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Doctor accused of 'inappropriate' womb removals breaks down during testimony

There have been testy exchanges today at surgeon Dr Peter van Geene’s Fitness to Practice inquiry.

Image: Shutterstock/Tyler Olson

Updated 14.59

DR PETER VAN Geene continued his evidence to his Fitness to Practice Medical Council inquiry this morning.

Dr van Geene faces allegations that he performed a number of ‘inappropriate’ hysterectomies on four women at the Aut Even hospital in Kilkenny between 2009 and 2011.

Van Geene became slightly overcome this afternoon under questioning from Medical Council committee member and medical expert Professor Anthony Cunningham as he described the circumstances which led to his move to Ireland from London in 2006.

“My wife was on a tube train in London that immediately preceded a train that was bombed during the events of the July bombing in London in 2005,” he said.

Appearing visibly emotional Dr van Geene said that his wife was so traumatised by the experience that she couldn’t bear to live in London any longer.

I had a very significant career in gynae oncology in London. I moved to Ireland for my family. I considered that I couldn’t move any further away than Ireland and that is why I came here.

Cross examination

Continuing where she left off yesterday evening Neasa Bird, representing the Medical Council, asked van Geene whether it was appropriate that he would have performed a vaginal hysterectomy on Ms Helen Cruise, a then 57-year-old mother of seven, without previously meeting her.

Van Geene replied that she had been referred to him by an expert, a Dr O’Sullivan, and ‘who was he to question him’.

Ms Cruise was referred to Dr van Geene via the National Treatment Purchase Fund (NTPF). She had presented with severe incontinence. It was previously suggested to the inquiry by the former Master of the Rotunda Hospital Dr Peter McKenna that a vaginal hysterectomy would have in no way solved Ms Cruise’s problems.

Ms Cruise was in attendance at the inquiry this morning.

20150928_114440 Helen Cruise

“Not ideal”

Van Geene said that it is not unheard of for him to not meet a patient such as Ms Cruise prior to her coming to the operating theatre.

He agreed that the situation Ms Cruise found herself in was “entirely not ideal”.

“Absolutely I would have preferred to see her on the ward but with her having reached theatre I thought surgery was the best option,” he said.

Bird countered that van Geene had performed a surgery designed to alleviate a prolapse, something that Ms Cruise didn’t have.

A prolapse is a slipping-down of a part or organ of the body.

Van Geene replied that as far as he was concerned, she did indeed have a prolapse.

Van Geene said it was “quite impossible” that he could have obtained Ms Cruise’s consent to undergo surgery the first time he met her, which was while fully scrubbed up pre-surgery in the operating theatre.

The allegation that this consent was obtained after Ms Cruise had undergone a spinal anaesthetic and was lying on the surgical table is one of the key charges against van Geene with respect to Ms Cruise.

“It is absolutely incorrect that I discussed the consent with Ms Cruise in the theatre, it was done outside, I cannot be more categorical than that,” he said.

Long exchange

There followed a lengthy exchange where Ms Bird asked Dr van Geene extensively about his dealings with Ms Cruise following her second visit to theatre to have her post-operative bleeding stopped.

“There were no complications during the surgery,” he said.

Ms Bird contended that Dr van Geene had told Ms Cruise following the surgery that he had “thrown her womb in a bucket”.

“Absolutely not,” he replied.

You’re asking whether I had said whether I had thrown her womb in a bucket. Why would I do that? Firstly I would never do that. The first thing that happens is that when it is removed the womb is handed to a scrub nurse who puts it on a table with her instruments. I tie the ligatures to make sure there is no bleeding.
Some surgeons like to cut the uterus in half before it goes off.
Why would I even want to say that I’d thrown your womb in a bucket? How can you say that to a patient? You can’t. It would be outrageous.

“Ms Cruise had a recollection of it and that it had been upsetting,” replied Ms Bird.

Ms Cruise had a number of recollections about a number of things, but it didn’t happen.
No, I didn’t say it.

“Did you say when meeting several members of her family after Ms Cruise’s second trip to theatre: ‘My God how many generations have we got here’, did you say that?”

No.

“Did you say ‘she’s not out of the woods yet,’ and walk off?”

No.

“Did you say ‘your mother is a smoker, she coughed and put pressure on her organs’? You removed one ovary, did you tell her family ‘and I ripped the other one out too’?”

No.

“Did you say: ‘your mother didn’t lose enough blood to become brain damaged’?”

No.

“Did you say: ‘well at least she won’t get ovarian cancer’?”

I did.

20150722_131106 (1)

“I put it to you that you did use all these phrases?”

I’m afraid not. I did not use that language at all, it is not the sort of language I would use. Why would I? Why would I start antagonising people? I wouldn’t.
It’s probably true she would have died if she hadn’t been taken back to theatre.
At the subsequent meeting at St Luke’s Nurse (Caitriona) Kenny said she thought I was rude, I don’t think I am. If she said I was I accept that and I deeply regret it.
I would think Ms Cruise would be quite traumatised and upset yes. I was very happy to talk to her.
I was expecting to go there and explain the circumstances to her. Unfortunately she took umbrage to everything I said. Patients can develop transference, where they blame their doctor for everything.
She dismissed my explanations and got very angry with me.
It’s untrue to say I was antagonistic towards her. If I had been antagonistic and inflammatory then I could understand her response, yes. But I wasn’t.
Nurse Kenny says I was rude and I accept it. Therefore I understand Ms Cruise’s reaction.

Fault

“If she’s suffered a bleed surely the operation is at fault?” asked Ms Bird.

We don’t know why it happened. If a stitch is going to fall off it happens much sooner than 8 hours. I felt something was likely to have precipitated it.
She had previously had a sterilisation via a tungsten tube being placed near her ovary. Where I wanted to put my clamps on ovarian vessels this clip was already there. So I had to clamp much closer to the ovaries.
I knew there had been very little space between my stitch and the ovary. If something was going to go wrong that is where it would have done so.
But it didn’t for 8 hours. And generally it wouldn’t have done so after that length of time.
We know that at 2200 she was ok, at 2300 she was very definitely not ok. So something happened. I knew she was a smoker, and I surmised that perhaps a cough was behind what happened. All I was trying to do was tell the patient what had happened.
I thought she had coughed, and that’s what I had told her family.

“Did you say: ‘I already told your family what happened, why don’t you ask them’,” asked Ms Bird.

No.
Was I irritated going to St Lukes? No I wasn’t irritated.
She said to me ‘How do you know it was a cough? You weren’t there. You’ll have to prove it.’ – it was my best guess. And we still don’t know.

“Did you say: ‘you coughed and busted yourself open’?” asked Ms Bird.

That is not the kind of word I would use, I have never used it in my life.
I did say ‘you’re a smoker aren’t you’. I thought it was a factor absolutely.

“Did you say: ‘sue me, sue me, sue me’?” asked Ms Bird.

I never said that. I never challenged her. She said ‘I’m going to see you again and it won’t be in a hospital’. I told her she did have the right to sue me. That was probably not the right thing to say either. She also said ‘you’re not God’.
It was to be expected she would be upset.  I tried to explain it to her in a non-inflammatory way.
Yes nurse Kenny said I was rude, but she and I don’t know what I said.
Ms Cruise also said that I hit her, and I just didn’t. She said a lot of things that I didn’t do.

“Did you say that you weren’t getting paid to be there?” asked Ms Bird.

No.

The hearing continues.

Originally published 11.18 am

Read: Kilkenny surgeon accused of removing women’s wombs ‘inappropriately’ says he made the ‘right decisions’

Read: Patient describes being “traumatised” by her treatment at hands of hysterectomy surgeon

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