spinal surgery at CHI at Temple Street”.
“These concerns related to poor clinical outcomes of some complex spinal surgery, including a high incidence of post-operative complications and infections, and two particularly serious surgical incidents, which occurred in July and September 2022.”
CHI’s internal review was commissioned in November 2022 and this was also when the consultant at the centre of the case ceased performing complex spinal surgery.
Úna Keightley of the Spina Bifida & Hydrocephalus Paediatric Advocacy Group said the review announced for Temple Street did not go far enough as surgeries were also carried out at Crumlin.
She criticised the fact that the external review already received by CHI may have made recommendations that had not been published. The Spina Bifida & Hydrocephalus Paediatric Advocacy Group cooperated with the external review.
Consultant not suspended
The consultant under investigation by the HSE has also worked at the National Orthopaedic Hospital Cappagh (NOHC). On Tuesday, NOHC said it “cannot comment on individual staff or patient cases”.
It said that the issues raised in Temple Street related to cases that were too complex to be treated at NOHC. It added that its paediatric clinical director had given assurances that “the implants in question were not used in NOHC”.
CHI said the surgeon in question is “in a HR process and is on leave but not suspended”.
“In response to the CHI management’s knowledge of issues and concerns, changes to the clinician’s scope of practice were implemented. The clinician therefore ceased complex spinal surgery in CHI in November 2022, ceased all spinal surgery in May 2023 and ceased all surgeries in July 2023,” CHI said.
“Additional clinical governance controls and supports for the clinician were also put in place during this period. These were all communicated to Cappagh at the time they occurred.”
The consultant in question did not operate at any other CHI site, including Crumlin, in the past three years.
To embed this post, copy the code below on your site
have your say