Spinal Surgery concerns identified at Children’s Health Ireland, Temple Street

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Children’s Health Ireland, the body responsible for the delivery of paediatric health services in hospitals at Temple Street, Crumlin, Tallaght and Blanchardstown, published a document setting out findings and recommendations of two reports which have been carried out into spinal surgery, particularly for spina bifida, at Temple Street Hospital over recent years.

Media Reports on Surgical Incidents

The publication of this document has led to reports in the national media that a number of “serious surgical incidents” occurred which prompted the review. However, the information which has been published by Children’s Health Ireland (CHI) so far appears to be wholly incomplete and selective. Notably, neither of the two actual reports (one an internal review and one external) which have been prepared have been published.

Purpose and Scope of CHI’s Publication

The stated purpose of the CHI publication is to “collate findings and recommendations from two clinical reviews into spinal surgery for patients with Spina Bifida in CHI at Temple Street” and it runs to less than 20 pages of content which is remarkable in the circumstances where there have been reports of nineteen individual patients affected with many of them requiring multiple additional surgical procedures.

Details of Internal and External Reviews

According to the collated summary published by CHI, the internal review involved an analysis of the records of sixteen individual patients. The external review, carried out by a team of experts from Boston, appears to have essentially been an overall review and analysis of CHI at Temple Street’s Spinal Surgery Programme for patients with Spina Bifida undergoing spinal surgery.

Therefore, in combination, the two reviews encompassed an assessment of the care provided to individual patients along with an assessment of the Spinal Surgery Programme in Temple Street as a whole. This was clearly quite an extensive investigation.

Lack of Specific Details in CHI’s Report

In those circumstances, it would be expected that the published summary would be capable of containing significant specific detail of what exactly these reports revealed in terms of safety issues. However, the majority of the report is comprised of background information regarding how/why the investigations were instigated, background information regarding spina bifida services in Temple Street, the approach and methodology of the reviews, a synopsis of literature of complication rates for kyphectomy procedures and recommendations arising from the reviews in terms of best practice into the future.

Summary of Key Failings

In terms of specific detail of the underlying failings themselves the CHI summary document is shockingly bare and can essentially be distilled down to:

• There was a high rate of further unplanned surgeries,
• There was a high rate of wound infection, and
• There was a high rate of “mechanical complications requiring removal of metal work”

Unexplained High Complication Rates

There is absolutely no explanation or reason provided as to how these high complication rates arose which leaves a significant gap in the information being divulged by CHI. Similarly, while the numerous recommendations set out in the summary document in terms of best practice requirements into future could be an indication that these practices were lacking or deficient in Temple Street previously, there is minimal, if any, detail to go on in the summary document as to what exactly was going wrong to cause so many patients to suffer such serious complications.

Media Reports Fill Information Gap

This information vacuum has been partly filled by media reports of “unauthorised devices” in a number of surgical cases. The Irish Times quotes the clinical director of CHI Temple Street, Dr Ike Okafor, as stating that these devices (compression springs) were “procured by unusual means”. There have also been separate reports of cultural issues regarding a failure to investigate the high complication rates earlier together with a fear of being punished for blowing the whistle internally.

Lack of Transparency Compounds Issues

The serious nature of the issues being reported in the media greatly compounds the lack of transparency in the published report by CHI. Indeed, it appears that the full detail of the reports has even been withheld from key stakeholders in this scandal such as the Spina Bifida & Hydrocephalus Paediatric Advocacy group who took part in the review and yet are reported to have been denied access to the review findings.

Need for Full Disclosure

This approach only serves to amplify concern regarding what exactly the two completed reports disclosed around the issues in the Temple Street Spinal Surgery Programme and it seems clear that much more fulsome disclosure is required in order to assure patients that all necessary steps are being taken to ensure there is no repeat and also that all appropriate actions are taken as against those culpable for these failings.

Public Concerns Over Safety

In addition, whilst it is being reported that the number of affected patients is less than 20, full disclosure of the review findings is vital to satisfy the broader public regarding the safety of the systems in place at CHI Temple Street as concerns will naturally arise, given significant failings of the type being reported, that these issues may not be confined to as narrow a patient group as is currently being reported. Transparency is greatly needed yet it appears to be sadly lacking. 

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