LAST UPDATE | 20 Sep 2023

HEALTH MINISTER STEPHEN Donnelly has yet to discuss the crisis in paediatric orthopaedic surgery at Temple Street Children’s hospital with Taoiseach Leo Varadkar. 

Speaking to reporters in New York, where he is attending UN and World Health Organisation meetings including on pandemic preparedness, the health minister also said the HSE has not been able to tell him how unauthorised devices used in children’s surgeries ended up in the hospital. 

Donnelly said he spoke to Tánaiste Micheál Martin today about the case, but when asked about whether a discussion has taken place with Varadkar, he said:

I haven’t spoken to the Taoiseach.

Varadkar said in an interview with The Journal that he has asked the Department of Health for a full brief on the issues.

When questioned on why that has not been received yet, Donnelly said his department only sent over the brief this morning to the Taoiseach’s department.

Donnelly said his department was notified of the use of the unapproved springs being used in the surgeries in the last few weeks. 

“In August there was notification to that effect. I’ve spoken with the Chief Clinical Officer and there has been engagement with CHI to make sure that there are additional protocols put in place such that only authorised medical equipment is used.

“There are already numerous protocols in place before any operation, and so exactly those issues are what we are looking for answers for and that’s what the review is going to look through,” said Donnelly. 

The review will also be investigating that no unauthorised devices are being used in other hospitals. 

“Before any operation, there are various protocols that are gone through to ensure that the equipment being used is the is the right equipment, is the authorised equipment for any given procedure. What happened should not have happened,” he said. 

The minister said his understanding is that concerns were raised about what was taking place, and those concerns were listened to.

“Issues were raised and they were acted on,” he said.

Donnelly said he would be happy to meet with the families affected. 

Two reviews into the matter, which were published today, found that children who received a particular spinal surgery in the hospital had to return to the operating theatre 11 separate times on average, with one child returning on 33 occasions.

The HSE confirmed on Monday that very serious concerns had been identified in relation to the care of 19 children, one of whom, Dollceanna Carter from Co Meath, died in September 2022.

Donnelly told reporters today that as a father of three children, what happened to Dollceanna was “unspeakable”.

“It is absolutely heartbreaking and devastating,” he said, adding that as speaking as a father himself, his “heart is broken. It is absolutely devastating”.

Donnelly said transparency with the families impacted is paramount, adding that he hasn’t been satisfied on an ongoing basis with a level of communication with the families.

A new review will begin shortly into the crisis under the HSE’s Chief Clinical Officer, said Donnelly, who added that the review has been widened to include all children’s spinal services, right across all children’s hospitals. 

When put to the minister that the Taoiseach said yesterday that widening the scope right now would be “premature” and questioned why he has yet to have reached out to the Taoiseach to discuss such matters, the minister said the families asked for it to be widened, as did advocacy groups. 

Opposition members have called on Health Minister Stephen Donnelly to return from home to answer questions in the Dáil.

The minister said he is in constant contact with the HSE boss Bernard Gloster as well as senior officials. “I can assure you this has my full attention,” he said. 

The minister said he is working on the issues on an “hourly basis”.

Tánaiste Micheál Martin slapped down the suggestion that Donnelly should return to Ireland, stating that there are three very important health summits at the UN over the next three days on pandemic preparedness.

“I think an Irish minister should be at those,” said Martin, adding:

“But it’s not good, I think, juxtaposing his presence at a summit here with the implied suggestion that means the minister isn’t attending to the issue. I think it’s unfair.”

He said the world has gone through a once-in-a-century pandemic in the last three years and Ireland has always had leadership positions in terms of public health initiatives.

“We can’t resile from our international commitments because they do have impact ultimately on public health more generally,” said Martin.

“I don’t think we should play politics with this issue because it’s a very serious issue in respect of the scoliosis situation. And the minister has acted, ordering an external review has been established, which is very important, because it’s particularly concerning to the parents of the children involved here,” said the Tánaiste.

Martin said “we must ensure the full truth emerges with that comprehensive review, and that we do justice by the parents and by the children”.

He said that must be the most overriding consideration in this case.

“I think the minister has acted on that and his presence at the summit today doesn’t detract from that action. That would be my perspective,” he said. 

“To be fair to members of the opposition, I would acknowledge that it’s a matter of interest of concern to them,” Martin said. 

Minister Eamon Ryan also responded to questions about whether Donnelly should return home. 

“Obviously, it’s going to be the focus of his attention. But I think that can be managed, but he still does important work here. I don’t think the timelines require him to return immediately. His department and he himself would be across it very quickly, I’m sure,” he said.

The Social Democrats, Labour and People Before Profit-Solidarity have called for the government to provide a clear answer today on when complex spinal surgeries, paused by CHI due to concerns, will recommence.

Social Democrats TD Róisín Shortall said: “I’m calling on the Minister for Health, Stephen Donnelly to return from New York, and to come into the Dáil tomorrow and to make a full and comprehensive statement on this scandal and to take questions from members of the Dáil.”

“It’s our view that this is an appalling national scandal involving children who are probably the most vulnerable group of children in the country, children who are extremely medically challenged, many of whom have been utterly failed by the state,” Shortall said.

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People Before Profit-Solidarity TD Paul Murphy, said that the Minister for Health, the Taoiseach and the CHI group had serious questions to answer.

Murphy said it seemed that the earlier reviews had failed to deal with one of the key issues in the controversy, namely the use of unlicensed implants in three children.

Murphy criticised a “really shameful failure yet again by the state of children with spina bifida, over 100 of whom are on the waiting list for operations for over a year”. 

“Now families are discovering that operations were not carried out with appropriately licensed implants and children did not get the care that they deserved,” he said.

He called for reassurances to be given that the fresh review announced on Monday would include the expertise of a surgeon “capable of going through patient records and identifying if patients were treated appropriately”.

Meanwhile, it is understood that the independent review of paediatric orthopaedic surgery will examine resourcing of the service and the impact of delayed access to surgery.

The terms of reference for this review published by the HSE on Monday have been drafted to allow for the implementation of two action plans to address waiting times for scoliosis and spina bifida surgery to be examined by the review. 

Patient advocates and a lawyer working with a number of families whose children suffered adverse outcomes called yesterday for the scope of the review to be extended to cover other branches of CHI, including Crumlin Children’s Hospital, and other elements of care for patients with spina bifida including the impact of long delays in treatment on surgical outcomes.

It is now understood that provisions in the terms of reference on “service capacity and access, including the delivery of the current agreed plans” will allow for these elements to be examined.

Although the HSE said on Monday that the “primary focus” of the review would be “the clinical care provided by an individual consultant based at CHI at Temple Street”, the review is expected to assess other CHI hospitals including Crumlin.

It remains unclear whether surgery at the National Orthopaedic Hospital Cappagh will also be examined.

The review was announced in response 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, at Temple Street.

One child died and a further sixteen children suffered serious post-operative complications. They were all patients of the same consultant.

A separate review has been commissioned by CHI into the implantation of unauthorised metal devices in three children. 

The HSE’s review will also assess the governance of the CHI paediatric orthopaedic surgery service. The terms of reference state that the review will “make any necessary recommendations in regard to improvement in governance including quality, safety, outcomes and performance metrics”.

The minister said he planned to meet with Selvadurai Nayagam, who will lead the HSE review. Nayagam is a consultant in orthopaedics and trauma at the Royal Liverpool University and Royal Liverpool Children’s Hospitals.

He added Mr Nayagam would meet patients, families and advocates as part of his work.

With reporting by Political Correspondent Christina Finn at the UN in New York.