Children’s Health Ireland (CHI) has begun an audit after claims by an internal whistleblower that needless surgeries are being carried out on children with dysplasia “purely for financial gain”.
The Ditch can also report that the external expert tasked with auditing the dysplasia operations at Cappagh and Temple Street hospitals has resigned because of a “lack of clarity” from CHI and its failure to pay him.
CHI disclosed to some staff recently the existence of a protected disclosure concerning potentially unnecessary surgeries on children with developmental dysplasia of the hip (DDH) in Cappagh and Temple Street hospitals. It is believed the disclosure was made by a member of staff at CHI.
Sources at CHI say concerns about surgeries date back several years.
A higher number of osteotomies than usual
CHI appointed a senior medical professional from England to lead a clinical audit into the relevant surgery in April this year but he resigned the following month.
DDH is a condition where the ball and socket joint of the hip doesn’t properly form in babies and young children.
While surgery – called an osteotomy - may be needed in some cases to prevent the joint deteriorating in later life, in many instances the condition corrects itself over time.
CHI has admitted that a higher number of osteotomies than usual have been carried out in Cappagh and Temple Street than in Crumlin hospital.
The state agency however said it doesn’t know yet if this “is due to different referral patterns, a backlog of cases or other factors”.
In response to a freedom of information request Cappagh last month confirmed that 377 osteotomies had been performed at the hospital between 2022 and 2023, with 143 of those procedures funded by private medical insurance.
The CHI memo says that “it is important to note that this clinical audit was not commissioned due to any reports of surgical complications or any reports of negative outcomes or incidents”.
While CHI say it has now engaged an “independent expert” to carry out the audit, this only came after a scathing resignation letter from their previous independent expert was sent to chief medical officer Allan Goldman at the end of May.
In the letter, the NHS consultant surgeon outlined his reasons for resigning because of “a lack of clarity, the confusion regarding the direction of the initial work you requested and the prolonged discussion regards various other aspect(s) of DDH”.
The independent expert also raised CHI’s failure to confirm how he would be paid for the report.
“You also verbally agreed terms of my hourly fees and you would organise a formal contract and indemnity to be provided. As of today's date, eight weeks into the process, I have not received any of these or payment for work done,” he wrote.
The surgeon added that he was appointed to the audit on the basis that “concerns were raised regarding some surgeons had different indications over operating on children” but that subsequently “we seem to go down many other routes not directly related to the question of surgeon variance”.
The consultant went on to state that “my concern is what should have been a simple audit to see if there was any concern has expanded into the review of the whole practice of hip dysplasia in Ireland. This is not a solitary surgeon’s responsibility.”
In comments similar to members of staff at CHI concerning a lack of accountability mechanisms and support structures for medical practitioners, the NHS surgeon put it to Goldman, “In the UK, the type of review that I seem to be doing inadvertently is done by at least two or more surgeons assisted by a legal representative and usually requested through and backed up by the Royal College of Surgeons.”
“I feel the breadth of what you have asked me has been too wide and can expose me as a single surgeon,” he wrote.
The consultant concluded that CHI senior management should have a “definitive idea of your request and organise an appropriate team to help you decide the next step”.
While it is not clear if CHI management have responded to the consultant’s concerns, one senior member of medical staff at the children’s health body said they believe the underlying reason for his resignation “is that he realised after consultations that the department is wholly dysfunctional and unfixable”.
This member of staff is adamant that far too many osteotomies are being performed and that several of them are unnecessary.
“The motivation to perform these operations is complex, but given the significant proportion that are funded privately, and the fee per procedure, I am worried that these operations are being performed purely for financial gain,” they added.
“This aggressive approach to hip dysplasia is not seen anywhere else in the world. There is also no published evidence supporting the decision to proceed to surgical management.”
It is unclear if the families of those children who have had osteotomies at Cappagh and Temple Street have been informed of the audit.
CHI have been contacted for comment.
