Deputy, ask whatever questions you want, but your line of questioning now is-----

-----to undermine an internationally renowned paediatric orthopaedic surgeon we are bringing in to do this review. It is entirely up to you to do that. You are, of course, free to try to discredit the reviewer.

I would suggest to you, Deputy, if I may, because you have just said something that really-----

-----is not very helpful, and I will respond, if you do not mind. Mr. Nayagam was specifically identified by the chief clinical officer. It was important to the chief clinical officer that this would not be someone who was just a spinal orthopaedic expert. It was important that the totality of paediatric orthopaedics was reviewed. It was important that was done by someone who has broad experience. Of course, if the reviewer wants to bring in specific external spinal orthopaedic expertise, he can and will do that. C…

I just want to be very clear on this, if I may. This is important, because Deputies have quite rightly spoken about trust. The reviewer does have the clinical expertise to conduct this review. I most certainly do not.

That is a very fair question. The question around generalists, specialty, subspecialty as well as the amount of work and patients in that is a very important one. It is one that the reviewer will look at and provide advice to me and, in turn, to the Oireachtas on.

What I can say is that he has not been suspended. There are clinical protective measures that have been put in place, including as part of the consultant contract. Some of them are contained in the reports. For example, having a second surgeon involved when there is complex surgery is one of them. The surgeon is currently not doing any clinical work, but it is important to say, and I do not believe any of us in this House are guilty of it, there have been no findings made against this doctor.

It is absolutely clear, and we do not need any report to tell us this, that non-medical materials should not have been used. That is a given. The Irish Medical Council is in a formal process. That is a legal process when it comes to the review of clinicians. We have to let that process go through.

So, we know the rate of complication is higher than would have been expected internationally. However, there have been no findings at this time that have been made against this surgeon.

I thank the Deputy. What I can tell him is this: the springs that were used were not authorised for medical use, which is very serious. We do not know - the review is now establishing this - how that happened in terms of procurement and getting into theatre. There are protocols for checks on everything that is used in theatre. Exactly how all of that happened is being established right now, but we know that these were not authorised. Furthermore, we know there are processes in place through the Health Products Regu…

I thank the Deputy. It is a very fair question. The answer to that is that there are extensive patient safety and clinical governance mechanisms in place in all our hospitals to do with every procedure. In this case, two serious incident reviews have been kicked off. They will be reporting very shortly. They have done extensive work on what happened in two particular cases. Concerns were raised through the multidisciplinary team. That kicked off an internal and external review. A complaint has been made to the Iris…

That is exactly what two reviews are looking at – an external review commissioned by CHI and an external review commissioned by the chief clinical officer, with the reviewer reporting to the chief clinical officer and meeting me regularly. This is exactly what we need to establish.

There was an adverse event reported in July and there was an adverse event reported in, I believe, September. Let me double-check.

Does the Deputy mean when was the serious incident review kicked off?

I believe it was kicked off in July as soon as the serious incident was notified.

My advice is that Crumlin decided to examine its own caseload on the basis of Temple Street having done the same. The advice I have is that it was not kicked off by an adverse event or concerns being raised.

I beg the Deputy’s pardon for interrupting, but in case there are families listening whose children were involved in Crumlin, what Crumlin and CHI have said is that they did not find concerns through their own review.

I would need to check to see what report that was.

My advice is that it was a small note on an accreditation visit. If that is what it was, then I have not read it.

Is the Deputy referring to an implementation plan for the recommendations from the Boston review?