LAST UPDATE | 29 Jun 2022
A DÁIL COMMITTEE today heard that some women with severe complications as a result of surgeries using vaginal mesh implants were told their pain was “in their minds”.
The Oireachtas Joint Committee on Health heard from representatives from two groups – Mesh Ireland and Mesh Survivors Ireland – as well as officials from the HSE.
Vaginal mesh devices are used in operations to treat stress urinary incontinence (SUI) and pelvic organ prolapse (POP); two conditions women can suffer from after childbirth or in their later years.
Thousands of women across the world – including women in Ireland – who had these surgeries have suffered life-changing complications, including significant reduced mobility and chronic pain. These complications generally occur when the mesh erodes through the vaginal wall or other surrounding tissue.
Fianna Fáil TD Cathal Crowe said he had spoken to one woman in his constituency who suffered such complications.
“Her story is one of pain and of horror and not being believed or trusted by our so-called best physicians,” he said.
“Something that really disturbed me was that some of our eminent physicians are saying that this is a problem of the mind,” he said.
“I’ve had one patient tell me that were told they have augmented pain syndrome, ie you’re imagining it. Now I’m a man, I can’t begin to imagine what pain these women have gone through, but I know if had a tooth ache or any type of pain and I was told it was in my mind, that in itself would drive me absolutely mad.”
Terri Martin, a member of Mesh Survivors Ireland, said this situation has happened with many women in her group.
“They’ve been to doctors, GPs, everything over the years, some have been put on nerve stimulant drugs and everything, reflecting that this is a problem with your mind – not a pain problem,” she said.
In November 2018, then Minister for Health Simon Harris confirmed the suspension of surgeries involving these devices until the HSE implemented recommendations from a report, which included the provision of aftercare for women living with complications from these procedures.
Martin told the committee today that despite a report by the Chief Medical Officer in 2018, implementation plans and advisory committees, “nothing has changed and we still live with the after-effects of mesh injury limiting our life quality”.
The group is calling for a number of supports including medical cards for all patients with mesh complications, patient transfer to facilitate access to the two mesh centres in Cork and Dublin, and the inclusion of patient advocates in decision making for the upcoming Steering Committee on Mesh Injury.
Mary McLaughlin from Mesh Ireland, which represents member in the North and South of Ireland, told the committee that while other countries have introduced reimbursement schemes to fund mesh removal procedures, “a different wind is blowing here in Ireland”.
Patients have to finance their own full removal procedures, she said, as the focus in the Irish healthcare system remains on surgeries that only remove parts of the device. Several women have travelled to the UK or elsewhere and paid significant costs for full removal procedures as they were unable to get approval through the State’s treatment abroad scheme.
“Mesh removal skills are a special skill-set,” she said. “It is a perfect storm scenario, which should be resolved by stepping up access to the treatment abroad scheme, not restricting it.”
McLaughlin said HSE patients are currently faced with a mindset “akin to ‘like it or lump it’, partial removals or nothing”.
“They deserve to be treated with respect,” she said.
She said NHS England’s figures show 100,000 women had mesh implanted between 2008 and 2017, with an estimated complication rate of 15-20%.
The HSE, however, does not have comparable data, she said so it is unclear exactly how many patients have had these devices implanted, the complication rate or outcomes of any corrective procedures. The committee heard that some patients, when they sought their medical records, discovered that information about the device used in their procedure was missing.
Fine Gael TD Bernard Durkan expressed concern at the “huge lack of data and information and advice in relation to this entire matter”.
“I would be strongly of the opinion that there be an immediate appraisal of the entire numbers on waiting lists, the entire number of people who have had treatment, the nature of the treatment, and the result,” he said.
Care pathway
HSE assistant national director Robert Kidd later told the committee that 11 recommendations in the CMO’s 2018 report are completed, five are ongoing and three are no longer deemed clinically appropriate to address.
He said the five ongoing recommendations will be implemented if vaginal mesh implants are used again in the figure.
Kidd said the HSE made attempts to identify and assist patients who needed support, through a dedicated web page, media content and the circulation of details through hospital groups. He said communications from approximately 70 women were received and they were all offered appointments.
The HSE put in place a three tiered response to mesh complications to ensure that women always had a pathway of care, he told the committee. This includes two dedicated centres that provide specialist care and he said the clinicians in in the mesh complication service have specialist and sub-specialist training earned mostly abroad in the US, UK and Australia.
The centre in Cork has seen 40 patients and there is no waiting list, he said, while the Dubin clinic, which has seen 69 patients, has a waiting list of 16.
Kidd said access to treatment abroad is part of the care pathway, for patients who “have defined clinical complexities”.
The committee also heard from Consultant Obstetrician Dr Suzanne O’Sullivan who said that while she understands some patients want their mesh completely removed, as a clinician she does not always think it is the best course of treatment.
She said in some cases this procedure can make things “an awful lot worse” and her clinic has treated two women who returned from the UK after a total removal surgery who have “very significant problems”.
“If I, as a clinician, am fairly confident that a) it may not make their problem any better and b) it has a high chance of making their problems an awful lot worse and leaving her in a much, much more devastating situation, that’s a huge ethical dilemma for us,” she said.
“So I can’t recommend what I think is major and potentially mutilating surgery that I don’t believe is going to be in the interest of the patient, I just can’t do that. And I have to be honest with women, it’s not push-back, we’re here to do our best, we’re here to try and help them we’re here to make them better and we have options to do that.”
One of those options, she said, is total mesh removal but only if doctors believe “it is absolutely the right thing for them”.
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