Q&A: What is happening with spinal surgery for children?

Among the serious concerns are the death of one child, the use of an unauthorised medical spring device implanted into three children, and a high rate of unplanned follow-on surgery and complications for a group of children.

Altogether 19 children have been affected.

A solicitor acting for some of the families said they are “at sea” and feel like they have been thrust into a horror story.

What have the CHI hospital group done to fix this?

CHI published a summary of two reviews on Monday.

The surgeon at the centre of the allegations is no longer conducting surgeries, and the case has been referred to the Irish Medical Council.

A CHI spokeswoman said: “Changes to the clinician’s scope of practice were implemented.

"The clinician therefore ceased complex spinal surgery in CHI in November 2022, ceased all spinal surgery in May 2023, and ceased all surgeries in July 2023. 

"Additional clinical governance controls and supports for the clinician were also put in place during this period.” 

Complex spinal surgery for patients with spina bifida at Temple Street has been halted and moved to its sister hospital, in CHI at Crumlin.

They carried out two reviews, neither of these reviews have been published in full, only a summary.

They also opened a third review, on September 15, specifically into the issue of the use of unauthorised devices.

The HSE set up an oversight group to monitor the management of the patient safety concerns identified by CHI in July 2023. 

It has now stepped up that intervention with the external review by a British-based specialist.

How many spinal surgeries have been done this year for children?

Up to September 8, some 145 spinal fusion surgeries were carried out across Crumlin, Temple St, and Cappagh hospitals with 15 of those done at Temple Street. 

The overall number also includes 23 outsourced operations.

There were also 167 other spinal procedures, with 59 of these at Temple Street and two outsourced.

How many children are waiting on spinal surgeries at the moment?

As of September 15, there were 54 patients waiting for spinal surgery at Temple Street hospital. 

In all across that hospital, Crumlin and the Cappagh site, a total of 261 children were waiting for spinal surgery.

Why are people talking about a four-month waiting list?

In 2017 the then health minister Simon Harris pledged on RTÉ radio that “by the end of this year [2017] no child will wait longer for a scoliosis procedure than four months.” 

In February last year the current minister Stephen Donnelly announced a new investment plan to reduce waiting times, saying: “I have approved the plan and welcome the target to ensure that no scoliosis patient is waiting over four months for a procedure by the end of this year.” 

However, parents and advocates say this has not been the case. 

One family told RTÉ’s Katie Hannon on Monday they were first told their son Harvey would need an operation in January 2020, and he is still waiting.

The Scoliosis Advocacy Network said: “Children with scoliosis have been failed by the State for many years now with long wait lists, a lack of access to timely care, broken promises, and continued poor communication with patients and their families.” 

The Spina Bifida & Hydrocephalus Paediatric Advocacy Group said the cancellation of surgeries now as part of reviews of care follows “historical failures” for their families.

Why are there so many delays?

There are a number of reasons, but over them all is lack of investment into children’s healthcare for years, if not decades, before the funding announcement last year.

Complex spinal surgery is challenging, and requires staffing, infrastructure, time, and expertise as well as specialist experience.

Ideally, it is understood, one to two spine surgeons would be involved in these procedures, supported by anaesthesia and plastic surgeons, as well as specialist nursing and theatre staff.

So staffing is a challenge. CHI said it has “15 orthopaedic surgeons in total. Nine orthopaedic surgeons work in spinal surgery currently. 

"Five do predominantly spinal surgeries, including complex spinal surgery. Four do occasional spinal surgery.” 

Theatre-space is also an issue with shortages highlighted across the hospital group, although this is being addressed.

What does the Department of Health have to say ?

The Department of Health said scoliosis and spina bifida were identified as priority areas in the 2022 and 2023 Waiting List Action Plans.

“Last year some €19m of current and capital funding was committed to tackle these waiting lists,” a spokeswoman said on Tuesday.

“In 2022, 509 scoliosis procedures were carried out, compared to 380 for the same period in 2019 (the most recent comparable year given the covid pandemic). This represents a 34% increase and an increase of 47% compared to 2021.” 

However she said despite the numbers completed, that “corresponding reductions in the waiting list were offset by significant increases in demand and referrals compared to previous years”.

She said there was a 30% increase in additions to the spinal surgery list compared to 2021. Under the Action Plan for this year up to August “ over 290 spinal procedures” were completed the Department's figures show.

What impact do delays have for these children?

The most complex surgery, which the consultant who is on leave had been doing, benefits children with scoliosis — abnormal twisting and curvature of the spine — and spina bifida — a central nervous system birth defect.

Delays can mean worsening of curvature of the spine, to a point where children need a wheelchair and their breathing suffers as their organs become compressed. 

Children have spoken of having a slight curvature on diagnosis which increases to a point where they almost bent over in pain during long waits, despite efforts to tackle the delays.