LAST UPDATE | 23 May

HSE LEADERSHIP HAS confirmed that the surgeons who performed hip surgeries on children that did not meet the criteria for operating are still carrying out these operations, with no disciplinary process being pursued at this time. 

Dr Colm Henry, Chief Clinical Officer of the HSE, told media in a technical briefing today that surgeons at three hospitals performed a number of operations that have been found to be unwarranted by an independent expert.  

An independent audit into children’s hip surgeries in Irish hospitals which was published today has called for an open inquiry into operations that were carried out at Temple Street and Cappagh Hospital, where the criteria for operating wasn’t met in a high number of cases.

The audit found that a lower threshold was used by surgeons in Temple Street and Cappagh Hospital, though this issue wasn’t identified in CHI Crumlin, which was also examined in the audit. 

The independent expert found that in Temple Street roughly 40% of the surgeries the audit reviewed were indicated to have met the criteria; in Cappagh 21% were indicated, and in Crumlin virtually all of the surgeries fell under the criteria. 

Around 1,800 children in the two hospitals will now be offered a follow up appointment with a multidisciplinary team to assess whether the surgery has had any adverse impact on them, and to give them the chance to find out whether their surgery was necessary. 

The CEO of CHI, Lucy Nugent, apologised to “impacted families were not offered consistent and excellent standard of care”.

“To one family in particular, whose child experienced complications during their care in Children’s Health Ireland, I extend my heartfelt apology that we have let you down,” said Nugent.

She said the families affected will be directly supported and are being contacted with the next steps.

She added that CHI is currently standardising care across all CHI sites and that CHI will “act swiftly” and in an “open and transparent” manner to “answer outstanding questions raised by this audit”.

Elsewhere, the CEO of National Orthopaedic Hospital Cappagh, Angela Lee, also apologised for the “distress that today’s published report may understandably cause”.

She said work has been undertaken in recent years to improve children’s access to planned paediatric orthopaedic surgery and that Cappagh is committed to implementing the audit recommendations.

“Some changes are already underway, with others planned,” added Lee.

Meanwhile, the CEO of the HSE Bernard Gloster said that the variance in surgical practice is “of very serious concern”. 

He said that the HSE will now establish an expert panel to respond to parents and families about their individual cases “and whether they were necessary”. 

‘Concerning’

Dr Henry said that CHI and the HSE are focused on “cutting off the source of the variation” in the decision-making process behind children’s surgeries. 

“That will ensure that anyone who may have been applying a low threshold before has to go through a peer review of surgeons in order to progress the surgery,”  he said. 

He said that it is “leaping ahead” to talk about disciplinary action for surgeons who applied a low threshold for surgery until follow-up appointments are conducted with children who have been impacted to assess any potential complications they may have suffered. 

Though the audit did identify one child who was adversely impacted by an operation, that child “didn’t require [further] surgery” as a result of the complication, Dr Henry said. 

Dr Henry said there is variation in practices around the world when it comes to surgical decision-making, but that this audit has found that the variance in the two hospitals was “at the higher end” of variation, which is “concerning”. 

Dr Henry said that the plan is to offer these follow up appointments over a six month period. 

He further said that this will only be offered to those who have not yet reached skeletal maturity, but that the HSE is aware of those within the cohort who will be nearing skeletal maturity soon, and that they will be prioritised. 

Dr Henry acknowledged that decision-making across the three hospitals had not been coordinated, and that this audit has undermined the public’s confidence in the clinical processes of CHI – which is especially concerning in advance of the opening of the new National Children’s Hospital. 

However, he added that having all of the teams in the same place geographically in the new hospital will enable closer collaboration, and that all decision-making on this type of procedure will now be done under a new framework, overseen by two surgical experts. 

The audit identified that there was no informed consent from parents or families when a novel surgical technique was used on some of the children. 

The review, carried out by Simon Thomas, a UK consultant paediatric orthopaedic surgeon, looked at the clinical records and X-rays of children aged 1-7 who were operated on between January 2021 and December 2023. 

Ten cases of each surgeon who was operating at that time in CHI Crumlin, Temple Street and Cappagh hospitals were examined as part of the review, amounting to 147 cases in total. 

The surgeons were anonymised for the purposes of the audit, as were the children whose cases were examined.

The review found that in many cases, children underwent major pelvic osteotomy surgery though they had not been treated for persistent hip dysplasia after bracing and hip reduction failed to work. 

There were many cases of children being operated on who had no prior history of diagnosis of developmental dysplasia of the hip. 

At the outset of the audit, the reviewing surgeon notes: “It would be unusual for corrective pelvic osteotomy in childhood to be indicated in large numbers of essentially untreated hips.” 

Dr Henry said at the technical briefing today that predicting the likelihood of persistent DDH (developmental dysplasia of the hip) later in life is “never 100%”, and that parents are informed of that. 

In an official statement the HSE welcomed the publication of the audit. 

“We acknowledge and deeply regret the anxiety that the audit, and the time taken before publication, has caused to children and their families,” a spokesperson said.