THE MEDICAL COUNCIL
FITNESS TO PRACTISE COMMITTEE UNDER PART 8 OF THE
MEDICAL PRACTITIONERS ACT 2007
PROF. P. CORBALLY & DR. SRI PARAN THAMBIPILLAI
TRANSCRIPT OF HEARING HEARD ON
THURSDAY, 2ND SEPTEMBER 2010 - DAY 3
AT KINGRAM HOUSE
KINGRAM PLACE
DUBLIN 2
3
Gwen Malone Stenography
Services certify the
following to be a true
and accurate transcript
of the shorthand notes
of the evidence in the
above-named action.
______________________
APPEARANCES
COMMITTEE:
DR. J. MONAGHAN
(CHAIRMAN)
MS. A. DURKAN
MR. T. O'NEILL
LEGAL ASSESSOR:
MR. K. CROSS SC
FOR THE CEO:
MR. P. LEONARD BL
INSTRUCTED BY:
MR. JP McDOWELL
MS. A. RYAN
McDOWELL PURCELL
SOLICITORS
THE CAPEL BUILDING
ST. MARY'S ABBEY
DUBLIN 7.
FOR PROF. CORBALLY:
MS. E. BARRINGTON BL
INSTRUCTED BY:
MATHESON ORMSBY PRENTICE
SOLICITORS
FOR DR. SRI PARAN:
MR. C. MEENAN SC
MR. C. BURKE BL
INSTRUCTED BY:
O'CONNOR SOLICITORS
COPYRIGHT: Transcripts are the work of Gwen Malone
Stenography Services and they must not be photocopied or
reproduced in any manner or supplied or loaned by an
appellant to a respondent or to any other party without
written permission of Gwen Malone Stenography Services
INDEX
WITNESS
EXAMINATION
PAGE NO'S
PROF. M. CORBALLY
DIRECT
CROSS
CROSS
QUESTIONED
FURTHER CROSS
RE-DIRECT
-
MS.
MR.
MR.
THE
MR.
MS.
BARRINGTON
LEONARD
MEENAN
COMMITTEE
LEONARD
BARRINGTON
4
80
108
171
177
179
-
80
107
170
177
178
185
MR. P. OSLIZLOK
DIRECT - MS. BARRINGTON
187 - 189
MR. F. BREATHNACH
DIRECT - MS. BARRINGTON
CROSS - MR. MEENAN
190 - 192
193
MR. F. MURPHY
DIRECT
CROSS
CROSS
QUESTIONED
-
MS.
MR.
MR.
THE
BARRINGTON
LEONARD
MEENAN
COMMITTEE
196
205
207
211
-
205
207
211
214
1
THE HEARING RESUMED, AS FOLLOWS, ON THURSDAY, 2ND
2
SEPTEMBER 2010
3
4
CHAIRMAN:
Good morning everybody.
5
You are welcome to the
09:44
6
third day of this inquiry.
7
point where Ms. Barrington had applied for a direction.
8
So would you like to resume?
9
MS. BARRINGTON:
Thank you, Chairman.
CHAIRMAN:
Well perhaps I will say,
10
11
We stopped yesterday at the
09:45
the Committee considered
12
the matter of No. 7 on the inquiry, and we have looked
13
at the transcript this morning, so I think we would be
14
happy that No. 7 would be withdrawn along with the
15
other ones.
16
MS. BARRINGTON:
09:45
Very good.
17
Thank you,
Chairman
18
CHAIRMAN:
So, that is all we have to
19
say about that.
20
MS. BARRINGTON:
Yes.
21
Well then I propose
09:45
proceeding to call
22
Prof. Corbally.
23
24
PROF. MARTIN CORBALLY, HAVING BEEN SWORN, WAS EXAMINED,
25
AS FOLLOWS, BY MS. BARRINGTON
09:46
26
27
1
Q.
MS. BARRINGTON:
Thank you, Professor.
28
29
We
are going to hand into the
Committee a copy of the Professor's CV.
4
Gwen Malone Stenography Services Ltd.
I am not sure
1
what exhibit that is?
2
13.
3
your CV.
4
5
2
(SAME HANDED).
Thank you, Professor.
That is Exhibit
The Committee has a copy of
I am not sure if you have it yourself there?
A.
No, I do not.
(SAME HANDED TO WITNESS)
Q.
As the Committee will of course already have heard,
6
Professor, you are a Consultant Paediatric Surgeon and
7
a Paediatric Surgical Oncologist in Crumlin Hospital.
8
You are also an Associate Professor in Paediatric
9
Surgery at the Royal College of Surgeons.
10
How long
have you been working in Crumlin Hospital?
11
A.
proleptic training in liver transplantation in Kings
13
College Hospital, London.
3
Q.
I know you have a slight difficulty hearing with your
15
right ear, Professor, but if you could, you might try
16
to keep your voice up and direct your answers to the
17
Committee.
18
19
4
A.
Of course.
Q.
Looking through your Undergraduate education,
20
Professor, page 5 of the CV, I think you graduated from
21
University College Galway in 1978, is that right?
22
23
5
A.
That's correct.
Q.
Thereafter, you did your initial training at SHO level
24
6
A.
That's correct.
Q.
I think you then took some time overseas, approximately
27
09:47
09:47
a year in West Africa, is that right?
28
29
09:47
in Cork Hospital?
25
26
09:47
Since 1994, but I was appointed in 1993 and took a year
12
14
09:46
7
A.
That's correct.
Q.
You worked then in Temple Street Hospital for some time
5
Gwen Malone Stenography Services Ltd.
1
as a Locum Registrar?
2
3
8
4
5
9
6
7
10
A.
Yes, that's correct.
Q.
Then you started in Crumlin as a Registrar in 1984?
A.
That's correct.
Q.
You then went abroad again to Iraq for some time?
A.
For six months, yes.
Q.
After that you did some training in the Sloan-Kettering
8
Cancer Centre.
9
the nature of that centre and its reputation globally?
10
A.
Can you just outline for the Committee
Sloan-Kettering, Memorial Sloan-Kettering Cancer Centre
11
is one of the world's largest institution dealing
12
primarily with cancer, both in adults and paediatric
13
patients.
14
in a research clinical fellowship where I gained
15
extensive experience in paediatric surgical oncology
16
in the last year of that fellowship.
17
11
Q.
18
I was fortunate to work there for tree years
A.
That's correct.
I have very good relations with the
staff in Sloan-Kettering and was very happy to organise
21
a rotation for Mr. Paran in Sloan-Kettering, where he
22
spent one year and was highly commended after his year
23
in that institution.
12
Q.
again in Ireland for a while, and you then did a year
26
in the Great Ormond Street Hospital in London?
27
13
09:49
On your return from the Sloan-Kettering, you worked
25
29
09:48
I think in fact Mr. Paran has also done a fellowship in
20
28
09:48
the Sloan-Kettering, is that right?
19
24
09:48
A.
That's correct.
Q.
Ultimately then, as you have indicated, after some
visiting fellowships abroad, you took up your position
6
Gwen Malone Stenography Services Ltd.
09:49
1
as a Paediatric Surgeon in Crumlin in 1993/1994?
2
3
14
A.
That's correct.
Q.
Are you the longest serving, that is probably not the
4
way to put it, but the most senior Paediatric Surgeon
5
in Crumlin?
6
7
15
09:49
A.
As of last week, yes.
Q.
Can you outline for the Committee your duties in
8
Crumlin?
9
A.
Well I have several duties to maintain in Crumlin.
10
There is a large service commitment to the generality
11
of paediatric surgery; neonatal surgery, oncological
12
surgery, and also paediatric hepatobiliary surgery.
13
addition to an active clinical role I am responsible
14
for Undergraduate teaching and training in the College
15
of Surgeons and Post Graduate training of doctors who
16
rotate through the hospital to gain experience in
17
paediatric surgery.
18
16
Q.
19
09:50
You deal with your teaching duties at page 11 of your
17
A.
Yes, that's correct.
Q.
I understand, and it is set out at page 12, that you
09:50
22
have also done a significant amount of humanitarian
23
work.
24
In
CV?
20
21
09:50
A.
What does that involve?
We work through the College of Surgeons in Ireland and
25
the Christina Noble Foundation to deliver a skills
26
based workshop platform to train our colleagues in
27
Vietnam in paediatric surgery, mostly in complexity,
28
complex paediatric surgical procedures.
29
recently been able to establish a cardiac, an open
7
Gwen Malone Stenography Services Ltd.
We have
09:50
1
heart surgery in the same hospital, which is in its
2
first year at this point.
3
18
Q.
You have listed the various learned articles you have
4
authored.
5
courses you have attended, including a course you have
6
enrolled in for this September, is that right?
7
A.
Then at page 30 of your CV, you outline the
Yes, I am enrolled as a Graduate Student in the
8
University College Hospital Dublin, in a diploma course
9
on Health Care Risk Management and Quality.
10
19
Q.
11
You also, in 2008 and 2010, attended courses in Safer
A.
Yes, I attended one in London in May 2008, shortly
13
after this incident, and in February I think of this
14
year I attend a Safer Operative Course run by Professor
15
George Youngson in Crumlin.
20
Q.
Thank you, Professor.
just outline for the Committee, you did so very
18
briefly, but your working obligations as a surgeon
19
firstly?
20
A.
Surgery involves many points of patient contact, not
21
only in theatre, but also in the out-patients and on
22
ward rounds.
21
Q.
24
A.
26
On how many days do you perform surgery in the working
My working list, operating list, is Monday, Wednesday,
and Friday.
22
28
29
09:52
week?
25
27
09:52
Professor, I wonder would you
17
23
09:51
Operative Surgery?
12
16
09:51
23
Q.
You operate every day yourself, do you?
A.
Every day on those three days, yes
Q.
On the Monday, Wednesday, and Friday?
8
Gwen Malone Stenography Services Ltd.
09:52
1
2
24
3
A.
On those three days, yes.
Q.
How many patients would your team operate on in a year?
A.
I think the average is about 1,200, but there could be
4
5
more or less than that in any given year.
25
Q.
6
In addition to your surgical commitments, you have an
on-call obligation, is that right?
7
A.
Yes.
Since 1994, I have been on-call ten to twelve
8
nights for emergency call every month.
9
oncological surgical problems on 24/7 since 2005 in
10
11
On-call for
addition, yeah.
26
Q.
12
09:53
So you have a significant on-call commitment in
addition to your...(INTERJECTION)?
13
A.
There is a very significant on-call rota.
The problem
14
is that there are only two full-time paediatric
15
surgeons in Crumlin, and up to very recently two
16
part-time surgeons.
17
surgical service, both in terms of neonatal surgery,
18
oncological surgery, trauma surgery, hepatobiliary
19
surgery, and the generality of if paediatric surgery.
20
So it is quite an onerous commitment to have to
21
deliver.
22
consistently over many years.
23
27
Q.
24
25
09:53
09:53
We deliver a national paediatric
09:53
We have been trying to improve staff numbers
Is that by way of looking for additional paediatric
consultants?
A.
Yes, exactly.
We have, hopefully we will have four
26
part-time surgeons, two full-time surgeons, very soon.
27
I did address the College of Surgeons in, I think
28
2005/2006 at a surgical forum and pointed out that we
29
needed eight surgeons to be appointed in total.
9
Gwen Malone Stenography Services Ltd.
We
09:53
1
have had difficulty, politically and institutionally,
2
in attempt to try and fill these positions over the
3
years.
4
28
Q.
5
Paediatric Surgeons, is that right?
6
A.
7
8
But in 2008, there two were two full-time Consultant
Two full-time surgeons; myself and Mr. Quinn, and two
part-time surgeons.
29
Q.
9
09:54
Yes.
So you have your three days a week where you are
operating yourself, you have your significant on-call
10
rota, and you also have an Out-Patients Department
11
commitment.
12
works?
13
A.
Yes.
Can you explain to the Committee how that
At that time I, well I have, I still have two
14
out-patient sessions; Tuesday morning and Thursday
15
morning, and also at that time I had the spina bifida
16
clinic in the afternoon on a Tuesday as well.
17
has, neurosurgical service have now transferred to
18
Temple Street so I no longer have that commitment.
19
30
Q.
20
A.
In the out-patients clinic that you do twice a week,
sometimes 45 patients in a clinic.
23
morning there are two hours to see that number of
24
patients.
25
to delegate appropriately to the SHOs and Registrars
26
assisting with the clinic the patients that I think
27
they feel competent and able to deal with.
29
31
Q.
09:55
The booked numbers of patients would be at least 35,
22
28
09:54
That
how many patients would you see per clinic?
21
09:54
On a Thursday
My practice is to review all the charts and
Because you couldn't possibly see all 35 yourself in a
two hour period?
10
Gwen Malone Stenography Services Ltd.
09:55
1
2
32
A.
Not in two hours, no.
Q.
Professor, can I move on to your involvement in this
3
case with Master Conroy.
I note the Committee has a
4
Book of Extracts from the medical records, which is
5
Exhibit 2.
6
I am also going to hand into the Committee two very
7
small booklets of some additional extracts from the
8
chart.
9
CHAIRMAN:
I am not sure if you have that, Professor?
(SAME HANDED)
We will call these Exhibits
10
14 and 15.
11
MS. BARRINGTON:
Exhibit 14.
12
09:56
If Exhibit 14
is the letter to Dr.
13
Sheridan, commencing with the letter to Dr. Sheridan.
14
Then Exhibit 15 is the other smaller booklet.
15
CHAIRMAN:
Okay.
MS. BARRINGTON:
Professor in the, I know it
16
33
Q.
17
14 and 15 then.
to have three booklets, but in the bigger of the three
19
booklets at page 5?
20
CHAIRMAN:
Exhibit 2.
MS. BARRINGTON:
That is Exhibit 2.
34
Q.
22
27
I hope
8th February 2002.
24
26
09:57
you have the report of the
23
25
09:57
is a little confusing now
18
21
09:55
35
A.
Yes.
Q.
That is a report that recorded:
"Minimal left sided Grade I reflux."
28
Can you explain to the Committee the significance of
29
that report?
11
Gwen Malone Stenography Services Ltd.
09:57
1
A.
Well, clearly in retrospect the attributing left-sided
2
reflux was incorrect in this patient.
Reflux, on
3
review by our radiology colleagues, confirmed that this
4
was an erroneous report in fact and that the reflux
5
occurred on the right side.
6
rather than leaving in an antegrade direction from the
7
bladder actually passes retrogradely into the ureter.
8
If that urine has bacteria in a significant degree it
9
cause damage to the kidney on that side.
Reflux is where urine,
So reflux in
10
association with the patient's ongoing anorectal
11
problems could be associated with a reflux nephropathy
12
on the side of the reflux.
13
36
Q.
14
When was this error in the February 2002 report picked
37
A.
Only after the incident.
Q.
This error then was replicated in the chart on a number
17
After.
09:58
of occasions, is that correct?
18
19
09:58
up?
15
16
38
A.
That's correct.
Q.
I think you have gone through the chart and have noted
20
how many times the left sided reflux was noted.
21
many times was that?
22
A.
Eleven times in total.
How
multi-disciplinary meeting x-ray conference, where the
24
images were in fact reviewed and wrongly assigned to
25
the left side.
39
Q.
09:59
I am just going to ask you to look then at one of the
27
smaller of the two booklets, it is Exhibit 14 for the
28
Committee, starting with the letter to Dr. Sheridan.
29
A.
09:59
One of those times was at a
23
26
09:58
Yes.
12
Gwen Malone Stenography Services Ltd.
1
40
Q.
That letter, back in March 2002, records in the third
2
paragraph much the MCUG showing minimal reflux into the
3
left distal ureter.
4
instances of the replication of the error in the
5
February 2002 report, isn't that right?
6
7
41
So that was one of the first
09:59
A.
That's correct.
Q.
If you turn over the page then, there is a letter of
8
January 19th 2004.
That is in fact a letter from
9
Mr. Paran, who at the time was the Surgical Registrar
10
to Prof. Fitzgerald, which again in the body of the
11
letter erroneously refers to left sided reflux, isn't
12
that right?
13
14
42
A.
That's correct.
Q.
Over the page again, a letter from April 2004, from a
15
different Registrar to Prof. Fitzgerald.
16
through the first paragraph:
17
Half way
10:00
10:00
"The original MCUG showed mild grade
reflux on the left side."
18
19
20
21
43
A.
That's correct.
Q.
Again turning over the page, there is a letter from
10:00
22
Dr. Mary Waldron who is a Consultant Paediatric
23
Nephrologist.
24
in the management of Master Conroy by Dr.White, who was
25
the Consultant Paediatrician Neonatologist in Crumlin
26
Hospital at that -- in the Coombe Hospital, is that
27
right?
28
29
44
I think she was asked to become involved
A.
Coombe and joint appointment at Crumlin, yes.
Q.
Coombe and Crumlin.
I see.
Dr. Waldron also refers to
13
Gwen Malone Stenography Services Ltd.
10:01
1
the left sided reflux?
2
3
45
A.
That's correct.
Q.
The next letter is one from Dr. White himself, which in
4
the summary of diagnosis refers to "left sided VUR"?
5
6
46
A.
That's correct.
Q.
There is a further letter then in June 2006 from
10:01
7
Dr. White, again referring, under the summary of
8
diagnosis, to "left-sided VUR".
9
of June 2007 from Dr. White.
There is a letter next
Again, recording
10
left-sided VUR.
11
conference that you alluded, a note of the x-ray
12
conference you alluded to earlier.
13
early x-ray conference on 13th February 2002, at which,
14
it would appear, that the report was discussed but the
15
error wasn't picked up.
16
17
47
The next record is I think the x-ray
That is a very
Is that correct?
A.
That's correct, yes.
Q.
The Committee will see then that there are thereafter a
18
number of extracts from notes made in the chart at
19
various stages referring to "left-sided VUR".
20
Unfortunately that error in the notes doesn't seem at
21
any stage to have been picked up prior to these events?
22
23
48
A.
That's correct.
Q.
Your initial involvement with Master Conroy I think at
24
10:02
10:02
the outset related to bowel issues, is that right?
25
26
10:02
49
A.
That's correct, yes.
Q.
Master Conroy was first referred to you, or to your
10:03
27
team, in April 2006.
I am going to ask you to turn
28
back, Prof. Corbally, to the main booklet, which is
29
Exhibit 2.
You will find a note at page 15?
14
Gwen Malone Stenography Services Ltd.
1
2
50
3
4
51
A.
That's correct, yes
Q.
From your Out-Patients Department, is that right?
A.
That's correct.
Q.
Dated 13th April 2006.
That was the first time that
5
your team became involved.
6
Registrar, Dr. Mortell, who saw the patient at that
7
stage, is that right?
8
9
52
I think it was your
A.
That's correct.
Q.
Can you just outline for the Committee what the problem
10
was in relation to bowel issues at that time?
11
A.
10:04
The patient was at that time four years of age and had
12
been born with a high anorectal abnormality where the
13
rectum and anus had not formed.
14
predecessor and senior colleague at the time, had
15
performed an operation to create a new anus and rectum.
16
That, in terms of producing a conduit or a channel, had
17
been very successful.
18
these issues, especially when they are sacral
19
abnormalities, the continence issue had become a
20
serious problem.
21
years of age and was not continent of faeces.
22
was referred primarily to my clinic (inaudible due to
23
coughing) not because of urological issue or a renal
24
issue but primarily to sort out his continence issues.
25
At four years of age one would expect a child, a male,
26
to be toilet trained.
27
patient at this time.
28
29
53
Q.
10:03
Prof. Fitzgerald, my
10:04
However, as often happens with
The patient at this time was four
So he
This was not happening with this
I think the chart shows that he was seen again in your
Out-Patients Department in June 2006.
15
Gwen Malone Stenography Services Ltd.
10:04
The notes
10:05
1
related to that are in the third of the small booklets,
2
Exhibit 15.
3
in June.
4
the bottom right-hand side, a further attendance in
5
August 2007.
6
management in relation to those incontinence and
7
soiling issues?
8
9
A.
There is a record there of an attendance
Over the page, page 690 in the pagination on
How did Master Conroy fair under your
10:05
Well initially I had not seen him in the out-patients
and he had been seen by the SPRs or Surgical
10
Registrars.
When I saw him ultimately it was apparent
11
that a variety of treatment measures had been tried,
12
and all of these were appropriate, first of all to try
13
and stimulate his bowel to empty, and then laterally to
14
try and slow him down a little bit, but none of these
15
were working, and he was still using at least ten
16
nappies per day.
17
faeces.
18
problem from the congenital aspect of his case, with a
19
high anorectal abnormality, the next step is to
20
introduce a technique called the Willis Washout
21
Programme.
22
a retrograde enema using fluid saline and a stimulant
23
laxative which is passed into the colon through a small
24
cone shaped nozzle, and that washes out the retained
25
faeces or faeces in the colon, so the colon is empty.
26
So effectively they become socially continent.
27
are not in the true sense continent, but they become
28
socially continent, which is a fantastic achievement
29
considering that an anorectal abnormality results in
10:06
10:06
So he was still incontinent of
In that situation, and particularly with this
10:06
The Willis Washout Programme essentially is
16
Gwen Malone Stenography Services Ltd.
They
10:07
1
poor muscle development around the anus.
2
muscle that gives you continence.
It is that
3
4
So after the Willis Washout Programme was instituted,
5
which means roughly speaking washing his colon out
6
every two days, he became socially continent.
7
54
8
9
55
Q.
So his situation improved considerably?
A.
Yes, exactly.
Q.
Then ultimately in September 2007, he was, the
10:07
10
Committee has seen already I think, referred by his
11
general practitioner, Dr. Kenny to you, to deal with a
12
discrete issue.
13
at page 21 of the main booklet, Exhibit 2.
14
the first time you became involved with Master Conroy
15
in relation to his urinary issues?
16
A.
17
18
10:07
The letter is, the referral letter is
Was that
10:08
That was the first time I was aware of the urinary
problem, yes.
56
Q.
She asked in her letter of September 10th 2007, that
19
you would see Master Conroy as a matter of urgency.
20
think he was seen in October 2007, and you arranged for
21
his admission, I think as a day case, in November of
22
2007.
The record of his admission is at page 23 of the
23
book.
Is that correct?
24
25
26
57
I
A.
That's correct.
Q.
What was the admission in November for?
A.
That was to perform a DMSA scan and a renal ultrasound
27
to establish a cause for his urinary tract infections,
28
which is why Dr. Kenny had sent him to me in the first
29
place.
17
Gwen Malone Stenography Services Ltd.
10:08
10:08
1
58
Q.
Those scans then were performed in November, and you
2
wrote a letter back to the GP on 22nd November, which
3
is to be found at page 22 of the book.
4
5
59
A.
Yes.
Q.
Can you just outline for the Committee the findings you
6
had noted on the ultrasound and what you informed the
7
general practitioner of?
8
A.
He had had quite significant and severe recurrent
9
urinary tract infections recently, but in the years
10
prior to that he had been relatively infection free.
11
But he was requiring antibiotics.
12
Antibiotic Prophylaxis.
13
fever, headache, and vomiting.
14
abnormal on the examination at that time.
15
that he was managing well on his Willis Washout
16
Programme and was clean with this.
17
that faecal contamination was contributing to his
18
urinary tract infections.
19
likely had a renal abnormality because of his previous
20
congenital abnormality.
21
ultrasound to confirm this, and a DMSA scan to confirm
22
function, or any damage to function in either or both
23
kidneys.
24
60
Q.
He was quite symptomatic with
I could find nothing
I considered
I considered that he most
So, I organised and an
10:10
The scan was carried out, and we have seen, the results
26
has seen that.
27
function in the right kidney, isn't that correct?
29
10:10
I did not consider
of the scan are at page 28 and at 29.
A.
10:09
He was an Augmentin
25
28
10:09
That's correct.
that?
The Committee
That is the scan that recorded the 9%
Can I just say too before I comment on
I did continue him on prophylactic antibiotics
18
Gwen Malone Stenography Services Ltd.
10:10
1
because I felt that we needed to keep his urine free of
2
infection.
3
possible, to get him to empty his bladder in what is
4
called "double voiding" so that his bladder would not
5
be a source of infection.
6
of stasis in his bladder.
7
61
Q.
I also asked his parents to attempt, where
If there was any possibility
You saw Master Conroy again in the Out-Patients
8
Department on January 17th, 2008.
9
to discussing the treatment subsequent to the scan
10
A.
12
13
Was that with a view
having been carried out?
11
10:11
That was to review the imaging primarily and to discuss
a treatment plan based on the imaging results.
62
Q.
Yes.
Were the scanned reports, which the Committee now
14
has at page 28 and 29, available to you at that meeting
15
on January 17th?
16
A.
10:11
These reports were not available.
They were not in the
17
patient's chart.
18
Out-Patients Department.
19
is kept in the patient's x-ray folder, and also a copy
20
of the report is kept in the patient's chart.
21
of these reports, no official report was in the chart.
22
63
Q.
23
24
10:11
Yes.
Nor were the x-rays available in the
Normally a copy of the report
Neither
10:11
Was that an unusual phenomenon at the time for
the imaging reports not to be in the chart?
A.
Well we had, we have had some difficulty with this
25
problem, in that the X-ray Department, two or three
26
years before this event, had unilaterally decided that
27
because of the high number of x-rays that were being
28
misplaced and lost that x-rays would no longer be
29
released at all points of the patient's transit or
19
Gwen Malone Stenography Services Ltd.
10:12
1
2
journey through the hospital.
64
Q.
3
I wonder if I could ask you, Professor, just to slow it
down a little bit for the Stenographer, please?
4
A.
Sorry.
Two or three years prior to this event, the
5
X-ray Department had decided that they would not
6
release the x-ray packet, the x-ray folders, to
7
accompany the patient at all points of the patient's
8
progress through hospital.
9
however, x-ray reports would always be available in the
We were assured that,
10
chart, but regrettably that was not always the case,
11
and quite a common occurrence that x-rays would not be,
12
x-ray reports, would not be available in the chart.
13
X-rays occasionally going missing in a hospital system,
14
and the hospital does not have a computerised archive
15
retrieval system, or a PACS system, where x-rays can be
16
viewed on screen, so you don't need to have x-ray
17
copies.
18
mislaying x-rays could be minimised if we had a PACS
19
system.
20
now has approval to put in a PACS system.
21
65
Q.
10:13
We have been trying, and I think the Hospital
10:13
So there were two pathways for images, and the results
of the images, is that right, at that time?
23
themselves, the images didn't go into the chart lest
24
they be lost, but went back to the Radiography
25
Department where they could be retrieved if necessary,
26
is that right?
A.
10:13
So theoretically at least the chances of
22
27
10:12
The x-rays
The x-rays, the actual x-ray, the image, or the packet
28
of the images, are kept in a separate large folder call
29
the x-ray packet.
Radiology had decided that x-ray
20
Gwen Malone Stenography Services Ltd.
10:14
1
packets would not follow the patient throughout his or
2
her course through hospital.
3
reports...(INTERJECTION).
4
66
Q.
5
The images, the packets themselves, were retained
where?
6
7
The
67
8
10:14
A.
In the X-ray Department.
Q.
Yes.
A.
But even so, x-rays were still, from time to time
9
mislaid, even with that system in place.
The x-ray
10
report is generated by the radiologist having reviewed
11
the imaging, and that report is duplicated.
12
those reports should go into the x-ray folder, the
13
packet with the x-rays, and the other report should go
14
into the patient's chart.
15
68
Q.
One of
In this case, when you are doing your Out-Patients
16
Department Clinic, you had, if I have understood you
17
correctly, neither the packet of the images, and you
18
wouldn't normally have that in the Out-Patients
19
Department, but nor did you have on the chart a report
20
on the images, which in theory should turn up in the
21
chart at some stage?
22
A.
23
24
10:15
Normally the x-rays would be available in the
69
Q.
The x-rays themselves?
A.
They would be found for the clinic, but they weren't
26
available on that day.
27
been in the chart, but was not in the chart.
29
10:14
Out-Patients Department.
25
28
10:14
70
The report should also have
Q.
Yes.
A.
So I could not, I did not consult the official report,
21
Gwen Malone Stenography Services Ltd.
10:15
1
which was not available in the chart, and I did not
2
have the x-rays to review the x-rays in the
3
Out-Patients Clinic.
4
71
Q.
Yes.
Nor, if I have understood you correctly, did the
5
hospital have this PACS system that some hospitals have
6
that allowed the images to be reviewed on computer?
7
A.
That's correct.
There is one computer between five
8
consulting rooms in Crumlin, and that is at the nurses'
9
station, but it is not a PACS system.
10
72
Q.
Yes.
Just before dealing with the detail of your
11
interaction with Master Conroy's parents and the detail
12
of this meeting, I wonder could you outline for the
13
Committee what your working commitments had been that
14
week and how the Out-Patients Department operates in
15
this two hour period?
16
17
18
73
10:15
10:16
10:16
A.
Well, can I take the last part of that first?
Q.
Yes.
A.
The Out-Patients is a particularly busy place.
It is a
19
very small antiquated archaic room.
There is a couch,
20
a desk, a sink.
21
parent and one child to sit in the clinic.
22
adjoining door, which is another room a similar size to
23
this, where the Registrar, SPR, or SHO would sit, and
24
across the corridor there is another room where an SHO
25
or Registrar will also sit.
26
place.
27
people coming in and out asking for opinions, SHOs,
28
Registrars.
29
what not.
There is barely enough room for one
There is an
It is a particularly busy
There is a lot of distractions.
There are
There are nurses bringing results in and
There are phone calls.
It is a particularly
22
Gwen Malone Stenography Services Ltd.
10:16
10:17
1
busy place.
2
patients in a two hour period, it can be quite a
3
demanding place.
4
seven day period, including that Thursday morning, that
5
Thursday, I had been on-call five of those seven days.
6
I had a particularly onerous week that week with busy
7
on-call demands and service commitments.
8
on the day before the clinic, I had been involved in a
9
ten hour case of a chest wall tumour with chest wall
10
11
12
When you are trying to see 35 to 45
My duties that week had been, of the
For example,
reconstruction.
74
10:17
10:17
Q.
That was a surgery case?
A.
Surgery all day in that case with my orthopaedic
13
colleagues.
That finished I think around 6:30/7:00
14
o'clock.
15
again around 9:30 or so to deal with a newborn neonate
16
who had congenital oesophageal atresia fistula, where
17
the oesophagus hadn't formed and where an abnormal
18
connection from the distal, from the far end of the
19
oesophagus into the airway existed.
20
life-threatening condition.
21
about 1:30/2:00 o'clock in the morning.
22
spoken to the parents and got home, probably about 3:30
23
in the morning, to return again for 8:00 o'clock, an
24
8:00 o'clock meeting, a surgical audit meeting at 8:00
25
a.m., to start to do rounds at 9:00 and to start the
26
clinic at 10:00 and to finish the clinic by 12:00 so I
27
could attend the tumour board, Tumour Oncology Board at
28
12:00.
29
particular day.
I did rounds.
I went home.
I was called in
10:18
So, that is a
I finished that case at
After I had
So quite a busy and demanding schedule on that
23
Gwen Malone Stenography Services Ltd.
10:18
10:18
1
75
Q.
Yes, but not in any way out of the norm of the type of
2
days that you might have, having regard to your
3
obligations?
4
A.
Well, I have an ongoing service commitment to deliver a
5
paediatric surgical services, which would see us
6
working, and my colleagues all work the same, I am not
7
exceptional in this, we would work typically a 75/80
8
hour week, which does not include the emergency call
9
outs that we have to deal with on a regular basis, and
10
also I think being on-call ten to twelve days of every
11
month since 1994 adds to that, and one has to find, it
12
is a balance, a juggling act at times to try and
13
incorporate emergency patients into your ongoing busy
14
list, which has become even more busy because of the
15
national tendency to refer paediatric patients to a
16
paediatric centre because our anaesthetic and surgical
17
colleagues in peripheral hospitals are increasingly,
18
and perhaps I would have to say no longer prepared, to
19
operate on children below 1, 2, or 3 years.
20
has resulted in a very significant referral pattern
21
increase to Crumlin to look after these patients.
22
our workload has increased significantly, and the call
23
has remained significantly as before.
24
76
Q.
10:19
10:20
So
Then on the 17th January, we have heard from Master
Conroy's parents, they attended at the Out-Patients
26
Department and you met with them.
27
your recommendations were for Master Conroy's
28
treatment?
A.
10:19
So that
25
29
10:19
Can you outline what
I believe that I recommended a nephrectomy.
24
Gwen Malone Stenography Services Ltd.
I believe
10:20
1
that I recommended a right nephrectomy, but I
2
erroneously recorded a left nephrectomy.
3
77
Q.
4
30 of the booklet?
5
6
You are looking, I think, at the note you made at page
78
A.
That's correct.
Q.
You have clarified that the report, or reports I should
10:20
7
say, of the scans weren't on the chart, but you noted a
8
9% function in the note that you made, albeit that you
9
noted it on the left hand side.
What do you think,
10
what information do you think you did have that allowed
11
you to make that note?
12
A.
Well in the absence of an official signed report from
13
radiology and/or the x-rays themselves, I clearly had
14
specific information as to differential function
15
between the right and the left kidney.
16
surmise that I had an unofficial report of some form
17
handed to me that said a split function of 9% and 91%.
18
79
Q.
So, I can only
for the Committee on the difference between an
20
unofficial report and an official report?
A.
10:21
When you say an unofficial report, can you elaborate
19
21
10:21
10:21
An official report is when the radiologist has reviewed
22
the images and signed off on the content of the images
23
and their result.
24
in very many cases issued, and unfortunately it is a
25
practice that persists, and I have tried my best to
26
stop availability of unofficial reports on screen in
27
Crumlin, which I believe that administration are taking
28
seriously now.
29
is not an official report" on the top.
An unofficial report is often, and
Unofficial reports really state "this
25
Gwen Malone Stenography Services Ltd.
10:22
1
80
Q.
2
They haven't been signed off then by the Consultant
Radiologist, is that right?
3
A.
That's correct.
I have many times witnessed unofficial
4
reports being changed in the light of the official
5
report.
6
laterality are at risk in unofficial reports.
7
81
Q.
So typographical errors, or errors of
In this case presumably you looked at the chart, you
8
identified the fact that no reports were available on
9
the chart.
Who would you have asked to try to
10
ascertain information in relation to the results of the
11
scans from?
12
A.
Out-Patients, and they will go to the computer and
14
produce a report from the computer, but that report is
15
not an official report.
82
Q.
It is an unofficial report.
in the chart.
18
the nurse to go to the one computer that the five rooms
19
share in order to print off what was, at that stage,
20
probably an unofficial report?
A.
The parents were there, and you asked
That's correct.
10:23
I may have asked for that report
22
before the parents came into the room, as you would
23
normally go through the notes and have an idea of what
24
you are actually going to talk to the parents about.
25
83
Q.
26
28
29
The nurse may have simply transcribed what she saw on
the screen or...(INTERJECTION)?
27
84
10:23
So you would have identified that there was no report
17
21
10:23
Well generally nursing staff are most helpful in
13
16
10:22
A.
Or printed off a report.
Q.
Printed off a report.
I see.
The parents have
indicated in their evidence that they had a
26
Gwen Malone Stenography Services Ltd.
10:23
1
recollection that you told them the nephrectomy was
2
going to be on the right hand side.
3
did say that to them?
4
5
85
A.
I absolutely agree that I would have said that, yes.
Q.
Which would suggest that the report, in whatever form
6
86
A.
I agree with that too, yes.
Q.
Then you made an error in noting down the contents of
9
the report, is that the case?
10
11
87
A.
Regrettably so, yes.
Q.
You did indicate, I think, to the Great Ormond Street
10:24
12
Review that you may have got an incorrect report.
13
Which do you think is the more likely scenario?
14
A.
Well, what certain is that there was no official report
15
because at the time of the event there was no, in
16
theatre there was no official report in the chart, and
17
when I took the x-rays from the x-ray packet, there was
18
no official x-ray report, there was no report at all in
19
the x-ray packet.
20
unofficial report or a handwritten report off the
21
screen.
22
88
Q.
23
24
10:24
you got it, was probably a correct report?
7
8
Do you believe you
So it was one of those.
You wrote in your note "for nephrectomy".
10:24
It was an
10:25
What did you
mean by that?
A.
Well I have heard evidence that that may have been in
25
some way a temporising measure, but it wasn't a
26
temporising measure.
27
plan that a nephrectomy was required.
28
this note, it was clear that I intended, I erroneously
29
intended a left nephrectomy, whereas I may have
It was in fact a clear management
27
Gwen Malone Stenography Services Ltd.
In looking at
10:25
1
discussed a right nephrectomy with the parents, I may
2
have been distracted, and I presume I was distracted in
3
some form or other, and got the side wrong.
4
89
Q.
5
that right?
6
7
If that is so, it was a human error on your part, is
90
10:25
A.
Yes.
Q.
Mr. Wheeler has said that if you are faced with a
8
situation where there was no report on the chart, you
9
had a number of options, one of which was to ask the
10
parents to come back another day.
11
that was one of your options, and if it was, why didn't
12
you do that?
13
A.
Do you agree that
I believe that that was certainly an option.
These
14
parents have been up and down to hospital a lot.
15
really wanted to have management plan in place for this
16
patient.
17
significant and severe infections, so we wished to
18
arrive at a management plan that would sort out his
19
infections and improve his quality of life.
20
it was an option not to do anything.
21
not to see the patient at all.
22
write anything, to explain that I hadn't got the
23
imaging and that we would come back another day.
24
in writing this note, I clearly intended to actually
25
review the imaging myself, and I clearly intended to do
26
this operation myself, because at that time the Senior
27
Registrar on my service would not have been able to do
28
this procedure.
29
91
Q.
10:26
I
10:26
I also considered that he was having
So, yes,
It was an option
10:26
It was an option not to
Who was that Senior Registrar on your team?
28
Gwen Malone Stenography Services Ltd.
But
10:27
1
A.
That would have been Mr. Farhan Tareen.
So at that
2
stage in his career he would not be able to do an
3
nephrectomy unaided, or in any way.
4
have possibly booked the procedure without considering
5
that I was doing the procedure myself, and in that
6
situation I would have realised that I would have had a
7
chance to review the imaging myself.
8
92
Q.
9
So, I could not
10:27
When you say you would have had a chance to review the
imaging, in what circumstances would the imaging have
10
been reviewed by you?
11
A.
10:27
Well, I think hospital systems are in place because
12
they recognise that everyone is fallible and that
13
mistakes can happen.
14
should be a series of brakes, and the brakes should be
15
applied when the red flag goes up, and the red flag is
16
when the parents express concerns.
17
and sadness to me that the parent's concerns were not,
18
were not adhered to or not listened to in significant
19
detail.
20
the imaging when the patient was in theatre, or before,
21
if I had had an opportunity to see him on the ward
22
round that morning, but unfortunately I did not have an
23
opportunity to do that.
24
93
Q.
Yes.
They are there to actually, there
It is a great pity
So, it would have been my intention to review
what happened when Master Conroy was admitted into
26
hospital.
27
brought forward from the original date?
29
94
10:28
I am going to move on, Professor, if I may, to
25
28
10:28
10:28
I think his surgery, Ms. Stewart said, was
A.
Yes.
Q.
Ultimately Master Conroy was admitted on the 20th.
29
Gwen Malone Stenography Services Ltd.
He
1
was seen subsequent to his admission, the Committee has
2
heard, by Dr. Ghallab.
3
where you yourself might see patients on their
4
admission, or is it, in Crumlin Hospital, always a
5
member of your team who sees patients on admission?
6
A.
Would there be circumstances
Generally on the morning of surgery, it is not possible
7
to do rounds at 8:00 o'clock because we have a nurses'
8
hand over.
9
rounds, but generally the Registrar will do a ward
It is very difficult to do full ward
10
round on the patients who are not in ICU.
11
my own ward round in ICU in the morning before surgery.
12
95
Q.
I would do
occur on the morning of the 21st.
14
Mr. Paran who did the ward round, isn't that right?
A.
That's correct.
I think it was
Mr. Paran, at that time, I had no
10:30
16
knowledge as to who would be helping me with my list on
17
that day, because Mr. Farhan Tareen was on leave.
18
I booked this patient for surgery, I had no idea that
19
Mr. Tareen would be on leave that week, or indeed that
20
Mr. Paran would be the helping SPR at that time?
21
96
Q.
When
say they raised a concern on the evening of the 20th,
23
with Dr. Ghallab, when he was performing the consent,
24
although he doesn't appear to recall the question of
25
the laterality being raised.
26
raise this issue with Dr. Ghallab, who indicated that
27
he also was not able to find a report in the chart,
28
what in your view should he have done?
A.
10:30
We have heard from Ms. Stewart and Mr. Conroy that they
22
29
10:29
The ward round, in this case a ward round did of course
13
15
10:29
Assuming the parents did
Firstly I would like to state that I totally believe
30
Gwen Malone Stenography Services Ltd.
10:30
1
that the parents raised this issue on admission.
2
think Dr. Ghallab at that point should have alerted the
3
Senior Registrar on call, and if that was
4
unsatisfactory he should have alerted me.
5
a question of laterality being raised at that point,
6
there is a ward based computer, and I believe that you
7
can access reports, although they may be unofficial
8
reports, on that computer.
9
cross-checking would have been possible, and certainly
10
it would have been possible to communicate this problem
11
at that stage, before it escalated to the point to
12
which it did.
13
97
Q.
I
If there was
So some degree of
they raised a query in relation to laterality, but
15
subsequent to the consenting process with Dr. Ghallab,
16
they say they still had concerns and they raised the
17
issue on a second occasion with Nurse Hart.
18
indicated that she indicate to Nurse Quinn to pass the
19
issue on, and that doesn't seem to have happened.
20
you think Nurse Hart should have taken any further
21
steps?
A.
10:31
That was, the parents say, the first occasion on which
14
22
10:31
10:32
Nurse Hart
Do
10:32
I think it is very difficult for nursing staff to go
23
outside the normal hierarchical system, so to speak.
24
She had, Dr. Ghallab had obtained consent, and he had
25
assured the parents, although they weren't completely
26
assured at that time.
27
difficult to be totally critical of the nursing staff
28
for not communicating it to anyone else but a senior
29
nurse at that time.
I think it would be very
However, I have written to the
31
Gwen Malone Stenography Services Ltd.
10:32
1
Director of Nursing in Crumlin and advised that in a
2
situation like this that it is most appropriate for a
3
nurse to feel that she has the right and authority to
4
contact any senior member of staff if there is an issue
5
of laterality with any patient.
6
98
Q.
10:33
The following morning then, Dr. Paran conducted the
7
ward round with the SHO, Dr. Yeap.
8
in your team, is that right?
9
A.
Dr. Yeap was an SHO
At that time he was an SHO, but he was a highly trained
10
Malaysian paediatrician surgeon who was with us for a
11
year, and has subsequently taken up a position in
12
Punang as a Consultant Paediatric Surgeon.
13
99
14
15
100
Q.
But he was assigned to your team?
A.
He was.
Q.
Yes.
The parents again say they raised a query, a
16
third query, on the morning, although I think they are
17
not clear who it was that they spoke to on the morning.
18
Again, neither the anaesthetic team, Dr. Zaidi, who
19
also would have seen Master Conroy, recalls that, nor
20
does it seem that Dr. Yeap recalls that.
21
Dr. Paran says he didn't speak with the parents at all
22
during that ward round, but he did ask for the x-rays
23
to be made available.
24
on the ward round?
25
A.
26
27
Q.
28
29
Yes.
Why would one, would Mr. Paran want to have ensured
that the x-rays were available?
A.
10:33
10:34
Would that be standard practice
That would be good practice to ensure that the x-rays
are available.
101
I think
10:33
For what purpose?
Well because we are dealing with a situation of
32
Gwen Malone Stenography Services Ltd.
10:34
1
laterality.
2
important to be paranoid about that and to ensure that
3
no errors have been made in booking process or
4
assignment of right to left.
5
reason.
6
case.
7
102
Q.
There is disease on one side.
It is
That is primarily the
It is to confirm that that is the correct
So he was clearly and correctly conscious of the need,
8
when conducting the ward round in the morning, to have
9
the images to ensure that the laterality could be
10
verified?
11
A.
12
13
10:35
He was doing the absolute best thing at that time to
ensure that the x-rays were available.
103
Q.
Yes.
The parents, unfortunately, and their concerns had not
14
been allayed, and they say that they raised the issue
15
for a fourth time with Nurse Davey in the lift when
16
they were going down to the theatre.
17
appears to have appropriately passed the issue on to
18
the theatre nurse, Nurse Suska, who in turn, the
19
Committee has heard, passed it on to her superior,
20
Nurse Delaney, and the Committee has heard from Nurse
21
Delaney.
22
that Nurse Delaney understood that Mr. Paran, at that
23
time, was doing the surgery, although he says he didn't
24
believe that he was doing the surgery at that stage.
25
When were you made aware that this cascade of queries
26
had been made by the parents?
27
A.
10:35
10:35
Nurse Davey
10:36
She passed it on to Mr. Paran, on the basis
The first knowledge I had of this was after the event,
28
when I went to see the parents to inform them, and I
29
will never forget that meeting with the parents, that
33
Gwen Malone Stenography Services Ltd.
10:36
1
the wrong kidney had been removed, that I had attempted
2
to revascularise the kidney, but unfortunately that
3
that had been unsuccessful.
4
had said it, but they told me that they had informed
5
people along the line of their concerns re: laterality.
6
I was amazed that that had happened and that no-one had
7
communicated that concern or anxiety to me.
8
104
Q.
I am not sure which parent
What, in your view, should Mr. Paran have done when the
9
issue of laterality, which he appears to accept now was
10
raised, when the issue was raised with him, what should
11
he have done?
12
A.
have been done.
14
to look at the x-rays, to confirm that the right side,
15
the correct side was being operated on, and to, if any
16
concern whatsoever remained after that, to discuss this
17
with me.
105
Q.
I think that it would have been better
there was no need to escalate the concern to you,
20
because the parent's concerns had been allayed.
21
your view that the parent's concerns could properly be
22
allayed in circumstances where the images were not
23
viewed?
24
MR. MEENAN:
like a leading question.
10:38
I
am sure my Friend would probably like to rephrase it.
106
Q.
MS. BARRINGTON:
I accept that.
28
29
Is it
Chairman, it does sound
25
27
10:38
Mr. Meenan yesterday put to Mr. Wheeler that in fact
19
26
10:37
Well it is always ease in retrospect to say what should
13
18
10:37
that.
I accept
Perhaps it is a
question you have already answered, Prof. Corbally, but
34
Gwen Malone Stenography Services Ltd.
10:38
1
how do you believe that the parent's concerns could
2
best have been allayed?
3
A.
I think their concerns were perhaps allayed in that
4
they were assured that the correct side was the left
5
side.
6
at any level, it is our standard guidance that parents
7
are always correct and that they should be listened to,
8
and in that situation it takes one or two minutes to
9
pull the x-ray out of the folder and look at the
10
11
However, if a concern has been raised by parents
imaging and confirm the side.
107
Q.
10:39
Of course the parents say, although Mr. Paran denies
12
this, that in fact they asked Mr. Paran to look at the
13
x-rays, isn't that correct?
14
15
108
A.
I gather that is true.
Q.
On the morning, you had a list of patients who were to
16
be operated on, and to that extent it is your list,
17
isn't that right?
18
19
109
A.
That's correct.
Q.
But can you or do you operate on all of the patients in
20
your list?
21
A.
It is not physically possible to do that with the
service commitment that we have and the level of sick
23
and critically ill patients that we treat, to be
24
available for every single patient on the list.
25
not, just not possible to do that.
110
Q.
10:39
10:40
22
26
10:39
It is
To that extent, the service provided in Crumlin
27
Hospital is not the consultant led service that
28
Mr. Wheeler described yesterday in his evidence, isn't
29
that right?
35
Gwen Malone Stenography Services Ltd.
10:40
1
A.
2
3
necessarily consultant delivered.
111
4
5
Well I think it is consultant led, but it is not
112
Q.
Yes.
A.
At all aspects.
Q.
Well I think in fairness to Mr. Wheeler, when he was
6
talking about consultant led service he meant that the
7
surgery is necessarily delivered by the consultant in
8
charge of the list?
9
10
113
11
A.
That's correct.
Q.
That is not what happens in Crumlin Hospital?
A.
Crumlin, or a lot of other hospitals in this country
12
13
10:40
with significant service commitments.
114
Q.
We have heard from Emma Cooney how the list operates,
14
and reference to the term "parallel lists".
15
your understanding of a parallel list?
16
A.
What is
10:41
I think there are certain academic details and
17
definitions of the parallel list.
18
the parallel list is a list that, a list of patients
19
designated for surgery on a day and X number of
20
patients are identified to be operated on by the Senior
21
Registrar, and Y number of patients to be operated on
22
by the consultant, with very little if any interaction
23
between the two lists.
24
25
10:40
115
My understanding of
Q.
Is that the way the list works in Crumlin?
A.
No, it isn't.
It is not the way the list worked in the
26
Crumlin because a list is a fluid and dynamic entity.
27
Everyone's focus is to get the patient in to theatre,
28
minimise inconvenience to parents and patients alike,
29
and get the procedures done in the allocated time.
36
Gwen Malone Stenography Services Ltd.
So
10:41
10:41
1
there is a cross over of patients.
2
becomes available, then a patient will go into that
3
theatre.
4
other theatre, then the patient will move to that
5
theatre.
6
116
Q.
7
If that finishes and there is a slot in the
It is a fluid and dynamic process.
10:42
But there are often occasions where two theatres are
being used?
8
9
If a theatre
117
A.
Simultaneously, yes.
Q.
And some people, as we have heard from Emma Cooney,
10
referred to that scenario as being a situation where
11
parallel lists are run, is that right?
12
A.
That's correct.
There has been great debate about how
13
appropriate parallel lists are, both in this country
14
and in the UK.
15
acceptable to have such an arrangement if the delegated
16
Senior Registrar in the other theatre is of a
17
sufficient standard and quality.
18
Mr. Paran was, and is, of that standard and quality.
19
However, might I add that in light of this event, and
20
also because we were trying to appoint new surgeons,
21
and have appointed two new part-time surgeons, that I
22
no longer have a second theatre available to me.
23
have one theatre all day on a Monday, one theatre on a
24
Wednesday, and one theatre on a Friday.
25
118
Q.
26
A.
28
29
My understanding is that it is
That also would apply to many of
my surgical colleagues in Crumlin.
119
Q.
There has been, I hope I am not understating, but some
37
Gwen Malone Stenography Services Ltd.
10:43
I
But on this day there were two theaters in operation;
Yes, that's correct.
10:42
I had no doubt that
Theatre 7 and Theatre 5?
27
10:42
10:43
1
suggestion in Mr. Paran's observations that he was
2
assigned to Theatre 7.
3
that, but what is your view in relation to Mr. Paran's
4
role.
5
A.
Olive Delaney didn't agree with
Was he assigned a particular theatre?
No, I mean it would be I think probably traditional
6
practice that Theatre 7, the SPR would tend to do his
7
cases in there, but equally so I could go into Theatre
8
7 to do a case after Mr. Paran.
9
been extremely helpful and generous with his time, and
10
11
Mr. Paran has always
he would do that quite willingly.
120
Q.
normal SPR.
13
have done this nephrectomy yourself?
15
121
10:44
You have indicated that Mr. Farhan Tareen was your
12
14
Had he been assigned to you, you would
A.
That is absolutely correct.
Q.
What were your feelings then when you realised that
16
Dr. Paran was providing cross cover in the absence of
17
Mr. Tareen?
18
A.
I was absolutely delighted to know that Mr. Paran was
20
helping me with my list.
122
Q.
22
10:45
Was that unusual for a different Registrar to be made
available to you just on the morning?
23
A.
Yes, it could have been any of the other three
24
Registrars or SPRs on that day.
25
fortunate that Mr. Paran was helping me.
26
extremely talented and accomplished surgeon.
27
10:44
Well, I only discovered that on the Friday morning, and
19
21
10:44
123
Q.
I considered myself
He is an
I am sorry, I was asking, Professor, was it unusual for
28
you to find yourself with a Registrar who was providing
29
cross cover on a morning, when you didn't know in
38
Gwen Malone Stenography Services Ltd.
10:45
1
advance who that Registrar would be?
2
A.
3
4
Sorry, no, that would be the norm.
That would be the
normal arrangement, yes.
124
Q.
5
So Mr. Paran was made available to you, and you were
happy to have him.
6
A.
Why were you happy to have him?
10:45
Well, Mr. Paran was the senior of the Senior
7
Registrars, the most senior.
He had recently been
8
approved for admission to the Irish Medical Council
9
Specialist Registrar Paediatric Surgery.
He had
10
returned approximately six months before from a
11
fellowship in Memorial Sloan-Kettering, where I knew he
12
would have been exposed to multiple solid tumour
13
surgeries, and when I discussed his training with
14
Dr. Michael La Quaglia, who is the Chief of Paediatric
15
Surgical Oncology in Sloan-Kettering, Dr. La Quaglia
16
was extremely complementary about his performance
17
during that year.
10:46
10:46
18
19
Mr. Paran had sat and passed the exit fellowship of the
20
European Board of Paediatric Surgery.
21
more than eight years, maybe eight and a half years in
22
paediatric surgery at that point.
23
him closely, he had been my SPR in the previous six
24
months.
25
conscientious surgeon, and I had no doubts whatsoever
26
about his ability to perform, what I regarded as a very
27
straightforward procedure.
28
29
125
He had I think
10:46
I had worked with
I knew Mr. Paran to be a dedicated and
Q.
Where did he do his medical training?
A.
Mr. Paran, I understand, went to University College
39
Gwen Malone Stenography Services Ltd.
10:46
1
Galway to do medicine.
2
secondary school in Galway as well.
3
126
4
5
127
I think he may have gone to
Q.
You had previously worked with him?
A.
Yes.
Q.
Although at that time he was the Registrar assigned to
6
one of your colleagues, is that correct?
7
A.
That's correct.
When he returned from Sloan-Kettering,
8
I think in July or August of 2007, he spent that six
9
month period with me as my SPR.
Then for the next six
10
months he was rotating through with Prof. Puri.
11
was kind of, he was in his last year of training, and
12
he was eligible from that point, within six months of
13
that point, to apply for a consultants post.
14
apply for a consultant post in Temple Street initially,
15
was unsuccessful in that, but was successful in, I
16
think February of this year, in obtaining a post as a
17
Paediatrician Surgeon in Crumlin, a position that I
18
welcomed him to, as his experience in paediatric
19
surgery and oncology would augment my practice and take
20
some of the pressure off me, I felt.
21
128
22
23
129
This
10:47
He did
10:47
10:48
Q.
Had he previously performed nephrectomies?
A.
Yes, he had.
Q.
Had he previously performed nephrectomies on patients
24
who were patients on your list?
25
26
10:47
130
A.
Yes, he had.
Q.
I want to hand you in, Professor, if I may, the listing
10:48
27
of the theatre procedures for 21st March.
28
HANDED)
29
CHAIRMAN:
(SAME
We will call this Exhibit
40
Gwen Malone Stenography Services Ltd.
1
2
16.
131
Q.
MS. BARRINGTON:
This has been redacted only
3
to remove the patient name,
4
but you have a column with the chart number, the
5
patient's date of birth, the surgeon in charge/surgeon.
6
What is the difference between "surgeon in
7
charge/surgeon"?
8
A.
9
11
Well the surgeon in charge is the consultant in overall
charge of the patients on the list.
10
The surgeon would
be a delegated SPR or SHO.
132
Q.
10:49
So, the surgeon in charge is the person on whose list
12
the patient is, and the surgeon is the operating
13
surgeon.
14
between the two?
15
A.
Is that right?
That is the distinction
Well in that column that distinction is not clear.
One
16
would have to look at the operational note to actually
17
get that final distinction.
18
133
Q.
the operation.
20
the anaesthetic and the end of the anaesthetic.
21
the operation in fact end before the time given for the
22
end of the anaesthetic?
A.
10:49
The operation type is listed, and then the timing of
19
23
10:49
There is the timing for the start of
Does
10:50
Yes, it takes approximately 10, 15, 20, sometimes
24
slightly longer, maybe 25 minutes for anaesthesia to
25
have anaesthetised the patient, put in an epidural
26
catheter for analgesia, inserted their IV lines, and
27
all of those procedures, before the surgeon can
28
actually start the procedure.
29
at least 15, 20, 25 minutes before the surgeon will
So there is a hiatus of
41
Gwen Malone Stenography Services Ltd.
10:50
1
2
start the procedure.
134
Q.
Yes.
Timing is given here for the end of the
3
anaesthesia, but I am asking you, Professor, has the
4
surgery stopped before this time, the end anaesthetic
5
time?
6
A.
Yes.
10:50
Sorry.
The anaesthetic time is when the patient
7
is awoken from anaesthesia.
8
when the abdomen or the wound, wherever that wound may
9
be, is closed.
10
135
Q.
The surgical time finishes
So the surgery presumably will have finished some
11
significant time before the time given for "end
12
anaesthesia" on this list, is that right?
13
A.
Yes.
It depends on the level of anaesthesia that has
14
been used.
15
given, the drugs they have used to retain anaesthesia,
16
and that could be 10, 15 minutes after the surgical
17
time has...(INTERJECTION).
18
136
Q.
Yes.
It depends on the medications they have
Then the procedure is listed.
them in time order, it would seem that the first
20
operation conducted on the day was the second listed,
21
chart number 535492.
That was an operation where
22
tongue tie division.
You are listed as surgeon in
23
charge and surgeon.
24
is 8:36 and the end anaesthetic 8:45.
25
short procedure?
27
137
28
29
138
10:51
If one looks at
19
26
10:51
10:51
The start time of the anaesthetic
So that was a
10:52
A.
That's correct.
Q.
Who do you think did that procedure?
A.
I did that procedure.
Q.
Then the next procedure, following the time line, it
42
Gwen Malone Stenography Services Ltd.
1
seems to be three down, chart number 542878.
2
you are the surgeon in charge.
3
surgeon.
4
time 8:54, end time 9:27.
5
again two down, chart number 481283, and there you are
6
listed as the surgeon in charge, but the operating
7
surgeon is Mr. Paran.
8
anaesthetic.
9
was put to Nurse Delaney that Mr. Paran had performed
You are the operating
That is a hernia repair.
Anaesthetic start
Then the next procedure is
End time of anaesthetic 9:35.
two short procedures in the morning.
11
was the first of those procedure?
13
139
Do you think this
I think that is correct, yes.
Q.
The next procedure where yourself and Mr. Paran are
listed is over the page, 483570.
15
anaesthetic time is 9:25.
16
hypospadias.
A.
18
19
I think it
A.
14
17
The end is 10:50.
This is a
Not in great detail, but I accept that that is the
patient on the list.
140
Q.
I think again Mr. Burke, when cross-examining Nurse
21
procedure?
22
141
24
A.
That's correct.
Q.
You recall that?
A.
I recall him helping with the case.
25
142
29
143
Q.
That was in Theatre 5?
A.
In Theatre 5.
Q.
Yes.
10:53
The details I
cannot remember in great detail.
27
28
10:53
Do you recall that procedure?
Delaney, accepted that Mr. Paran assisted you in that
26
10:53
Here the start
20
23
10:52
The start time is 9:07 of the
10
12
Again,
Yes.
So, he had come to Theatre 5 to assist you with
that case?
43
Gwen Malone Stenography Services Ltd.
10:54
1
A.
2
3
Yes.
He had worked in Theatre 7 and then he came into
Theatre 5 to assist.
144
Q.
The end of the anaesthetic time there is given at
4
10:50.
5
been concluded, from a surgical perspective?
6
A.
When do you believe that operation would have
Probably around 10:45, 10:40/10:45.
A fistula repair,
7
it is quite a straightforward repair.
8
15 minutes to do.
9
145
10
11
146
Q.
Oh yes, the hypospadias.
A.
Yes.
Q.
Yes.
10:54
It takes about
That is a fistula repair?
10:54
Then the next procedure is just above that
12
515562.
13
surgeons listed are yourself, and as operating surgeon
14
Mr. Paran.
15
anaesthetic is over at 10:06.
16
that?
17
18
147
The start anaesthetic time is 9:55.
That is a very short procedure.
The
The
Who do you think did
A.
Mr. Paran.
Q.
Then the next procedure listed is the procedure on
19
Mr. Conroy.
20
you are listed as surgeon in charge and operating
21
surgeon.
22
charge and operating surgeon?
23
A.
It is at the very start of the list, where
Because when this procedure went wrong I immediately
scrubbed in to try and salvage the case.
25
nursing staff entering the data on the computer screen
26
would have acknowledged me as the senior person there
27
doing the operating.
28
operating notes as well.
148
Q.
10:55
Why do you think you are listed as surgeon in
24
29
10:55
So the
I think that is reflected in the
Nurse Delaney's evidence, that you of course heard, was
44
Gwen Malone Stenography Services Ltd.
10:55
1
that she was in the theatre with you and that you, at
2
the end of your procedure, asked for the next patient
3
to be brought down, which was Mr. Conroy, sorry,
4
Master Conroy.
5
brought down.
6
know that that was given at 10:30.
7
had told her at that stage, which was therefore some
8
time before 10:30, that Mr. Paran was doing this
9
surgery.
10
She rang the ward and asked that he be
He had not had his premedical, and we
She says that you
Do you think her version is correct?
When do
you believe you had the conversation with Mr. Paran?
11
A.
hypospadias case would have finished, or the surgical
13
part would have finished, and I asked him if he would
14
like to do the case.
15
happy do to, and he said he would.
16
that he was going to do it.
149
Q.
I requested whether he would be
I was delighted
couldn't say whether you had already spoken to
19
Mr. Paran, because he wasn't there, but she said it
20
would be unusual for you to ask, to tell her that
21
Mr. Paran was doing the surgery if you hadn't had the
22
conversation with Mr. Paran.
23
Do you think by the time you spoke to Nurse Delaney you
24
had already spoken to Mr. Paran?
A.
10:57
When you had the conversation with Nurse Delaney, she
18
25
10:56
I had a conversation with Mr. Paran shortly after the
12
17
10:56
10:57
Do you agree with that?
I cannot be sure of the precise time.
I know that I
26
spoke to Mr. Paran before the patient in question
27
arrived in theatre, at the theatre reception area even.
28
That was after the hypospadias repair had been done.
29
So it was some time between 10:30 and 11:00 o'clock.
45
Gwen Malone Stenography Services Ltd.
10:57
1
I cannot tell you whether or not I had spoken to Olive
2
Delaney in advance of that or not.
3
that.
4
150
Q.
5
A.
7
10:58
I asked Mr. Paran if he would like to do the
nephrectomy.
151
9
Q.
What was his response?
A.
He seemed please and he said, yes, he was more than
10
11
What did you say to Mr. Paran in relation to the
performance of the nephrectomy?
6
8
I cannot recall
happy to do the procedure.
152
12
10:58
Q.
Why did you ask him to do it?
A.
Well Mr. Paran was at that point where he was
13
transiting from his Senior Registrar training into
14
consultant status, and I felt that this procedure was
15
well within his capability to do it, and as an
16
accomplished trainee I had every confidence in him.
17
think it was a measure of the confidence in him and the
18
trust that we had that he would be given this procedure
19
or asked to do this procedure.
20
153
Q.
concern about his ability to perform the operation.
22
Was that the impression you had?
A.
I
Mr. Paran, in his observations, says that he had no
21
23
10:58
Yes.
10:58
That would be not only my impression but also
24
Dr. Mannion, the anaesthetist's impression.
Very often
25
anaesthesia are the people who tell you that a trainee,
26
that they are not happy with a certain trainee doing
27
the procedure, and they will intervene in that
28
decision.
29
Mr. Paran doing the procedure.
Dr. Mannion was completely happy with
46
Gwen Malone Stenography Services Ltd.
10:59
1
154
Q.
Mr. Paran says that you didn't ask would he like to
2
perform the nephrectomy until some time after the
3
patient was anaesthetised, is that correct?
4
5
155
A.
Is it correct that Mr. Paran states that or?
Q.
I am sorry.
6
Do you believe that his version, as he has
stated, is correct?
7
A.
No, I do not.
I came back into the theatre and the
8
patient was now asleep on the table, and I asked him
9
again if he was okay to proceed.
10
156
Q.
11
So are you saying you had two conversations with
157
A.
I had two conversations.
Q.
Yes.
In the first conversation you asked him if he
14
would like to conduct the nephrectomy and he indicated
15
that he was happy to do so.
16
17
158
A.
That's correct.
Q.
Yes.
18
Is that correct?
11:00
Then you subsequently had a conversation when at
that stage the anaesthesia had been induced?
19
20
11:00
Mr. Paran?
12
13
10:59
159
A.
That's correct.
Q.
Thank you.
We know Professor the external review timed
21
the commencement of the operation, by which I mean the
22
knife to skin, as I think the surgeons call it,
23
commencement of the operation at 11:40.
24
Mr. Mannion, the anaesthetist says, while he did not
25
record it in his anaesthetic note he thinks it was
26
around 11:40.
27
time yesterday that the conversation he had with you
28
was five minutes before the operation started.
29
is not clear whether he means five minutes before the
Mr. Paran said I think for the first
47
Gwen Malone Stenography Services Ltd.
Now it
11:00
11:01
1
knife to skin or 5 minutes before the anaesthesia was
2
induced.
3
saying that he was asked five minutes before, and I am
4
sorry to put it crudely, but to distinguish the time
5
frame before knife to skin, then he is saying that he
6
was...(INTERJECTION)
7
MR. MEENAN:
Could I just possibly --
8
MS. BARRINGTON:
Yes.
9
MR. MEENAN:
Intervene here, because I
That remains to be clarified, but if he is
10
think when I put the matter
11
to Mr. Wheeler yesterday, I put it to him very
12
specifically that this conversation took place after
13
anaesthesia had been introduced, because I put to
14
Mr. Wheeler the sequence of events which was namely
15
that Mr. Paran went back to 5, the patient was being
16
induced.
17
catheterise the patient, which he did, and he was then
18
turning to leave.
19
about what I put, which was to the effect that the
20
conversation I say took place took place after
21
anaesthesia had been induced.
22
MR. LEONARD:
11:02
11:02
The anaesthetist asked Mr. Paran to
So there is absolutely no dispute
11:02
That is also my memory of
23
24
11:01
that.
MR. MEENAN:
That is entirely clear from
25
the questioning, and I
26
think my friend is incorrect to say that there is a
27
dispute there.
28
MS. BARRINGTON:
Yes.
29
MR. CROSS:
It is a dispute between the
48
Gwen Malone Stenography Services Ltd.
11:02
1
2 witnesses.
2
MR. MEENAN:
No, no I think Mr. Cross
3
what had been put to the
4
witness was it was not clear--
5
MR. CROSS:
That's right.
6
MR. MEENAN:
Whether the conversation
7
took place either before
8
anaesthesia or after anaesthesia, and I put very
9
specifically it took place after anaesthesia.
10
160
Q.
MS. BARRINGTON:
I am grateful to Mr. Meenan
11
One of the questions, and perhaps there are other
13
questions that make it clearer that I did not
14
appreciate.
15
Mr. Paran in this case is that he was told he was going
16
to be doing this elective nephrectomy on the child less
17
than five minutes before the operation.
18
page 103, question 250, but it seems, and I am grateful
19
for the clarification, that what is being said by
20
Mr. Paran is that he was asked by you to perform this
21
nephrectomy five minutes before the knife to skin,
22
which is about 11:35.
23
A.
24
He said to Mr. Wheeler the evidence from
11:03
That is at
11:03
What do you say about that?
I would have to dispute that.
That is not my
recollection of events at all.
161
Q.
26
27
11:03
for that clarification.
12
25
11:03
What did you, when you asked Mr. Paran to perform the
nephrectomy, what did you expect Mr. Paran to do?
A.
I expected to see Mr. Paran after the case was
28
finished.
I expected that Mr. Paran would take over
29
all aspects of management of the case, as he had done
49
Gwen Malone Stenography Services Ltd.
11:04
1
many times before.
2
difficulty whatsoever with him doing the case or the
3
procedural aspects of the case.
4
expectation that everything would be done properly.
5
162
Q.
I expected that there would be no
I had every
When you say "everything would be done properly", can I
6
ask you to be a little bit more specific.
7
documentation would you have expected Mr. Paran to have
8
had regard to?
9
10
163
The consent, patient identity and the imaging.
Q.
And what would you have expected him to have done with
A.
13
I would have expected him to confirm that the correct
side was the left side.
164
Q.
And how would he have gone about doing that?
Should he
15
have, for example, in your view placed the images on
16
the, is it the image box or the x-ray box?
17
18
165
19
A.
The x-ray screen.
Q.
The x-ray screen?
A.
Yes, he could have done that or he could have taken the
20
images out of the packet and looked at them against the
21
light.
22
166
Q.
really matter whether he put it on the box or not, and
24
that different practitioners have different ways of
25
doing it, is that your view?
26
A.
27
29
That is correct, but normally the x-rays are left on
the box during surgery.
167
11:05
11:06
Mr. Wheeler has expressed the view that it did not
23
28
11:05
the imaging?
12
14
What
A.
11
11:05
Q.
Can you describe this box for us?
A.
It is just an...(INTERJECTION).
50
Gwen Malone Stenography Services Ltd.
11:06
1
168
2
Q.
In particular in theatre 5?
A.
It is an illuminated surface, back light, shining
3
4
through the surface which highlights the x-ray picture.
169
Q.
5
performing a nephrectomy?
6
7
170
8
9
What is your practice in relation to imaging when
171
11:06
A.
I would like to have the images there all the time.
Q.
Do I take it from that, that you mean on the box?
A.
On the box.
Q.
Do you believe that Mr. Paran knew that for this type
10
of surgery it was necessary to have regard to the
11
imaging?
12
A.
I would be very surprised if Mr. Paran did not know
13
that given his level of experience and training and his
14
track record to that date.
15
would have known the importance and value of looking at
16
the at x-rays, and also in the context of parental
17
concern, reviewing the x-rays at that point also.
18
172
Q.
I believe that Mr. Paran
when he did the ward round in the morning, he was
20
conscious of the need for the x-rays for surgery?
A.
22
23
I believe so.
11:07
I think he was acting properly and with
best practice in mind at that time.
173
Q.
24
25
11:07
Do you consider that as Mr. Paran wanted the x-rays
19
21
11:06
In terms of timing of the commencement of knife to
skin, who dictates the starting time?
A.
The surgeon dictates the start time.
There is never in
26
elective situations, whilst there may be pressure to
27
get through the list, the surgeon has to be sure that
28
he is operating on the right side and in the right
29
context.
So the surgeon decides when the list starts
51
Gwen Malone Stenography Services Ltd.
11:07
1
or the case starts.
2
responsibility.
3
174
Q.
Knife to skin is the surgeon's
Yes, and we have heard -- the Committee has heard from
4
Nurse Delaney and Mr. Mortell and Nurse Davey, that
5
they all went to look for the images when the patient
6
was brought to the reception.
7
they all went to look for the images?
8
A.
9
Why do you believe that
I think they were all being helpful, but they also had
an instinctive belief that the images were important as
10
part of the procedure.
11
that is actually a surgical belief.
12
175
Q.
I think in Mr. Mortell's case
trolley while the parents were still conversing with
14
Mr. Paran, and that she caught Mr. Paran's eye and
15
said, "you have everything now Sri" I think she said.
16
So there seems to be no doubt but that the images were
17
on the trolley before the patient was brought into
18
theatre, is that not correct?
19
176
A.
I think that is correct.
Q.
If Mr. Paran had believed that he required more time to
21
prepare before commencing the knife to skin part of the
22
operation, what should he have done?
23
A.
Mr. Paran had every opportunity to say, hold on, let us
25
pause for a minute, let us review the x-rays first.
177
Q.
11:09
11:09
I think with his level of experience and training,
24
26
11:08
And Nurse Delaney says the images were placed on the
13
20
11:08
In terms of familiarising himself, as you have said he
27
should have done, once he was asked to perform the
28
surgery with the documentation, including the imaging.
29
How much time does that take?
52
Gwen Malone Stenography Services Ltd.
11:10
1
A.
Well, ideally one should have longer than a few
2
minutes, but it does essentially take one or 2 minutes
3
to actually look up an x-ray.
4
178
Q.
How much time do you believe at a minimum that
5
Mr. Paran in fact had between the time when you asked
6
him to perform the nephrectomy, and the knife to skin
7
time?
8
A.
9
11:10
I think he had at least 30 minutes, considering that
the procedure started at 11:40.
That is knife to skin.
10
By time line estimate and Dr. Mannion's estimate, the
11
patient arriving in theatre at around 11:05 perhaps.
12
know that somewhere between the end of the hypospadias
13
case and 11:00 o'clock, I would have asked Mr. Paran if
14
he wished to do the procedure.
15
minutes in that window to look at imaging and discuss
16
procedure.
17
18
179
Q.
11:10
I
So there is at least 30
11:11
How do you think you relate to junior staff?
MR. MEENAN:
Could I just possibly
19
intervene at this stage,
20
and there may well be a difficulty here insofar as
21
virtually none of this was put to the expert by my
22
friend to Mr. Wheeler, most critically the suggestion
23
that Mr. Paran had at least 30 minutes to prepare for
24
this operation.
25
MR. CROSS:
But is that something that
26
should have been put to the
27
expert, because it is a matter of fact for the
28
Committee to decide how long that is the case.
29
MR. MEENAN:
I appreciate that, but what
53
Gwen Malone Stenography Services Ltd.
11:11
11:11
1
appears to be happening now
2
is that Prof. Corbally is now effectively being used as
3
an expert witness in allegations of professional
4
misconduct against Mr. Paran, and I say that is
5
fundamentally wrong.
6
to...(INTERJECTION)
7
MR. CROSS:
That should have been put
11:12
I mean I think the
8
Professor is being used as
9
a witness and he is giving opinions certainly in his
10
own defence.
11
MR. MEENAN:
11:12
On the basis that attack is
12
the best form of defence.
13
MR. CROSS:
No, no, Mr. Meenan.
14
I
think that, yes, certainly
15
and it was flagged yesterday that there was a
16
difference between the likely evidence as to the time
17
that your client was told to do the operation, or asked
18
could he do the operation and that may have
19
implications in relation to your --
20
MR. MEENAN:
Yes.
21
MR. CROSS:
But I think the other
22
11:12
matter is matters of his
23
defence, I think.
24
MR. MEENAN:
We will just see how
25
matters develop.
26
MR. CROSS:
We will see how matters
27
28
11:12
develop.
180
Q.
MS. BARRINGTON:
Very good.
29
I am sorry I am
just trying to recall the
54
Gwen Malone Stenography Services Ltd.
11:12
1
question I was going to ask you, Professor.
2
asked you how do you think you relate to junior staff
3
or staff more junior to you?
4
A.
Yes, I
Well, I hope that I relate well to junior staff.
I
5
think that I am level headed and balanced, and I think
6
that it is not that long ago really that I was a junior
7
doctor myself, and I always think that it is important
8
that you put yourself in their shoes when you are
9
dealing with the difficulties they have to deal with on
10
a regular basis.
11
think that I have standards, and those standards should
12
be met, but standards can be met in an approachable
13
rather than a dictatorial way, and that is the way I
14
would like to think my practice runs.
15
least bit dictatorial or aggressive or authoritarian, I
16
believe, personally.
17
181
Q.
So I think I am approachable.
I
11:14
If Mr. Paran was in any way uncomfortable in relation
to performing the nephrectomy, whether for timing
19
reasons or otherwise, what do you think he should have
20
done?
A.
11:13
I am not in the
18
21
11:13
11:14
I think Mr. Paran should have spoken to me.
Our
22
relationship was many faceted actually because I would
23
have regarded Mr. Paran as a friend, not only as a
24
colleague.
25
say I have a problem or I am concerned, and to sit down
26
together and review that problem.
27
option and it is an option with anyone in my practice
28
to do that.
29
actually say, look, we have a problem, to bring it, to
So I think that it was always possible to
That is always an
In fact our trainees are encouraged to
55
Gwen Malone Stenography Services Ltd.
11:14
1
highlight the issue.
2
if a trainee does that at any level.
3
182
Q.
There is no criticism whatsoever
Mr. Meenan emphasised two matters yesterday in his
4
cross-examination of Mr. Wheeler, which he seemed to
5
have been suggesting illustrated the fact that
6
Mr. Paran was not being allowed sufficient time, or
7
that this delegation should not have happened when it
8
did happen.
9
was for Mr. Paran to do what I think it is referred to
11:15
The first of those is that he said that it
10
as "the group and hold" in relation to bloods.
11
the normal procedure in relation to performing group
12
and hold for blood?
13
A.
What is
It is standard operational policy that when a patient
14
is admitted for a procedure of this type, that blood
15
will be sent the day before to the lab for a group and
16
hold.
17
identified, and serum is preserved, the sample is
18
preserved for subsequent cross-matching against a unit
19
of blood, should the need arise to transfuse a patient.
20
We do not routinely group and cross-match, ie., pick a
21
designated unit of blood for that patient for
22
nephrectomies because blood less is typically quite low
23
in nephrectomies.
24
25
183
11:15
11:16
That means that the patient's blood group is
Q.
What is the normal blood loss for a nephrectomy?
A.
For a straightforward nephrectomy I would say about
26
25/35 mls.
I would cross-match blood for a Wilms'
27
Tumour, only if that tumour was extending into the
28
inferior vena cava or if there were significantly
29
pre-operative invasion of the liver, for example, then
56
Gwen Malone Stenography Services Ltd.
11:16
11:16
1
I would definitely need blood in that situation, but
2
otherwise if you cross-match blood and you don't use
3
it, the blood has to be thrown out.
4
very very valuable resource.
5
184
Q.
It is a waste of a
In this case I think the chart shows that one of the
6
pre-operative tasks in the nursing care was to perform
7
a G & H, that is group and hold, is it?
8
9
185
A.
Yes, group and hold, yes.
Q.
That is at page 50 of the chart.
10
12
You might please look
at that Prof. Corbally?
11
186
11:17
A.
Yes.
Q.
And then the nurses record at page 52 that on the 21st
13
the care was as per plan.
14
the second entry there for 20th March, 22 hours, shows
15
that the group and hold was done?
16
17
187
If you turn over to page 53,
11:18
A.
That's correct.
Q.
What do you think happened in this case in relation to
18
the group and hold?
19
A.
Occasionally the blood bank will run into problems with
20
the group and hold.
I am not quite sure what technical
21
problems they have.
I am not an expert on blood
22
cross-matching, but very often they will ask for a
23
second sample to be sent down and that second sample
24
then would be used to group and hold the patient or
25
cross-match if necessary.
26
27
11:17
188
Q.
Who takes the sample?
A.
We have a phlebotomy service in Crumlin.
11:18
So if it was
28
during regular working hours, they would take the
29
sample, but if that problem was highlighted
57
Gwen Malone Stenography Services Ltd.
11:18
1
intra-operatively, then the anaesthetist generally
2
would take the sample.
3
189
Q.
4
So is a request for a second group and hold
something that is directed to the anaesthetist?
5
6
Yes.
190
A.
Well, it may be or it may be directed to the surgeon.
Q.
But would it be fair to say that in circumstances where
7
the group and hold was done on the 20th, a request for
8
a second group and hold is not in any way indicative of
9
a lack of preparation of the list?
10
11
191
A.
Not at all, no.
Q.
What is the position in relation to the provision of
11:19
12
assistance?
13
asked outside the theatre by Mr. Paran to make himself
14
available to assist Mr. Paran in the surgery that he
15
was to perform.
16
that it was, perhaps I am overstating it, but somehow
17
irregular for Mr. Paran to have been asked to perform
18
the nephrectomy in circumstances where an SHO had not
19
been formally assigned to him.
20
does a registrar get his assistant?
21
A.
We have heard from Dr. Mohamed that he was
Again, Mr. Meenan seemed to suggest
How does it work?
23
contact an SHO or a fellow registrar to come to theatre
24
and assist, or he may also ask the senior nurse or one
25
of the circulating nurses to call for an assistant to
26
come to theatre, and Mr. Paran would recognise that as
27
best practice and indeed did that.
29
Q.
11:20
Well, the surgeon, the operating surgeon recognises the
need for an assistant and then either will directly
192
11:19
How
22
28
11:19
Is it, therefore, a part of your function to organise
the SHO for the registrar?
58
Gwen Malone Stenography Services Ltd.
11:20
1
A.
No, it is the operating surgeon's responsibility to a)
2
recognise the need for an assistant and b) to secure
3
one.
4
193
Q.
Dr. Mohamed told us that he came and assisted in the
5
surgery which had at that stage commenced, in that the
6
incision had been made, and that during the course of
7
the surgery Mr. Paran appreciated that the kidney
8
looked normal.
9
cross-examination that Mr. Paran had been having a
We have heard from Mr. Meenan's
10
difficulty, in that the incision he said was too small.
11
Were you made aware of any of these difficulties?
12
13
194
14
A.
No.
Q.
Where were you while the surgery was ongoing?
A.
Initially I went to see a patient in intensive care.
15
Then I had some calls to make in relation to queries
16
from patients, and then I was doing some chart work in
17
the surgical dictation room which is just outside
18
theatre 5, about 15 feet away.
19
195
Q.
the performance of the nephrectomy, what would you have
21
expected him to do?
A.
colleagues.
24
of any difficulty or trouble, and I would have expected
25
Mr. Paran to call me if there was any difficulty
26
whatsoever.
196
Q.
11:21
11:22
Well, colleagues are what they are, they are
23
27
11:21
If Mr. Paran had encountered any particular problems in
20
22
11:21
They are meant to be called in the event
11:22
I am skipping back a little in time, Professor, and I
28
am sorry, there is something I should have addressed.
29
You said you had 2 conversations with Mr. Paran.
59
Gwen Malone Stenography Services Ltd.
The
1
first you asked Mr. Paran was he happy to conduct the
2
surgery, and you understood that he was and he says in
3
his observations, he had no concerns.
4
had you said a second conversation with him, can you
5
outline for the Committee what was that second
6
conversation?
7
A.
Subsequently you
The second conversation occurred when the patient was
8
asleep on the table, anaesthetised, and I think
9
Mr. Paran had just finished catheterising the patient.
10
We were positioning the patient for surgery, I think he
11
had put a roll under the patient's side to elevate the
12
left side.
13
do it through a lower incision, which I thought would
14
be difficult to do the case through the incision, not
15
impossible, but difficult, and I suggested that he make
16
a left upper quadrant transverse incision which would
17
gain access to the left kidney.
18
197
Q.
19
I think he indicated that he was going to
A.
Well, I think as surgeons we are always conscious of
the effect of scars on appearance, and I think
22
Mr. Paran was thinking of trying to make it as
23
cosmetically attractive as possible.
198
Q.
25
199
28
200
11:23
And you then said to -- I am sorry I did not quite
catch the description you gave of the incision?
26
29
11:23
Can you recall the basis upon which he indicated to you
21
27
11:23
that he was proposing using the old scar?
20
24
11:23
A.
Yes, an incision that goes parallel to the body line.
Q.
Yes.
A.
In the left upper quadrant, under the left rib cage.
Q.
Yes.
So were you saying to him he could not use the
60
Gwen Malone Stenography Services Ltd.
11:24
1
old scar?
2
A.
I was saying that I thought he should not use the old
3
scar.
4
other scar.
5
but you would have to extend it significantly to access
6
--
7
201
Q.
8
I thought it would be better if he used the
You could use the lower scar and extend it
I think you said "the other scar", do you mean to
create a new scar?
9
A.
No, the patient had a left lower quadrant scar from his
10
previous colostomy.
11
had his repair of the congenital anorectal problem, and
12
that colostomy was subsequently closed.
13
scar there just below the umbilicus.
14
that incision would be too low to gain access to the
15
kidney.
16
202
Q.
He had a colostomy at the time he
So I thought that
11:25
It may be suggested by Mr. Paran that because you had
this conversation, he did not understand that there had
18
been a full delegation of the surgery to him.
19
ask you to comment on that?
20
A.
Can I
Well, I think it is implicit in asking a colleague of
21
seniority like Mr. Paran, that if you agree to do the
22
procedure that is you are accepting delegation of the
23
procedure.
24
discussion, that he was very happy to do the procedure
25
and delegation was an efficient process.
203
Q.
27
28
29
11:25
That is what I understood by the
Do you think the conversation you had in relation to
the scar changed that dynamic in any respect?
A.
11:24
So there was a
17
26
11:24
It might have changed the dynamic if I was going to be
physically involved in the procedure, but there was no
61
Gwen Malone Stenography Services Ltd.
11:25
1
intention or suggestion that I would be.
2
with Mr. Paran to do the operation.
3
204
Q.
4
Can I ask you to look at Mr. Paran's operation note?
That is at page 70 of the booklet?
5
6
It was still
205
A.
Yes.
Q.
Mr. Paran states at the start of the operation note,
11:26
7
the third line down, that "consent and chart notes
8
checked for side".
9
on his part at the commencement of the surgery that he
10
should verify the laterality?
11
12
206
13
These notes were written after the event.
Q.
Yes.
A.
So it may reflect that process was highlighted in his
mind.
207
Q.
16
But what he checked and what he records that he checked
208
A.
That's correct.
Q.
That does, does it not, demonstrate a consciousness
19
that...(INTERJECTION)
20
MR. LEONARD:
I think the witness has
21
11:27
given his
22
answer...(INTERJECTION)
23
MS. BARRINGTON:
No, I accept that.
24
I
accept that.
25
MR. MEENAN:
I think there has to be a
26
limit to the leading
27
28
11:27
at the outset is the consent and the chart notes?
17
18
11:26
A.
14
15
Does that indicate a consciousness
questions, and we have reached it.
209
Q.
MS. BARRINGTON:
No, very good.
29
that.
I accept
What do you think
62
Gwen Malone Stenography Services Ltd.
11:27
1
Mr. Paran should have done when he considered that the
2
kidney was normal?
3
A.
He should have paused.
He should have taken stock of
4
the situation.
5
be put on the screen if he was not willing to unscrub
6
and handle the x-rays himself, and he should have asked
7
for me to be brought to the theatre immediately.
8
210
Q.
9
He should have asked for the x-rays to
Mr. Meenan says Mr. Paran did pause, and he did ask I
think Dr. Mohamed to look at the consent form and the
10
chart.
11
A.
Do you have any criticism of that?
at theatre reception.
13
back to check the chart again.
14
to refer -- at that point it is not too late to refer
15
to the core reference, which are the images and the
16
images would have clarified the situation.
211
18
19
212
20
21
213
22
23
214
24
So there was no point in going
At that time you have
Q.
The images?
A.
The x-ray images.
Q.
I am sorry?
A.
Would have clarified.
Q.
Would have clarified?
A.
The situation.
Q.
When were you called in?
A.
Dr. Mannion called me in in fact.
He asked me to go
into theatre 5 and discreetly check the procedure,
26
because there was some more bleeding than normal and
27
that would have been maybe 45 minutes later, about 45 I
28
would say after the procedure had started.
215
Q.
11:28
11:29
25
29
11:28
Well, I think Mr. Paran had already looked at the chart
12
17
11:28
Can you indicate to the Committee what happened when
63
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1
you came in to theatre 5?
2
A.
I went through the anaesthetic room, which is
3
anaesthetic room 5, which is beside theatre 5's door.
4
I stood at the door and asked -- I had noted that in
5
the suction bottle there was more blood than I would
6
have normally expected in a routine nephrectomy, and I
7
asked Mr. Paran was he okay and he said he was.
8
some bleeding but it was under control.
9
the kidney was delivered to the surface of the
He had
At that point
10
abdominal wall, and to me standing at the door it
11
looked as if it was a normal kidney, and I said such to
12
Mr. Paran that I thought the kidney looked normal, have
13
you checked the x-rays?
14
216
Q.
There was a suggestion made through Mr. Meenan
yesterday that maybe Mr. Paran may have thought,
16
although it is not articulated in his observations,
17
that this was a baggy kidney.
18
if he had a concern that this was a baggy kidney?
A.
20
21
Q.
22
23
11:30
What should he have done
Well, he should have consulted the x-rays and he should
have called me.
217
11:30
He replied that he had not.
15
19
11:29
11:30
What did you do then when Mr. Paran said he had not
looked at the images?
A.
I was initially shocked by this and shocked by the
24
concept that this was a normal kidney, but I
25
immediately pulled the x-rays from the packet and put
26
them on the screening box and asked someone to review
27
the report.
28
not in the chart, and I believe he was the one who went
29
to x-ray, to produce an official report, whilst I was
I think Dr. Mannion said the report was
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looking at the imaging.
Looking at the imaging it was
2
immediately apparent that the left kidney was in fact
3
the kidney contributing 91% of function on the DMSA
4
scan, and in fact that the wrong kidney had been
5
devascularised.
6
Mr. Paran tied off the ureter at this point and removed
7
the kidney.
8
MR. LEONARD:
So I immediately scrubbed in.
Sorry, I did not catch, Mr.
9
Paran --?
10
11
218
A.
Mr. Paran tied off the ureter and removed the kidney.
Q.
MS. BARRINGTON:
the kidney?
13
A.
The blood supply to the kidney had already been
14
divided.
15
point.
219
Q.
So the kidney was devascularised at this
11:32
It may be helpful for the Committee if we were to hand
17
in an image of the kidney to fully appreciate at what
18
stage the surgery was at when Prof. Corbally entered
19
the room.
20
CHAIRMAN:
17.
Q.
MS. BARRINGTON:
17.
A.
So the diagram shows that there is a renal artery and a
21
22
11:31
At what stage did he remove
12
16
11:31
220
That is exhibit?
11:32
23
renal vein, which are marked, and the ureter which is
24
also marked.
25
the kidney in terms of nephrectomy.
26
structures that have to be divided and tied to remove
27
the kidney.
28
artery, and to remove the kidney one has to tie off the
29
renal vein and the renal artery and then tie off the
These are the 3 important components of
They are the three
The renal vein lies in front of the renal
65
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ureter and divide the ureter.
2
3
When I entered the theatre, the renal artery and the
4
renal vein had been already tied off and divided, and
5
the kidney was now lying on the surface of the abdomen
6
attached only by the ureter, and the ureter was then --
7
when I was looking at the imaging Mr. Paran tied off
8
the ureter.
9
221
Q.
10
A.
12
13
11:33
I don't think it would have interfered or influenced
the viability at that stage.
222
Q.
14
And that is because the blood supply through the artery
and vein had been gone for some time, is that correct?
15
16
And did the tying off of the ureter impact on the
viability of the kidney?
11
223
A.
I believe so.
Q.
Mr. Mannion has taken us through what happened then and
11:33
17
the attempts to re-implant the kidney and the
18
involvement of the Beaumont team.
19
move on to your conversation with the parents after,
20
which I think was at about 3:30 or 4:00 o'clock, is
21
that correct?
22
23
224
Can I ask you to
A.
It would have been around that time, yes.
Q.
The nursing notes at page 56 record a request timed at
24
3:30 or rather a call at 3:30 from you requesting to
25
meet with Master Conroy's parents on the ward.
26
just briefly outline to the Committee what you said to
27
the parents?
28
29
11:33
A.
Can you
I had attempted to re-vascularise the kidney and had
achieved a very good arterial anastomosis, with free
66
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11:34
1
blood running through the kidney, but unfortunately
2
there was some coagulation within the kidney beyond the
3
arterial anastomosis, which was confirmed...(inaudible
4
due to coughing) while the anastomosis was intact,
5
unfortunately the kidney itself was not viable.
6
that point we had Ms. Dilly Little, who is a renal
7
transplant surgeon in Beaumont in attendance, and she
8
advised that we should not leave this kidney in place,
9
that it should be removed because of potential for
So at
10
complications with this kidney.
So I had a very sad
11
and difficult task to tell both of the parents and
12
explain, as best I could, that an error had occurred
13
and that the wrong kidney in fact had been removed and
14
that I had attempted to revascularise the kidney, but
15
that our attempts had been unsuccessful.
16
profoundly and profusely to the parents, and the memory
17
of that conversation will live with me for a long time.
18
They were absolutely devastated and distraught by this
19
news.
I apologised
20
I advise that on further consultation, not only from
22
the transplant team, but from my colleagues within the
23
hospital, that the kidney as it now was was not
24
functioning and was not likely to function, and could
25
be a source of problems to the child in the next few
26
days, and that the advice was that the kidney should be
27
removed.
29
11:35
11:36
11:36
21
28
11:35
225
Q.
And the parents say that they did not appreciate during
the course of that conversation that you did not
67
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1
perform the surgery.
2
explain to the Committee why you apologised and why you
3
did not elaborate on your role in relation to the
4
surgery?
5
A.
You apologised to them.
Can you
I felt that the right thing to do was to apologise to
6
the parents and explain that an error had occurred, and
7
not at that point to make the situation worse by trying
8
to blame somebody else for the procedure.
9
the details would emerge in due course, and that that
I knew that
10
would be the right time to have -- that the right
11
information would be available at that time, but I felt
12
that ethically I had a responsibility to accept
13
responsibility for this procedure and for the mishap
14
that occurred.
15
any further pressure at that time by adding someone
16
else into the equation and blaming somebody else for
17
this procedure.
18
226
Q.
20
occurred here.
21
that report, Professor?
22
it.
23
tab 6.
24
report and the heading "contributory factors".
25
agree with the thrust of this report?
227
28
29
228
11:37
The independent review, Professor, has identified a
number of contributory factors in relation to what
27
11:37
I did not want to put the parents under
19
26
11:37
Can I ask you to look very briefly at
11:38
I am sorry, you do not have
It is in the core booklet and I think it is behind
I am looking, Professor, at page 4 of the
Do you
A.
Absolutely, yes.
Q.
Is there any personal criticism of you in this report?
A.
Not that I am aware of.
Q.
The contributory factors are identified at page 4 under
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the heading "contributory factors".
2
listed.
3
years earlier had not been identified and corrected.
4
That is the report of 8th February 2002, is that right?
5
6
229
At one, an incorrect imaging report from 6
A.
That's correct.
Q.
Is it your view that that incorrect background might
7
11:39
have contributed to your human error?
8
9
Ten of them are
230
A.
It is possible that it may have.
Q.
The second contributory factor is the delay in filing
10
hard copy x-ray reports in the medical records, and
11
lack of reference to an electronic copy.
12
issue that continues to be a problem in the hospital?
13
A.
Is that an
This is a very significant issue for the hospital to
14
deal with.
15
agreed to implement all of the findings and
16
recommendations of this independent report,
17
nevertheless as of February of this year there are
18
18,000 unfiled reports and letters in the hospital
19
system.
20
hospital to appoint a filing clerk purely to actually
21
file these appropriately, but they have only recently
22
started to try and cope with a significant backlog of
23
reports and letters.
24
issues and my secretary was not allowed, well, not
25
given the actual proper system to file and that
26
resulted in industrial action last year, which happily
27
is solved at this point.
28
29
231
Q.
11:40
Whilst the Hospital Board have accepted and
11:40
I have been trying very hard to encourage the
11:40
There have been secretarial
The third contributory factor is identified as the fact
that there was no failsafe system to ensure that a
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patient undergoing removal of a major organ was
2
discussed in a multi-disciplinary setting, as the
3
consultant had intended.
4
about that, Professor.
5
allegations as they now stand.
6
stage to have a multi-disciplinary discussion in
7
relation to the necessity to perform a nephrectomy?
8
9
A.
I have not actually asked you
It does not form part of the
Did you intend at any
11:41
Not in so much as the necessity to perform a
nephrectomy.
We had a situation of severe recurrent
10
urinary tract infections.
A child on prophylactic
11
antibiotics, being extremely sick with these infections
12
and having demonstrated a function of less than 10% in
13
a scarred kidney.
14
kidney should be removed.
11:42
By any, any standard that means the
15
11:42
16
I wrote to a radiology colleague asking that the images
17
be reviewed in relation to bladder function, because I
18
felt the bladder function may have contributed to this
19
problem, although he had very insignificant bladder
20
symptomatology and on the ultrasound also said the
21
bladder was normal.
22
radiology colleague, it does result in a discussion of
23
the imaging or the case and that discussion usually
24
takes place in either the radiologist's office, or the
25
radiologist brings that to our Wednesday morning
26
multi-disciplinary meeting, which is attended by x-ray
27
staff and the surgical teams.
28
intention, by alerting radiology, that there was a need
29
for discussion of this patient of the images and
11:42
Normally when one writes to a
So it would have been my
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Gwen Malone Stenography Services Ltd.
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2
results of this patient.
232
Q.
But that discussion, if I have understood you
3
correctly, was you envisaged a possible discussion in
4
relation to bladder functioning?
5
6
233
7
A.
Yes, as a discrete problem, yes.
Q.
Yes, and why did that discussion not occur?
A.
I cannot answer that.
8
9
11:43
The radiologist question did not
receive -- states he did not receive the letters.
234
Q.
The fourth contributory factor is that patients are
10
admitted outside normal working hours.
11
radiology is not normally sent to the ward or the
12
theatre, and I think that is the policy you indicated
13
that the hospital had introduced, that the x-rays do
14
not go with the patient through the patient's journey,
15
is that right?
16
A.
That's correct.
The fifth that
11:43
We have had several meetings with
17
radiology subsequent to this, and radiology will still
18
not release x-rays to the ward.
19
the PACS system, but x-rays, all x-rays, no matter
20
whether they were done 6 months before or 2 years
21
before on a patient, if the patient is having surgery
22
all x-rays are brought to the theatre on the day of
23
surgery.
24
235
Q.
They are waiting for
generally taken by surgeons not competent to perform
26
the procedure, and I think that is the taking of
27
consent by an SHO.
28
patients in Crumlin?
A.
11:44
The sixth contributory factor was that consent is
25
29
11:43
Do the SHO's continue to consent
Yes, but in this case the SHO who took consent was
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actually quite competent to take consent, and I have
2
issue with the statement as written here.
3
who took consent, had over 7 years of experience in
4
paediatric surgery.
5
registrar level in Saudi Arabia, and the content of his
6
consent, the description of potential complications was
7
quite reasonable for an SHO.
8
have is that Dr. Ghallab did not inform of any concerns
9
nor did he take the opportunity to look at the computer
Dr. Ghallab,
At least one of those was at a
The only issue I would
10
on the ward to review the radiology report.
11
time if a patient is admitted out-of-hours, the SHO,
12
who may not be a surgical SHO on the general surgical
13
team, will take consent for admission, but the
14
following morning consent will be either by myself or
15
the SPR.
16
236
17
Q.
Or the SPR?
A.
Yes.
Sorry, that is for major cases.
day cases.
19
consent is taken by the SHO.
237
Q.
At this
It is not for
Generally speaking day cases are, yes, the
The next contributory factor identified is that the
21
person taking consent for a procedure will not normally
22
review imaging.
23
planning for cross-cover is identified as a factor, and
24
I think that relates to the fact that Mr. Paran was
25
only made available to you on the morning of this day,
26
is that correct?
27
A.
11:45
11:45
18
20
11:45
11:45
8, SPR hours and workload and lack of
That's correct, because the list goes into theatre the
28
day before surgery and I would generally look at that
29
list and review the list with an SHO or my own
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1
Registrar, but on the day in question of course
2
Mr. Farhan Tareen was away and Mr. Paran would not have
3
been with me on the day before surgery.
4
no opportunity to review the list with the registrar
5
who was actually helping on the day.
6
238
Q.
So there was
11:46
The next factor is that the hospital had no site
7
marking policy or common practice, can you just briefly
8
say what that relates to?
9
A.
Well, that is correct.
We advocated sight marking but
10
it was not always enforced or it was difficult to
11
enforce, but it is now strictly enforced that no
12
patient will come to theatre without the proper siting
13
marking.
14
239
Q.
Ten, the operation and planning of a parallel theatre
15
list.
16
external review was critical, to some degree, of the
17
operation of parallel lists but do they continue to
18
some extent to be a fact of life in Crumlin?
19
A.
I think you alluded to this earlier on, that the
No, the second list is no longer available.
general surgeons have given up their second lists and
21
we have one theatre only per list.
22
would have all day theatre lists.
23
Monday, Wednesday and Friday.
24
consultants or half time consultants, they work in
25
Temple Street and/or Tallaght.
26
list allocated to them.
240
28
29
241
11:47
All the
20
27
11:47
11:47
So Mr. Quinn and I
I am there on
The other part-time
They would have one
Q.
I am sorry...(INTERJECTION)
A.
One theatre.
Q.
I was not clear about that, and is that as a result of
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the appointment of new staff?
2
A.
Well, it is to facilitate the appointment of new staff,
3
but it is also in recognition of the problems that
4
simultaneous theatre sessions have.
5
242
Q.
I think the view was expressed to the external review,
6
it is at page 11 of the report by the head of
7
department and that is Prof. Puri, is it?
8
9
243
A.
At that time Prof. Puri, yes.
Q.
Prof. Puri it is referred to.
10
The last paragraph at
page 11 that:
11
11:48
"The head of department felt at the
time that without parallel lists the
department would not be able to keep
pace with its service commitments?"
12
13
14
A.
That's correct.
As a result -- well, he have increased
15
our complement by one part-time surgeon and we are
16
hoping that Mr. Paran will start soon.
17
a total of 5 surgeons in Crumlin, 2 full-time, 3
18
part-time and that may well take some of the pressure
19
off our list, but we have tried to reduced our service
20
commitment.
21
waiting lists but that is unavoidable.
22
244
Q.
Unfortunately, that means extending
11:49
The external review made a number of recommendations,
and I don't propose going through them, Professor, but
24
have you personally taken steps to seek, insofar as you
25
can, to implement the recommendations?
A.
11:48
So we will have
23
26
11:48
I am 100% compliant with the concept of time out
27
surgical pause, which means that before the procedure,
28
the surgical procedure begins, the patient is
29
identified, any problems with the patient are
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identified.
If there is outstanding x-rays, the x-rays
2
are there.
3
as yet sort out pre-admission clinics.
4
staff costs implication.
We have addressed it with
5
hospital administration.
They are not able to oblige,
6
to sort that one out just yet.
7
theatre, not to the ward.
8
radiology sent to the ward, but we are assured that we
9
will have a PACS system next year.
The x-rays have to be reviewed.
We cannot
There is a
11:50
Radiology is sent to
We have not been able to get
The consent issue,
10
as I have addressed already, is not taken by anyone not
11
competent to take consent.
11:50
12
13
There is another issue too in that Mr. Quinn and I met
14
with senior management months before this incident and
15
advise that there was a serious problem in the medical
16
records department, and that there was a significant
17
and unacceptable delay in filing reports.
18
advice that a crisis was waiting to happen, and that we
19
were assured that the issue would be addressed, but
20
unfortunately it took several months for that to be
21
addressed.
22
23
245
We did
Q.
How did you feel after this?
A.
Personally devastated by this, by the entire event.
11:51
I
24
must say that I felt that I had let this child down.
25
felt the surgical team had let this child down, and I
26
felt that in addition, and significantly, the hospital
27
had let this child down and again I apologise to the
28
parents for the trauma caused to them and to their
29
child.
I
As a paediatric surgery, it is not what we are
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11:51
1
there to do.
2
families and improve their quality of life, and this
3
clearly was not the case and the situation but, yes,
4
absolutely devastated and shocked, horrified by the
5
entire procedure, and if that is how I feel like it is
6
only a small part of how the parents must feel in the
7
situation, especially when they made so many requests
8
to be heard and their requests were not listened to.
9
246
Q.
10
247
A.
That's correct.
Q.
And that is why you have signed up for the diploma, I
13
248
A.
That's correct.
Q.
Lastly, Professor, I wanted to ask you about the 360
16
degree review that was conducted in relation to you.
17
CHAIRMAN:
number 18.
19
Sorry for
interrupting.
249
Q.
MS. BARRINGTON:
Can you explain to the
21
22
11:52
We will call this exhibit
18
20
11:52
think the Committee saw referred to in your CV?
14
15
11:51
This tragic and devastating event has prompted your
desire I think to study risk management, is that right?
11
12
We are there to help children and their
11:53
Committee what this is?
A.
I think that a variety of medical practitioners were
23
canvassed by the Medical Council some time ago as to
24
whether or not they would participate in a trial or a
25
pilot study called a 360 degree clinical assessment,
26
which I think was meant by the Medical Council to help
27
them establish ongoing training accreditation of
28
practitioners in Ireland.
29
thing to do.
I felt this would be a good
76
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1
250
2
Q.
When were you asked to participate in this?
A.
I cannot remember precisely the date, but I believe it
3
was before this was sent to the Medical Council
4
initially, but it was actually only conducted in the
5
last 6 months I believe.
6
where all people who you encounter in your daily
7
practice, so patients, students, junior staff, nurses,
8
porters, secretaries.
9
radius would be asked to score your performance and
10
11
251
Q.
11:54
Can I ask you, Professor, to look at page 6.
I am
looking at 3rd August 2010, is that the --?
13
252
A.
Yes.
Q.
And the colleague assessment is set out there, and the
15
colleagues then are everybody you work with, is that
16
right?
17
18
253
19
20
254
21
22
11:53
everyone around you in a 360
your behaviour, etc.
12
14
So
Essentially a 360 clinical is
255
A.
It would be --
Q.
Well, samples I should say?
A.
A sample of everybody, yes.
Q.
Of everybody you work with?
A.
Yes.
Q.
And they have graded you under various headings, and
11:54
23
just to go through them very quickly.
24
diagnostic skill, 4 of the 12 gave you a good and 8
25
outstanding.
In relation to
26
procedures.
27
complex clinical problems, 2 good, ten outstanding.
28
Appropriate use of resources, 3 good, 9 outstanding.
29
Conscientious and reliable, they are all agreed that
Performance of practical, technical
2 good, 9 outstanding.
11:54
Management of
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you are outstanding.
Availability for advice and help
2
when needed.
3
were outstanding.
4
critical of you on time management.
5
only 6 outstanding.
6
service, 2 good, 10 outstanding.
7
knowledge and skills 1 good, 9 out standing and
8
contribution to education and supervision of students
9
and junior colleagues, 4 good and 7 outstanding.
Everybody consulted was agreed that you
Time management, they are most
You got 4 good and
Commitment to improving quality of
11:55
Keeps up-to-date with
10
11:55
11
I am going to ask you to turn then to page 10, which
12
continues the colleague assessment.
13
spoken English, got one good and 11 outstanding.
14
Communication with colleagues, 11 outstanding.
15
Communication with patients, families and carers, 2
16
good 10, ten outstanding.
17
and respectful to patients.
18
Polite and considerate and respectful to colleagues, 2
19
good, ten outstanding.
20
patients and their relatives.
21
outstanding.
22
multi-disciplinary team members.
23
outstanding.
24
circumstances arise.
25
outstanding.
26
outstanding.
Question 11, your
11:56
Are you polite, considerate
Everybody is outstanding.
Compassion and empathy towards
Everybody -- 12
11:56
Values, the skills and contributions of
2 good, 9
Takes the leadership role when
All those who could comment say
Delegates appropriately, 5 good, 7
27
28
Then your patients I think were also consulted, and the
29
scores your patients gave you are reflected at page 16.
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I think 22 patients were consulted.
Was the doctor
2
polite and considerate?
3
the doctor listen to what you had to say?
4
yes, definitely.
5
opportunity to ask questions?
6
Did the doctor answer all your questions?
7
yes, definitely.
8
way you could understand?
9
Are you involved as much as you want to be in the
All say, yes, definitely.
Did
All say,
Did the doctor give you an
21 of 22 say definitely.
11:57
All say,
Did the doctor explain things in a
All say, yes, definitely.
10
decisions about your care and treatment?
20 said, yes,
11
definitely and one, yes, to some extent.
Do you have
12
confidence in the doctor?
13
one, yes, to some extent.
11:58
21 say, yes, definitely and
14
15
Did the doctor respect your views?
16
position to answer say, yes, definitely.
17
doctor ask your permission to examine?
18
definitely.
19
your privacy and dignity?
20
of the consultation did you feel better able to
21
understand and manage your condition and care?
22
definitely.
23
the outcome of that review?
24
A.
25
Did the
Yes,
Yes, definitely.
By the end
11:58
Yes,
I take it you are happy, Professor, with
Yes.
MS. BARRINGTON:
Thanks, Professor, I don't
have any further questions
27
but Mr. Leonard will do.
A.
11:58
If the doctor examined you, did he respect
26
28
All those in a
Thank you.
29
79
Gwen Malone Stenography Services Ltd.
11:59
1
END OF DIRECT-EXAMINATION
2
3
MR. LEONARD:
If I could just have five
4
minutes, I think I should
5
be able to complete cross-examination by lunchtime.
6
CHAIRMAN:
Yes, that is fine.
7
11:59
We
might take a little break
8
at the end of that then.
9
take the break now?
10
MR. LEONARD:
Sorry, are you suggesting we
Yes, if I could just have
11
11:59
five minutes, a short break
12
and then I will finish by lunchtime.
13
CHAIRMAN:
Okay, so will take a short
14
break then.
15
16
SHORT ADJOURNMENT
17
18
THE HEARING RESUMED, AS FOLLOWS, AFTER THE SHORT
19
ADJOURNMENT
20
21
CHAIRMAN:
We will resume,
22
Mr. Leonard.
23
24
PROF. CORBALLY WAS CROSS-EXAMINED, AS FOLLOWS, BY
25
MR. LEONARD
12:20
26
27
256
Q.
MR. LEONARD:
Professor, do you have a
28
29
copy of the Notice of
Inquiry?
80
Gwen Malone Stenography Services Ltd.
1
2
257
A.
Is it in the core booklet?
Q.
I think it is probably the first tab of the core
3
booklet?
4
5
258
A.
Yes, I have it here.
Q.
There is only a number of allegations remaining against
6
you, the first of those is allegations two.
7
want to establish with you where you agree with the
8
case made by the Chief Executive Officer and where you
9
disagree with that case.
12:20
I just
You appreciate that with each
10
of the remaining allegations the Committee will have
11
to, first of all, establish whether as a matter of fact
12
they are true and, secondly, they will have to come to
13
the view as to whether any proven factual allegations
14
are also professional misconduct so that you understand
15
the purpose of the question I am asking you.
12:20
12:20
16
17
I think you agree as a matter of fact with allegation
18
two that you made a handwritten note Master Conroy's
19
medical records, erroneously recording a small left
20
kidney, 9% function of the left side. I think that is
21
factually true, isn't that right?
22
23
259
24
25
260
A.
I am looking at the wrong thing.
Q.
I will let you take some time to get that.
A.
I am looking at the Notice of Inquiry for Mr. Paran.
Q.
I have your copy, sorry about that, (Handed).
26
second page is allegation two, you might look at that?
27
28
29
On the
261
A.
Yes.
Q.
Just take your time to read that.
A.
Yes.
81
Gwen Malone Stenography Services Ltd.
12:21
12:21
1
262
2
3
263
Q.
I think you would agree that that is factually true?
A.
That is factually correct.
Q.
The next one is allegation ten, leaving aside now
4
issues of blame or responsibility I think as a matter
5
of fact you didn't review the medical records, et
6
cetera, before the operation on 21st March?
7
A.
I reviewed the medical records in theatre when the
8
patient was anaesthetised, I would have checked the
9
consent at that time and the patient ID.
10
264
Q.
If you like deleting the words "medical records" the
11
balance of the allegation is factually true, that you
12
didn't review the radiological imaging or the
13
radiological reports, isn't that right?
14
15
265
A.
That is correct.
Q.
Then the next allegation, you say that you delegated
16
the performance of the nephrectomy, but I think you say
17
that he did have adequate time to prepare for it, isn't
18
that right?
19
A.
20
21
Q.
In allegation 12 I think you agree that you indicated
that the nephrectomy ought to have been made on the
23
left upper quadrant transverse.
24
the allegation that you knew or ought to have known
25
that it ought to have been performed on the right side?
A.
12:22
12:22
22
26
12:22
My belief is that Mr. Paran had adequate time to
prepare for this, yes.
266
12:22
What do you say about
I think this is dependent on the planned site of
27
surgery and since it was a planned left nephrectomy to
28
operate on the left side through a left upper quadrant
29
incision was completely correct.
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Gwen Malone Stenography Services Ltd.
12:23
1
267
Q.
2
right, the CEO make the same point about allegation 13?
3
4
The same deals with allegation 13 as well, isn't that
268
A.
I think that is fundamentally the same allegation.
Q.
What do you say about the allegation that you failed to
5
apply the appropriate standards of clinical judgment
6
that can be expected of a surgeon with your experience
7
and expertise?
8
A.
9
I feel personally that I made a human error in booking
the patient for the wrong side surgery.
I feel that
10
the progression beyond that was limited by the Hospital
11
systems and the pressures that the surgical teams were
12
and are under in Crumlin to deliver a service.
13
not feel that I fell below clinical judgment standards
14
as would be expected from a surgeon of my experience
15
and expertise.
16
269
Q.
17
I do
12:24
Just so the Committee understand what you say, you say
270
A.
That is correct.
Q.
-- and that beyond that responsibility for this is with
20
hospital systems or standards or other people?
21
A.
a significant part of the allegation centres on the
23
issue of delegation.
24
appropriate to delegate a procedure of this type to
25
Mr. Paran who was and is an experienced paediatric
26
surgeon.
271
Q.
12:24
I believe that part of the allegation really centres or
22
27
12:24
that you made a human error in January 2008 --
18
19
12:23
I feel that it was quite
May I remind you that on the day in question that you
28
apologised to the parents.
I will just ask you to look
29
at the transcript of the first day, I will remind you
83
Gwen Malone Stenography Services Ltd.
12:24
1
of what Ms. Stewart said.
2
somewhere on the desk. It is Day 1, page 65.
3
read to you what Ms. Stewart said, I ask the question:
4
You should have it there
"Q. Did Prof. Corbally apologise."
5
CHAIRMAN:
What page are we on,
6
7
I will
Mr. Leonard?
272
Q.
MR. LEONARD:
8
Page 65. She said:
"He apologised and said he is taking
responsibility for it."
9
10
Can I also remind you of your observations and comments
11
to the Medical Council, which are at Tab 2 the core
12
booklet, in which you said on 30th September of last
13
year:
14
"I accept that I am ultimately
responsible for a patient's safety as
their treating consultant."
15
16
17
273
A.
That is correct.
Q.
Ms. Barrington when she was asking you about your
18
discussion with the parents and why you didn't tell
19
them that Mr. Paran had carried out the operation you
20
said that you felt, I think you used the word
21
"ethically" you were responsible and that it wasn't the
22
time to blame someone else?
23
24
12:25
274
A.
That is correct.
Q.
You are now here in this formal forum and you are now
25
trying to blame other people for what has happened, you
26
are trying blame to Mr. Paran, you are trying to blame
27
the mistake in radiology which took place in February
28
2002.
29
told and you have just some moments ago blamed hospital
You have said that Dr. Ghallab ought to have
84
Gwen Malone Stenography Services Ltd.
12:25
12:26
12:26
12:27
1
systems.
2
that you personally are professionally responsible for
3
what happened to Master Conroy?
4
A.
Can I ask you to this Committee to accept
I think you raise a very complicated issue in terms of
5
who has overall responsibility for a patient in
6
hospital.
7
responsible for what happens to a patient but I cannot
8
be responsible for individual actions that I have no
9
control over in that environment.
12:27
I have to be as the admitting consultant
I would distinguish
10
between the two in fact, I think there is an issue of
11
ultimate responsibility and actual discrete
12
responsibility.
13
particular in my explanation of the events, I am merely
14
trying to detail those events.
15
accepting responsibility I think that is well within
16
the Medical Council's Code of Practice that one should
17
except responsibility and it is the probably better at
18
a later stage to go over more detailed information
19
rather than try and apportion blame to everyone, which
20
seems to me as if one is trying to get out from a
21
difficult situation.
22
accept responsibility as the admitting consultant but I
23
do feel that individuals who work with you or who work
24
in the Hospital system have to bear responsibility for
25
their own actions.
26
between the two.
27
275
Q.
12:28
I am not trying to blame anyone in
I think in relation to
That is not my practice.
If you are accepting responsibility I am asking you to
28
accept that having regard to everything that went on
29
here that you fell seriously short of the standards
Gwen Malone Stenography Services Ltd.
12:28
I do
With respect I would differentiate
85
12:28
12:29
1
that would be expected of a surgeon in your position?
2
A.
I believe that I failed this family as a surgeon, yes,
3
and I believe that the surgical team failed this
4
patient and his family, as I have said.
5
that the Hospital have failed this family.
6
as the admitting consultant would have to accept
7
responsibility at all times for what happens patients
8
under my care, and that is what I do.
9
said, I cannot accept responsibility for systems
I also believe
However, I
However, as I
10
failures, systems failures that we had highlighted time
11
and time again to the hospital or failure to file
12
appropriately within a reasonable time frame.
13
said there are 18,000 un-filed reports and letters in
14
the Hospital system as of last February.
15
accept responsibility for a senior colleague of
16
Mr. Paran's experience and training for a mistake that
17
is essentially of his doing at that time.
18
trying to blame Mr. Paran, these are merely the facts
19
as they occurred.
20
276
Q.
21
As I
I cannot
12:30
I am not
You will not accept that you seriously fell short of
277
A.
Sorry, I didn't quite hear that.
Q.
I take it what you are saying to the Committee is you
24
do not accept that you fell seriously short of the
25
standards to be expected by a surgeon, is that correct?
26
27
12:30
12:30
the standards to be expected of a surgeon?
22
23
12:29
278
A.
That is correct.
Q.
Look at the first allegation against you, allegation
28
number two, you made what you describe as a human
29
error, that is the human error by writing down "left"
86
Gwen Malone Stenography Services Ltd.
12:30
1
as opposed to "right", isn't that right?
2
3
279
A.
That is correct.
Q.
You have accepted in direct examination that you think
4
it is likely that you had an unofficial report which
5
correctly identified that it would be a right problem
6
and you accept what the parents say, that you told them
7
that it was going to be right but that for whatever
8
reason you wrote down left?
9
A.
10
11
I absolutely completely accept what the parents said as
being true.
280
Q.
12:31
You went to great lengths in your direct evidence to
12
identify a mistake in a radiological report from 2002,
13
which is at page five of the booklet of medical
14
records, you went at great length...(INTERJECTION)
15
16
281
17
18
282
A.
Sorry, I haven't got that.
Q.
If you just get that please, Professor.
A.
Thank you.
Q.
You emphasise to the Committee the large number of
12:31
(Handed)
19
times you say that this error was replicated in the
20
notes.
21
ultrasound correctly identifying the right kidney as
22
being a problem, isn't that right?
23
24
283
Of course over the page at page 6 was a renal
A.
Yes, that is correct.
Q.
Several pages forward at page nine is again a detailed
25
report of a renal ultrasound identifying problems with
26
the right kidney?
27
28
29
284
12:31
A.
That is correct.
Q.
Indeed you must have known about this in October 2007
when one looks at your own letter on page 22.
87
Gwen Malone Stenography Services Ltd.
I will
12:32
12:32
1
read to you what you said in the last paragraph, you
2
said: "His last ultrasound in 2005 showed a scarred
3
right kidney.
4
5
285
A.
That is correct.
Q.
At the time of the DMSA scan you weren't under any
12:33
6
misapprehension about this being a left kidney problem,
7
were you?
8
A.
9
10
reviewed him in out-patients?
286
11
12
287
13
14
At the time the scan was performed or at the time I
288
Q.
When you wrote this letter?
A.
This letter was written before the DMSA scan.
Q.
In October 2007 you were under no misapprehension?
A.
No, I was not.
Q.
It is not really fair for you to blame an incorrect
12:33
15
report in '02 for the mistake which you made in January
16
'08, is it?
17
A.
12:34
I think in the context of looking at a chart and the
18
reports one doesn't always look at all of the reports
19
because there would be quite a few reports in the chart
20
and in the constraints of a busy clinic it is not
21
possible to go through every report.
22
time I was aware that the scarring was in the right
23
kidney and the right kidney was abnormal, subsequently
24
it was a crucial time in January when I got the
25
unofficial report of the DMSA scan and I erred at that
26
time and assigned the wrong side.
27
has been made, could the incorrect entries on 11
28
specific discrete occasions have influenced that?
29
I replied: Yes, it could have.
12:34
Whilst at that
I think the point
88
Gwen Malone Stenography Services Ltd.
And
12:34
1
2
So it is possible that I could have looked at the chart
3
and seen left-sided reflux and then confused the side
4
on that basis.
5
is that I was distracted between talking about a
6
right-sided problem and writing it down as a left-sided
7
problem in that time frame.
8
289
Q.
9
290
12
You have told the Committee that you had an intention
A.
That is correct.
Q.
When exactly did you intend to review them?
A.
Well normally if I was booking a patient for a
12:35
13
procedure like this and the images would not be
14
available, which happens sometimes, I would review the
15
X-rays in the hospital on the day of surgery. If I had
16
intended, as I had, to do this procedure myself then I
17
would have looked at the imaging myself at that time.
18
My intention was to review the imaging when they became
19
available in theatre or on admission at that time.
20
291
Q.
21
22
12:35
to review the films at a later date?
10
11
But I think the more likely explanation
There is no absolute guarantee that you would have been
12:35
12:35
the person who was going to do this surgery, is there?
A.
I would disagree with that because, as I have stated,
23
of the four surgical registrars in the hospital at that
24
time Mr. Paran was the only one who I would consider
25
suitably trained and experienced to do an nephrectomy
26
unsupervised.
27
sufficient level of experience or training to actually
28
delegate a procedure like that to. Mr. Tareen, who was
29
my registrar at the time I booked the procedure, would
The other three registrars were not at a
89
Gwen Malone Stenography Services Ltd.
12:36
1
be expected to have been with me on the date.
The date
2
was initially booked some time in July and it came back
3
to March, I cannot explain how that happened but I
4
suspect there was a discussion as to who should be put
5
into the list or perhaps the parents asked for it to be
6
done early, I am not entirely sure.
12:36
7
8
At any rate the patient appeared on the list as a left
9
nephrectomy at a time when Mr. Farhan Tareen was
10
absent.
11
Tareen would be taking his annual leave at the time I
12
booked the patient for the procedure. It would be my
13
expectation that Mr. Farhan Tareen would be my
14
registrar at that time and as such I could not possibly
15
delegate this procedure to anybody else, I could not
16
delegate it to Mr. Farhan Tareen, it would have to be,
17
it would just have to simply be me who did the
18
procedure.
19
292
Q.
20
A.
22
12:36
12:37
Were
12:37
Six months, yes, or sometimes they extended beyond a
little, six months, yes.
293
Q.
24
25
Professor, with respect, that is not the case.
these six month rotations?
21
23
I would have no knowledge of when Mr. Farhan
You see in January you wouldn't have known who your
registrar was going to be in July?
A.
That is quite true but it would still have been a
26
junior registrar, it could not have about Mr. Paran
27
because Mr. Paran had just finished six months with me,
28
which finished at the end of December. So even if it
29
wasn't Mr. Farhan Tareen in July it would have been one
90
Gwen Malone Stenography Services Ltd.
12:37
1
of the other two registrars who were of an experienced
2
level the same as Mr. Farhan Tareen and could equally
3
not do this procedure.
4
294
Q.
Prof. Corbally isn't the fact that Mr. Paran ended up
5
doing the operation proof positive that you couldn't
6
been sure that you were going to do the operation?
7
didn't know which registrar was to be assigned to you
8
on that day?
9
A.
You
I had no expectation, my regular registrar would be
10
away, that Mr. Paran would be the registrar who would
11
help me with my list on that day.
12
295
Q.
that it was relatively common not to know which
14
registrar was assisting you on the morning?
A.
16
17
296
297
20
21
298
Q.
You can't know when your registrar is going to be away?
A.
No, registrars take holidays like everybody else.
Q.
They could be sick?
A.
Yes, I agree, but that is an unlikely thing.
Q.
You couldn't know for certain you would do the
22
23
Only when my own registrar would be away, but not in
12:38
any other circumstance.
18
19
12:38
Professor, you told the Committee in direct evidence
13
15
12:37
12:38
operation?
A.
In the context of having three relatively inexperienced
24
registrars and Mr. Paran having worked with me for six
25
months I would suggest that that in fact would be the
26
case, the likelihood is that it would be me and one of
27
the other three inexperienced registrars and not
28
Mr. Paran and therefore not possible to delegate to any
29
of the other three registrars.
91
Gwen Malone Stenography Services Ltd.
12:38
1
299
Q.
Isn't that the very reason why you ought to have
2
written down in the note in January: I have not seen
3
the films or the report, this needs to be double
4
checked prior to the surgery going ahead?
5
A.
6
7
I would accept that, I think that is a reasonable
criticism.
300
Q.
If one looks at the Independent Review in the core
8
booklet, page 8 of that review, at the bottom of the
9
page there is a sub-heading saying:
10
"The person taking consent for a
procedure will not normally review
imaging."
11
12:39
12
Do you see that, page 8 of the internal pagination,
13
page 8 on the bottom right-hand corner.
14
that, Professor?
15
16
301
17
18
302
Is that the GOS Report?
Q.
It is the Great Ormond Street Report?
A.
At the very last paragraph.
Q.
The bottom right-hand corner is page number 8 and the
23
24
25
303
A.
Yes.
Q.
It says:
12:40
"In patient XY's case the imaging was
not reviewed at any stage:
In clinic at the point of listing for
surgery; at the point of clerking or
taking consent;
26
On the pre-operative morning ward
round;
27
In response to the parents' query about
the operation side.
28
29
12:40
paragraph heading is numbered 7, do you see that?
20
22
Do you have
A.
19
21
12:39
In addition it was not reviewed in
theatre prior to positioning XY for the
procedure or making the incision."
92
Gwen Malone Stenography Services Ltd.
1
2
You were involved at all points up to then, isn't that
3
right?
4
A.
Well I wasn't involved on the taking clerking and
5
taking consent, nor was I involved on the preoperative
6
morning ward round.
7
surgery, and I have not denied that, and I was not
8
involved in any aspect of parents' queries about the
9
operation site.
10
304
Q.
I was involved at the listing of
If I put it differently, the delegation which you say
11
took place to Mr. Paran took place at the very end of
12
that list, isn't that right?
13
A.
14
15
305
You mean in terms of the sequence of the chronology of
306
Q.
Yes?
A.
That is correct.
Q.
You were the responsibile person right up until the
18
12:41
delegation, is that not right?
19
20
307
A.
Yes, I would think that is reasonable, yes.
Q.
I suggest to you that it was inherently dangerous for
21
the imaging not to have been reviewed throughout all
22
that period?
23
12:41
events?
16
17
12:40
A.
12:41
I think the course of a patient through a hospital and
24
surgery can be a very complicated one but can be at the
25
same time looked at quite briefly and simplistically in
26
that at any point along this patient's course through
27
hospital there were ample opportunities for the imaging
28
to be reviewed and/or a report to be found, and that is
29
not something that I am able to do at every point of
93
Gwen Malone Stenography Services Ltd.
12:42
1
patient contact in the hospital.
There were I think at
2
least five medical personnel involved at contact points
3
with the patient and his family.
4
nursing points of contact between the patient and his
5
family. Concerns were raised at many of these junctures
6
and if I had been informed about those then yes of
7
course the imaging would have been reviewed and it
8
would have been resolved.
9
that people involved at those junctures would also
There were also five
I would have an expectation
10
undertake to review the imaging if there is a concern
11
about laterality.
12
308
Q.
Ormond Street Report, page 10 at the bottom, I am going
14
to read to you what it says:
15
"Patient XY was on a 'parallel' morning
list, running simultaneously in Theatre
5 and Theatre 7. The SpR was working in
Theatre 7 and the consultant in Theatre
5. After the first few patients there
was a pause in between patients coming
to Theatre 7 and the SpR went to
Theatre 5 to see how he could assist.
He helped to prepare and position
Patient XY, now anaesthetised for the
operation. The consultant asked him if
he would like to do the case. A
nephrectomy was within the competence
of the SpR, although he had never
performed one completely unsupervised
and was handed the case at short
notice."
16
17
18
19
20
21
22
23
309
A.
Yes.
Q.
Did you have an input into the preparation of this
27
28
29
12:43
12:43
Do you see that?
25
26
12:42
I want to move on to another comment in this Great
13
24
12:42
12:43
report?
A.
I was certainly interviewed on two occasions by the GOS
team, yes.
94
Gwen Malone Stenography Services Ltd.
1
310
Q.
2
nephrectomy completely unsupervised?
3
4
Is it true that Mr. Paran had never performed an
311
A.
That is not true.
Q.
That is not true. Do you think you told the team from
5
Great Ormond Street that it wasn't true?
6
A.
I cannot comment on that question, there could have
7
been all sorts of reasons for it.
8
example, quite simply an error in communication.
9
would not suggest that or concur with that.
10
312
Q.
11
A.
13
15
That may be, for
I
Do you agree that Mr. Paran was handed the case at
12:44
short notice?
12
14
12:44
No, I think Mr. Paran had adequate time to prepare for
the case.
313
Q.
They got that wrong as well?
A.
I think as the surgeon delegated with the procedure it
16
is that surgeon's responsibility to set the pace and
17
review the imaging, I think he had time to do that, I
18
don't think it was short notice.
19
the way the list ran in Crumlin at that time is that
20
situations like this arose quite often in that it is a
21
very busy list, there is a very significant service
22
commitment and it does happen from time to time that
23
you are asked to do something or one is asked to do
24
something at quite short notice.
25
the delegee, if you like, always has the option to say:
26
I will start the operation when I have reviewed the
27
imaging.
28
surgeon in question leading the operation, doing the
29
operation to say 'I am happy that I have checked
12:44
Could I also say that
12:44
The surgeon who is
So it is not an auto-start, it is up to the
95
Gwen Malone Stenography Services Ltd.
12:45
1
2
everything myself'.
314
Q.
Did you tell the Independent Review Team that you had
3
asked Mr. Paran to do this operation between 10.45 and
4
11 am?
5
6
315
7
8
316
A.
I cannot recall if I was asked that.
Q.
They don't seem to record that, do they?
A.
I don't think so.
Q.
In fact they recount in their report the version of
9
events given by Mr. Paran, don't they?
10
A.
I think it is a composite report from a variety of
11
inputs, including anaesthesia, myself, Mr. Paran and
12
other surgical members and nursing members of the
13
theatre.
14
12:45
317
Q.
Would you not agree that it is an important issue as to
15
whether you gave 40 minutes, 50 minutes' notice to
16
Mr. Paran or five minutes' notice?
17
A.
12:45
I think it certainly has become an important issue.
12:46
I
18
think also the GOS team might consider that perhaps a
19
longer period might be better, and I agree, in an ideal
20
world the longer you have to contemplate a case the
21
better.
22
operating surgeon with quite short notice, and that is
23
not uncommon practice either in Crumlin or in any other
24
hospital in the country.
25
318
Q.
However, it is possible to take on the role of
You heard Mr. Wheeler's evidence about notice and he
26
was very unhappy, to put it mildly, with the five
27
minute notice period?
28
29
A.
12:46
Five minutes I would also be somewhat unhappy about.
have to suggest to you that it is not unusual in the
96
Gwen Malone Stenography Services Ltd.
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I
1
situation of a busy service to be requested to do a
2
procedure at short notice.
3
anything from 10, 15, 20, 30 minutes.
4
five minutes is adequate time for somebody of
5
Mr. Paran's training to review the X-rays, because all
6
one has to do is take the image out of the folder and
7
look at it, it takes a minute.
8
319
Q.
9
320
12:47
A.
In what sense do you mean?
Q.
If the five minutes' notice wasn't given why are you
13
telling the Committee about it?
14
A.
15
Because you brought it up, you asked me about five
minutes.
321
Q.
17
12:47
I am asking why you didn't mention the longer period to
Ormond Street Hospital?
18
A.
They never asked me about timing, I believe, at that
19
time and I think they would probably have asked
20
Mr. Paran about time.
21
322
22
I am not sure in fact.
Q.
It is not mentioned...(INTERJECTION)
A.
In the time line it is there.
12:48
I think the GOS people,
23
actually the team looked at the time line in detail and
24
they are aware of the time the patient arrived in the
25
theatre and the time that the procedure began.
26
recall the GOS team were more anxious to know how my
27
list ran and whether or not it is normal practice to
28
delegate procedures to senior registrars or SpRs.
29
12:47
Sorry, are you backtracking from the evidence you gave
terms?
11
16
Certainly even
earlier or are you simply talking in hypothetical
10
12
Short notice can be
323
Q.
If I
The second thing they say, just down the page, is:
97
Gwen Malone Stenography Services Ltd.
12:48
1
"This means that the surgeons may have
no advance knowledge of which patients
they will be personally operating on.
There is no formal briefing at the
outset of the list (or the day before,
as has been the practice with one
consultant..."
2
3
4
5
Do you see that?
6
7
324
8
12:49
A.
Yes.
Q.
That is not desirable, is it?
A.
In fact when the list is presented to me for submission
9
to the theatre on the day before an operating list I
10
generally to this with the junior team but and we will
11
not formally assign a patient to any one surgeon
12
because it is not possible in logistical terms to do
13
that in the order of the list. It was not possible to
14
discuss this with Mr. Paran because I was not aware
15
that Mr. Paran would be assigned to me the next day?
16
325
Q.
exhibit that you handed in of the operating list,
18
Exhibit 16, you might just have that.
19
Presumably as a doctor one can grade these procedures
20
in terms of seriousness and difficulty?
22
326
(Handed)
A.
Yes.
Q.
Presumably the hernia repairs, the Hickman Broviac
23
removals, the fistula repairs, circumcisions they are
24
all relatively straightforward operations?
25
26
327
A.
Yes.
Q.
Nephrectomy is not a straightforward operation I think,
27
29
328
12:50
12:50
is that right?
28
12:49
I am not sure what exhibit number this is, this is an
17
21
12:49
A.
I regard nephrectomy as a straightforward operation.
Q.
Can I use perhaps different wording, it is more
98
Gwen Malone Stenography Services Ltd.
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difficult than the other operations we just talked
2
about, it is more difficult than a hernia repair?
3
4
329
A.
Yes, it would be more difficult than a hernia repair.
Q.
And a more serious operation. Are there any other
5
serious operations on that list?
6
A.
7
8
12:50
There was a patient, it doesn't seem to be on this
list, for the resection of a recurrent Wilms' tumour.
330
9
Q.
Sorry, I didn't catch that, a resection of a?
A.
A recurrent renal tumour. I don't know where that
10
patient is. I think that might have appeared on
11
Mr. Quinn's list because Mr. Quinn took over along with
12
Mr. Gillick and did most of the other cases after this
13
event.
14
331
Q.
I see. Of all of the operations on this list the
15
nephrectomy is up at the upper end in terms of
16
seriousness or difficulty?
17
A.
18
19
12:51
12:51
In comparison with the other patients on this list,
yes.
332
Q.
Surely, Prof. Corbally, that means that you are the
20
person who should be doing that operation rather than
21
your specialist registrar?
22
A.
12:51
Well, as I have stated already, if Mr. Paran had not
23
been on the list that day I would certainly have done
24
the nephrectomy.
25
role of senior registrar to that of consultant and had,
26
I believe, adequate training to an nephrectomy.
27
don't think Mr. Paran himself has denied he was
28
adequately trained to do an nephrectomy.
29
significant experience in the six months prior to this
Mr. Paran was close to leaving the
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Gwen Malone Stenography Services Ltd.
I
He had
12:51
1
period when he came back from Sloan-Kettering and he
2
had also worked for one year in Sloan-Kettering as a
3
fellow on paediatric oncology service, where he would
4
have been exposed to a significant number of more
5
difficult nephrectomies.
6
nephrectomy one has to look at simple nephrectomies, as
7
we anticipated this to be, and a nephrectomy for a
8
renal tumour, which is a significantly more different
9
and much more complex procedure. This was a simple
10
11
I think within the context of
nephrectomy and would not be considered that difficult.
333
Q.
sick child go into hospital and there is a series of
13
operations and procedures being carried out, many of
14
which are simple, straightforward and short and one of
15
which is more difficult, more serious, more life
16
threatening that the parents have the right and the
17
expectation that the senior man will do that operation?
A.
with you in the context, this was a simple nephrectomy
20
and would not be regarded as being technically
21
difficult or challenging.
22
for the senior surgeon to do an operation and in
23
addition we have an obligations to allow our trainee
24
surgeons to do procedures.
25
very well qualified do an nephrectomy, a simple
26
nephrectomy.
27
done a more difficult nephrectomy.
29
334
Q.
12:53
Well I hear what you are saying but I have to disagree
19
28
12:52
I am asking you to accept that when the parents of a
12
18
12:52
12:53
It is not always possible
At that level Mr. Paran was
Indeed, I have to say, qualified and had
There is a serious factual dispute between yourself and
Mr Paran, isn't that right?
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Gwen Malone Stenography Services Ltd.
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1
2
335
A.
I accept that.
Q.
The Committee are ultimately going to have to make a
3
decision as to fact on that.
4
the evidence of Mr. Wheeler insofar as if this were a
5
five minute hand over you would agree that that
6
wouldn't have been proper delegation, isn't that right?
7
A.
I think you agree with
There has to be a caveat in that assertion because the
8
surgeon doing the operation has the authority and the
9
right as to when he or she starts the operation, and
10
that necessarily involves crossing the Ts and doting Is
11
and making sure everything is in place.
12
the opportunity not to proceed, if you say five
13
minutes, and I am talking if that was the case,
14
Mr. Paran had the opportunity to stop the procedure
15
starting and say 'I need to review the imaging first.'
16
Five minutes I think becomes somewhat academic in that
17
context when the surgeon has the right, the authority
18
and indeed the expectation to confirm the imaging is
19
correct.
20
336
Q.
In your own observations and comments you described the
type of list system you worked under and you described
22
the specialist registrar working
23
"under my supervision"
24
are the words you used, you are not trying to pull back
25
from that?
27
337
12:54
Mr. Paran had
21
26
12:54
12:55
12:55
12:55
A.
Not at all.
Q.
Olive Delaney described that she considered that both
28
theatres were under your supervision and Emma Cooney
29
described how it is the consultant who is responsibile
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Gwen Malone Stenography Services Ltd.
1
ultimately, isn't that right?
2
3
338
A.
I agree.
Q.
Can I ask you to look at the transcript of yesterday,
4
it should have a "2" on the front of it?
5
6
339
A.
Yes.
Q.
Can I ask you to look first of all to page 103, Mr.
12:56
7
Meenan asked Mr. Wheeler a question at question 250
8
suggesting that you gave Mr. Paran less than five
9
minutes and Mr. Wheeler said:
10
"If that were the case I would say that
that was an exceedingly short time,
very little time for him to come to
terms with what he had to do, and I
would have thought that that was
undesirable."
11
12
13
14
14:00
Further down the page at answer 252 he says:
15
12:56
16
"I do not think that in five minutes
one can necessarily hand over all of
the appropriate pieces of information
to the delegate, I don't think they
necessary have time to absorb it..."
17
18
19
20
Do you agree with what Mr. Wheeler says?
A.
To some degree. I think in an ideal world five minutes
21
would not be sufficient, but I have dispute with the
22
five minute issue, it was not five minutes.
23
ideal world, yes, you need more time to assimilate,
24
but in reality looking at the X-rays takes a minute and
25
it is very clear from looking at the X-ray images which
26
kidney was involved.
27
taken, one or two minutes, and then highlighting or
28
flagging that problem and then the issue would never
29
have proceeded.
In an
That is all that it would have
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Gwen Malone Stenography Services Ltd.
12:57
12:57
1
340
Q.
2
At page 112 I would ask you to look at question 291,
Mr. Meenan says:
3
4
"Implicit in delegation is sufficient
time for the trainee in this case to
acquaint himself or herself with the
patient and the records, and so on..."
5
6
7
14:16
Do you agree with what Mr. Wheeler says?
8
A.
9
I think one has to look at delegation to certain levels
of trainees, Mr. Paran was a senior surgical trainee
10
about to leave the ranks of the SpR and enter
11
consultant posts.
12
trained trainees to come through Crumlin in some time.
13
So there is a little difference between handing over a
14
procedure at what you call short notice to a trainee
15
who is perhaps three or four years as an SpR to someone
16
of Mr. Paran's experience, I think it is completely
17
different.
18
handed a procedure which is relatively straightforward
19
that even five minutes, if that was the case, which it
20
was not, could have been sufficient to say:
21
that is the diseased side or hold on, there is a
22
problem, the side that is marked is not the correct
23
side and this needs to be reviewed, and to bring it to
24
my attention.
25
341
Q.
12:58
He is perhaps one of the best
12:58
I would suggest that in the event of being
Well, yes,
Prof. Corbally Mr. Paran will clearly say that he was
26
your junior, which he was, you were in charge, which
27
you were, and that you gave him five minutes notice to
28
do the operation and then directed him as to where he
29
was to put the incision.
If the Committee accepts that
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Gwen Malone Stenography Services Ltd.
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12:59
1
evidence would you not accept that you had the
2
responsibility to ensure that the films were checked?
3
A.
I think in a holistic sense the surgeon doing the
4
procedure has responsibility to ensure that he is doing
5
the right procedure.
6
someone suggested yesterday, in the request to do this
7
procedure or no direction on my part to Mr. Paran to do
8
this procedure.
9
and opportunity to actually review the imaging himself
There was coercion or force, as
Mr. Paran would have had ample time
10
and to say this was the right thing to do.
11
Mr. Paran's experience level should have satisfied him
12
that he should be aware of what the imaging said at
13
that point in the procedure.
14
merely a technical one between two colleagues, I was
15
not directing him in any sense in an absolute sense.
16
My recommendation was that the incision from the
17
previous colostomy enclosure was lower than one would
18
expect to do a nephrectomy through and that it would be
19
better to go through the left upper quadrant in the
20
transverse way and because I expected this to be small
21
shrunken kidney I asked him to make it cosmetic, that
22
is all.
23
in Mr. Paran's hands.
24
342
Q.
25
26
I think
13:00
The incision I think
13:00
13:00
Apart from that the rest of the procedure was
If it would only take two minutes to check the X-rays
why didn't you check them?
A.
12:59
I really wish I had checked the X-rays.
13:01
I was
27
convinced that Mr. Paran would do this and do this
28
well.
29
work with Mr. Paran I had no reason to expect anything
From my seven or eight years of experience of
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Gwen Malone Stenography Services Ltd.
1
2
different.
343
Q.
3
hadn't seen the films in January of that year?
4
5
Did you know on the morning of the operation that you
344
6
A.
No, I did not.
Q.
You didn't remember?
A.
No, I did not remember. The patient was listed for a
13:01
7
left nephrectomy and it appeared as such and when I
8
checked the consent and the ID they both matched and
9
they said left nephrectomy.
10
345
Q.
11
Why didn't you check the films when you were checking
the consent?
12
A.
Because I asked Mr. Paran to do the procedure and that
13
is part, in a holistic sense, the operating surgeon's
14
expectation to do that.
15
346
16
Q.
What were you doing during the procedure?
A.
I went to the surgical dictation room, which is close
17
beside the actual theatre, and dictated on some charts,
18
doing some chart work.
19
347
20
21
348
Q.
On the other operation?
A.
No, on existing patients and out-patients.
Q.
During one of the most serious operations on this list
22
23
13:01
13:01
13:02
you were dictating charts on other operations?
A.
Well unfortunately there is no provided time for
24
consultant surgeons in Crumlin, no protected time to do
25
administrative work, so one has to find time where one
26
finds it. If I had confidence in Mr. Paran, as I had,
27
that he would do the procedure properly and completely
28
then I felt relaxed in the knowledge that I could catch
29
up with my chart work.
I often have to do chart work
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Gwen Malone Stenography Services Ltd.
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1
between cases and we have to find time wherever we find
2
it to do that, there is no protected time to do this.
3
It is a very busy demanding service.
4
349
Q.
5
Are there any protocols as to delegation between
surgeons and specialist registrars in this situation?
6
A.
There are no written protocols for delegation but there
7
is an expectation that the consultant will delegate to
8
trainees only when the consultant is happy that the
9
trainee has reached a certain level of experience and
10
competency.
11
in any protocol in Ireland, that is a matter of
12
on-going surgical training and education.
13
350
Q.
I don't know if that is written anywhere
account your initial human error, your failure to
15
record the necessity to look at the films and the fact
16
that it was only on the morning of the operation, on
17
your own evidence, that you handed the matter over to
18
Mr. Paran that you seriously failed the parents and
19
Master Conroy himself by never looking at the films?
A.
I have already stated that I failed the parents, as did
21
the team and the hospital.
22
constellation of bizarre events that culminated in this
23
tragic outcome, I don't think anyone could have
24
predicted this. It seemed that the system could not
25
apply the brakes appropriately at any point along this
26
patient's progress through hospital.
27
MR. LEONARD:
13:03
13:04
It seems to have been a
Thank you, Professor, those
28
29
13:03
Do you not agree, Prof, that when one takes into
14
20
13:03
are the only questions I
have.
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Gwen Malone Stenography Services Ltd.
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1
2
END OF CROSS-EXAMINATION OF PROF. CORBALLY BY
3
MR. LEONARD
4
5
CHAIRMAN:
Thank you, Mr. Leonard.
6
It is now 1 o'clock, I
7
wonder would Mr. Meenan be agreeable to having a break?
8
MR. MEENAN:
I think so, and I think the
9
witness is probably
10
entitled to a break at this stage.
11
CHAIRMAN:
13:04
At quarter to two we will
12
resume.
Thank you.
13
14
13:04
LUNCHEON ADJOURNMENT
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
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Gwen Malone Stenography Services Ltd.
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THE HEARING RESUMED, AS FOLLOWS, AFTER THE LUNCHEON
2
ADJOURNMENT
3
4
CHAIRMAN:
Okay.
5
If everybody is
present maybe we will
6
resume.
7
cross-examine.
8
MR. MEENAN:
14:02
I think maybe Mr. Meenan would like to
Yes, thank you indeed,
9
Chairman.
10
11
12
PROF. MARTIN CORBALLY WAS THEN CROSS-EXAMINED, AS
13
FOLLOWS, BY MR. MEENAN
14
15
351
Q.
MR. MEENAN:
Prof. Corbally, as you know
16
I appear on behalf of
17
Dr. Sri.
18
operation, isn't that right?
19
A.
20
21
You were present towards the end of the
Well, I was present when the kidney had been
revascularised.
352
22
23
353
14:03
Q.
Yes.
A.
That would not be the end of the operation.
Q.
All right.
24
Yes.
You, I think, knew immediately that there
was a problem, isn't that right?
25
A.
I recognised that the kidney appeared normal when I
26
entered the theatre itself, at which time I asked
27
Mr. Paran if everything was okay.
28
29
14:02
354
Q.
Yes.
A.
In terms of blood loss, and also if he had consulted
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Gwen Malone Stenography Services Ltd.
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1
2
the images at that time?
355
Q.
3
356
A.
Mr. Paran said he had not.
Q.
Yes.
6
A.
8
357
I guess you then consulted the images, is that
358
13
Q.
You saw immediately, having consulted the images, that
A.
That's correct.
Q.
This was before the operation had even ended?
A.
This was at a somewhat, proven to be an irreversible
14
359
Q.
Yes.
A.
I mean the operation extended from, if you want to call
14:04
17
it the nephrectomy, through to the attempt to
18
revascularise the kidney, through to another
19
nephrectomy, if you like.
360
Q.
Yes.
But you knew, before even the anaesthetic had
21
warn off, two things:
22
been removed.
23
it wouldn't have happened, isn't that right?
24
25
361
2.
If the radiography had been checked
A.
That's correct.
Q.
So where we can discuss matter like systems failures,
the failure of a doctor or a surgeon to read the
27
radiography before the operation isn't a system
28
failure, isn't that correct?
A.
14:04
1. That the wrong kidney had
26
29
14:04
part of the operation.
16
20
14:03
I retrieved the images from the packet in theatre and
a serious error had occurred, isn't that right?
11
15
Correct.
put the images on the screen.
10
12
And Mr. Paran told
correct?
7
9
That is absolutely correct.
you he hadn't?
4
5
Yes.
Or is it?
I am not so sure I agree with you, with respect,
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Gwen Malone Stenography Services Ltd.
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1
2
Mr. Meenan.
362
3
Q.
Oh?
A.
Because I think that a systems failure also constitutes
4
the systems in place to provide the doctor, surgeon, or
5
otherwise, with the information that is relevant to
6
making such a decision.
7
363
8
Q.
Yes.
A.
I would argue with you, with respect, that such
9
information was not available, perhaps most likely
10
because of systems failure within the Hospital, and a
11
failure to recognise and priorities filing, which we
12
had addressed with hospital management, which was never
13
acted upon until well into this, well and truly after
14
this event.
15
364
16
Q.
Yes.
A.
So I would actually have to say that systems are a part
17
18
of this problem.
365
Q.
I see.
All right.
There has been a considerable
amount of discussion concerning the concerns that were
20
raised by the parents, isn't that right?
21
366
A.
I think that is true, yes.
Q.
Yes.
at this objectively, in a sense the concerns that were
24
raised by the parents aren't really relevant insofar as
25
the reading of the radiography before an operation is
26
something that should have been done irrespective of
27
what the parents said?
29
A.
14:05
I would have to suggest to you that if one looks
23
28
14:05
14:05
19
22
14:05
Yes, but I would not wish to undermine or devalue the
concerns of the parents because I think that is crucial
110
Gwen Malone Stenography Services Ltd.
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1
to this situation.
2
devalue the significance of looking or not looking at
3
the imaging.
4
367
Q.
No.
Nor would I wish to undermine or
I understand that.
I am not undermining it or
5
devaluing it in any way, but what I am just suggesting
6
to you is that irrespective of whether the parents had
7
raised the concerns, the radiography should have been
8
looked at prior to the commencement of the operation.
9
Do you agree with that?
10
11
368
A.
I think that is correct.
Q.
Okay.
14:06
I suppose it also follows from that that whether
12
or not radiography is read before the commencement of
13
the operation, does not depend upon parents raising
14
concerns, isn't that right?
15
16
369
A.
That's correct.
Q.
Yes.
14:06
So obviously you would have known from the word
17
go that really one of the core mistakes in this whole
18
matter was the fact that nobody read the radiography
19
before the operation commenced, isn't that correct?
20
A.
Can you define what you mean by the word "go"?
Is that
21
that at Out-Patients?
22
that at the hospital admission?
23
the SHO should have actually looked at the report.
24
25
370
14:06
I have freely admitted that.
14:07
Is
I have suggested that
Q.
I see.
A.
When the parents raised concerns the following morning,
26
it is clear that one of the nursing staff did not pass
27
that concern on at that stage, and at subsequent points
28
of contact between nursing staff and medical staff,
29
that concern was not passed on either.
111
Gwen Malone Stenography Services Ltd.
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1
371
Q.
I see.
What I am suggesting to you is this; that
2
before the operation had ended, before the patient had
3
come around after the anaesthetic, you knew that one of
4
the central defects in this matter was that the
5
radiography had not been looked at prior to the
6
commencement of the operation, is that correct?
7
8
372
A.
I think that is correct, yes.
Q.
Yes.
9
Okay.
What you are saying is, what you are
telling us here this morning, as I understand it, is
10
that as you had delegated the operation to Mr. Sri
11
Paran, it was his duty to read the radiography before
12
the operation, is that right?
13
A.
14
15
removing a kidney.
373
Q.
I understand that it was your evidence this morning
that Dr. Sri had some thirty minutes prior to the
17
commencement of the operation to read the radiography,
18
is that correct?
19
A.
20
minutes.
374
Q.
14:08
At least thirty minutes.
Okay.
So so far as you are
concerned, this operation had been delegated to Mr. Sri
23
Paran some thirty minutes before the operation had been
24
commenced, is that correct?
25
375
27
28
29
376
14:08
I think that is an approximation, but at least thirty
22
26
14:08
That would be a standard expectation for someone
16
21
14:08
A.
Well at least thirty minutes.
Q.
At least thirty minutes.
A.
Yes.
Q.
Would you agree with me therefore, it has to follow,
Okay?
that that thirty minutes is an absolutely crucial piece
112
Gwen Malone Stenography Services Ltd.
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1
of evidence as to who is responsible for either reading
2
or not reading the radiography.
3
A.
I am not so sure that time is a crucial element.
I
4
think it is an absolute require of the surgeon doing
5
the operation.
6
time.
7
377
Q.
That is the crucial element, not the
Well you know well that Mr. Sri is saying that he had
8
less than five minutes before the commencement of the
9
operation.
You are telling this Tribunal, this
10
Committee, that in fact he had at least thirty minutes,
11
isn't that right?
12
A.
saying five minutes.
14
thirty minutes.
378
16
17
379
In fact, yes, he had at least
Q.
At least thirty minutes.
A.
Yes.
Q.
Right.
minutes, and as you say not less than five minutes,
19
that must mean that so far as you are concerned you do
20
not have any responsibility for not reading the
21
radiography before the operation, is that right?
A.
think it is standard practice that the person who
24
wields the knife, as Mr. Wheeler put it yesterday, that
25
the person who wields the knife has control over when
26
the operation starts, and also has responsibility, and
27
I would regard that responsibility as including
28
reviewing the x-rays.
380
Q.
14:10
Well, in terms of delegating a procedure like this, I
23
29
14:09
In a sense the fact that he had at least thirty
18
22
14:09
Well, I was made aware yesterday that Mr. Paran was
13
15
14:09
Yes, and you said that that, as I understand your
113
Gwen Malone Stenography Services Ltd.
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1
evidence now is that that responsibility was passed
2
over by this conversation which you say took place at
3
least thirty minutes before the commencement of the
4
operation, isn't that right?
5
6
381
A.
That would be my understanding.
Q.
How do you mean your understanding?
7
382
10
11
383
A.
That is what I understand happened, yes.
Q.
Well, no, do you understand happening...(INTERJECTION)?
A.
Sorry.
Q.
Sorry, bear with me.
12
14:10
Do you say you understand that
happened or that it did happen?
13
14
I thought you said
that is what happened?
8
9
14:10
384
A.
It did happen.
Q.
It did happen.
Okay.
Very good.
That thirty minutes,
15
I would suggest to you, is absolutely crucial, isn't
16
it?
17
A.
18
19
Well, the thirty minutes is the start time, if you
like.
385
20
Q.
Yes.
A.
But in fact the surgeon who wields the knife, if I put
21
it like that, has the opportunity to extend that time
22
beyond thirty minutes if he so wishes.
23
is just a standard securing surgical practice.
24
surgeon determines when he starts the operation.
25
that thirty minutes could have been forty five minutes,
26
if Mr. Paran had wished it so, or indeed longer, or you
27
know, as long as it took to actually establish the
28
facts.
29
14:10
386
Q.
Sorry, I am a little lost.
That is, that
The
So
How could Mr. Paran have
114
Gwen Malone Stenography Services Ltd.
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14:11
1
wanted it to be forty five minutes?
2
A.
I think if there was a concern at any level, that
3
Mr. Paran could have had the opportunity, and did have
4
the opportunity to address the imaging.
5
387
Q.
I see.
Yes.
So Prof. Corbally, you were then in the
6
position on the day of the operation knowing, firstly
7
that the failure to read the radiography was a crucial
8
defect in the whole way in which the operation was
9
done.
That is the first thing you know.
The second
10
thing you also knew on the day was that I had given
11
Mr. Sri Paran some thirty minutes before the operation
12
to actually read the radiography, isn't that right?
13
A.
That is correct.
piece for a second.
15
very adequate time to read an image.
16
minute to read an image.
388
Q.
18
I think that thirty minutes is a
It takes one
But he had thirty minutes to do it, isn't
389
A.
At least thirty minutes.
Q.
At least thirty minutes.
So that presumably then,
21
Prof. Corbally, if anybody was to criticise you for not
22
reading the radiography, your immediate answer would be
23
"well (1) I delegated the operation to Mr. Paran, and
24
(2) he had at least thirty minutes to read the
25
radiographs before the operation."
26
A.
Is that correct?
I think the most crucial part of that is that I
27
delegated to Mr. Paran, with the expectation that
28
Mr. Paran would read the imaging.
29
14:12
that right?
19
20
Yes, yes.
14:11
But I think -- well I will hold my
14
17
14:11
390
Q.
Yes.
115
Gwen Malone Stenography Services Ltd.
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14:12
1
2
391
A.
That's correct.
Q.
You had at least thirty minutes for that.
So if
3
anybody was going to criticise a failure to read the
4
radiographs, your response was "the doctor or the
5
surgeon who did the operation had at least thirty
6
minutes to read the radiographs."
7
8
392
Is that right?
A.
Could you just repeat that again for me, please?
Q.
Yes, of course.
So if anybody was going to criticise
9
you, Professor, for a failure to read the radiograph or
10
the radiographs, your answer would be "well, Mr. Paran,
11
who I delegated to do the operation, had at least
12
thirty minutes to read those radiographs."
13
correct?
14
15
393
A.
I think that is correct.
Q.
Yes.
16
Is that
So we now know, of course, that this matter was
394
A.
That's correct.
Q.
It was investigated firstly by a team from Ormond
19
A.
21
Well there was an internal review prior to the Great
395
Q.
Okay.
Let's just look at the Great Ormond Street
Report.
24
discussed this with you, so I won't spend very much
25
time with it.
26
396
28
29
14:13
Ormond Street Report.
23
27
14:13
Street, is that right?
20
22
14:13
investigated, isn't that correct?
17
18
14:13
397
I know Mr. Leonard, on behalf of the CEO, has
Internal page 10 of that report.
A.
I am sorry, could you bear with me for one second.
Q.
Yes, of course.
A.
Page 10.
Q.
Yes, the bottom of page 10?
116
Gwen Malone Stenography Services Ltd.
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1
2
A.
398
Yes.
Q.
3
"Patient XY was on a "parallel" morning
list, running simultaneously in Theatre
5 and Theatre 7. The SPR was working
in Theatre 7 and the consultant in
Theatre 5. After the first few
patients there was a pause in between
patients coming to Theatre 7, and the
SPR went to Theatre 5 to see how he
could assist. He helped to prepare and
position Patient XY, now anaesthetised,
for the operation. The consultant
asked him if he would like to do the
case. A nephrectomy was within the
competence of the SPR, although he had
never performed one completely
unsupervised, and was handed the case a
short notice."
4
5
6
7
8
9
10
11
12
13
Now presumably you made a statement, did you, to the
14
Ormond Street Inquiry?
15
A.
16
17
20
14:14
14:14
they took statements from all personnel involved.
399
18
19
The basis of the Great Ormond Street Inquiry was that
14:14
400
Q.
Yes.
A.
This report was then prepared independently.
Q.
Yes.
A.
Both Mr. Paran and myself, and I think all people who
21
had significant roles in this event, were invited down
22
to the CEO's office and told that this report could not
23
be taken from that office and that we could, both
24
myself and Mr. Paran individually, had several minutes
25
to review, to actually read this report.
26
that, and I have always thought that given several
27
minutes to read a report like this, without any actual
28
potential to change it, or alter it, or edit it in any
29
way was not an appropriate way to deal with the report.
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Gwen Malone Stenography Services Ltd.
I would think
14:15
14:15
1
401
2
Q.
Yes.
A.
So, yes, that is how the report was actually
3
4
constructed.
402
Q.
5
Yes.
All right.
So you are saying the report is wrong
there?
6
A.
14:15
No, I am not, Sir.
I am actually saying that the
7
report, that the way in which the report was
8
constructed did not give any potential to those
9
involved to express their own individual opinions.
10
403
Q.
11
14:15
the...(INTERJECTION)?
12
A.
13
14
Were you asked to make a statement to
I was asked, I was verbally interviewed, and that was
all, on two occasions.
404
Q.
In the course of that verbal interview, which I am sure
15
you recall, did you say anything about you having
16
delegated the operation to Mr. Paran some at least
17
thirty minutes before the operation?
18
A.
19
20
The time factor was never considered that important in
the interview they had with me.
405
21
Q.
Oh?
A.
I do not recall them asking me a specific time.
14:16
All
22
that I recall in that conversation, on two occasions,
23
was that I delegated and that I felt that Mr. Paran was
24
of appropriate training and experience to actually do
25
the procedure.
26
27
14:16
406
Q.
I see.
A.
That is all.
14:16
There was no question, that I can recall,
28
in relation to how long Mr. Paran had to make up before
29
doing the case.
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Gwen Malone Stenography Services Ltd.
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407
Q.
Yes.
Would you not have thought that information to
2
the effect that you had delegated the operation to your
3
junior some, at least thirty minutes beforehand, is an
4
important piece of information which should be
5
conveyed?
6
A.
14:16
I think at this point it is an important piece of
7
information, but it did not appear important in the
8
questioning that was directed to me by the Great Ormond
9
Street Inquiry Team.
10
408
Q.
11
Why do you think at this point it is an important piece
of information?
12
A.
Well, it is clear that the issue is now one of
13
delegation, and how appropriate delegation was, and
14
whether or not there was adequate time to prepare the
15
case.
16
409
17
Yes.
A.
I understand that is the reason why it has become
important.
410
Q.
20
It certainly became important when the Medical
411
A.
Yes, of course it is important.
Q.
Yes.
23
14:17
I think when the Medical Council got involved,
you sent them a letter, isn't that right?
24
25
Yes.
Council got involved, didn't it?
21
22
14:17
Q.
18
19
412
A.
Yes.
Q.
Let's have a look at that letter now.
I don't know
26
where it is in your pagination.
27
MR. CROSS:
Tab 2.
MR. MEENAN:
Sorry Tab 2 of the Core
28
14:17
413
Q.
29
Booklet.
119
Gwen Malone Stenography Services Ltd.
I just have it,
14:17
1
unfortunately I have got it loose.
2
3
414
4
5
415
A.
30th September?
Q.
Yes, that's right?
A.
Yes.
Q.
Well no, sorry, 10th February is the letter that I am
6
looking at.
7
was looking at a letter dated 10th February 2010?
8
MR. CROSS:
I am looking at a letter of -- sorry, I
I don't see that,
9
Mr. Meenan
10
MR. MEENAN:
That is what was furnished
11
14:18
to me.
12
MR. LEONARD:
That hasn't been handed
13
into the Committee by the
14
CEO.
15
MR. MEENAN:
Okay.
16
CHAIRMAN:
There is a letter of 30th
I am not sure I have a copy of it either.
17
Very well.
14:18
September we have, a long
18
letter.
19
MR. LEONARD:
I will just see if we have
20
21
14:17
a copy of it.
416
Q.
MR. MEENAN:
14:19
Yes I think in fact, the
22
portion in fact is exactly
23
the same.
So if you just ignore, I just want to go
24
with that letter which is dated 30th September 2009.
25
Could I just ask you to look at that letter.
26
might indicate to me in that letter where it says that
27
you gave the junior doctor, Mr. Paran, some at least
28
thirty minutes before the operation to, as it were,
29
acquaint himself with the radiography and so on?
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Gwen Malone Stenography Services Ltd.
You just
14:19
1
2
417
A.
I don't believe it says that in that letter.
Q.
Why would that crucial bit of information not be in
3
that letter?
4
A.
I am not sure why that crucial information would be
5
left out at that stage?
6
was -- in the context of what I was trying to explain
7
was that delegation had occurred and that Mr. Paran was
8
happy to do the procedure.
9
418
10
Q.
Yes.
A.
But the issue of time had not entered
11
12
It is -- I am not so sure it
419
Q.
Well, I think at this stage now the Medical Council is
involved, and you know that delegation is a crucial
14
issue, isn't that right?
15
420
A.
Delegation is a very important issue, yes.
Q.
It is a crucial issue, I would suggest, and you agreed
17
with that this morning.
18
effect that Mr. Sri Paran was given at least thirty
19
minutes before the operation should have been put into
20
that letter, is that right?
21
A.
22
23
14:20
Surely your evidence to the
14:20
I was merely trying to express the fact that delegation
had occurred.
421
24
Q.
Yes.
A.
That I think that delegation had been an appropriate
25
thing to do with Mr. Paran.
26
time issue at that time.
27
14:20
into...(INTERJECTION).
13
16
14:20
422
Q.
I had not considered a
I just want to suggest to you that you knew delegation
28
was crucial.
You must have known, couldn't possibly
29
not know I would suggest, that delegating the operation
121
Gwen Malone Stenography Services Ltd.
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1
to Mr. Paran at least thirty minutes before the off was
2
absolutely crucial.
3
is it?
4
A.
It is not, it is not there at all,
Well, could I say that I think, you know, thirty
5
minutes, or fifteen minutes, or forty five minutes, or
6
thirty five minutes, all of those are time constraints
7
in a procedure.
8
423
9
Q.
Yes.
A.
But the reality is that the operating surgeon has the
10
time at his hands, no matter whether it is ten minutes,
11
or fifteen minutes, or twenty minutes to decide to
12
stop, to pause, to review the imaging.
13
reality of any case that is delegated to any doctor.
14
don't think, and I think in writing this letter that
15
probably was my attitude, that Mr. Paran had plenty of
16
time to review the imaging.
17
424
18
Q.
Well did -- sorry, I interrupted you.
A.
Sorry, I beg your pardon.
20
proceed to examine the imaging.
22
I
14:21
Q.
Yes.
A.
That the timing -- procedures do not start on sort of
23
auto start, they start when the surgeon is ready.
24
the time issue, be it five minutes, ten minutes, twenty
25
minutes, half an hour, one hour, the time issue is set
26
by the surgeon in charge.
27
reflects, not the issue of thirty minutes.
28
29
426
14:21
No, but I felt that
Mr. Paran had the ability and knowledge to actually
425
14:21
That is the
19
21
14:21
So
That is what that letter
Q.
Yes.
Did you write that letter yourself?
A.
I wrote that letter myself, yes, with some input from
122
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1
2
my legal team.
427
Q.
3
Of course, yes.
I guess you must have told your legal
team about the thirty minutes, did you?
4
A.
I did at some point, yes.
Well not necessarily thirty
5
minutes, but that there was a second conversation and
6
that there was adequate time, I believe, to discuss and
7
review the imaging.
8
428
Q.
9
operation?
11
429
13
14
When did you first tell your legal team that Mr. Sri
Paran had at least thirty minutes to prepare for the
10
12
430
15
14:22
A.
I am not sure.
Several months ago, I believe.
Q.
Several months ago?
A.
I believe so, yes.
Q.
It is not in that letter at all, no?
A.
Well as I said, the issue of time, really it is an
14:22
16
issue of delegation of appropriate responsibility.
17
surgeon has the opportunity to slow the procedure down.
18
The start of the procedure is at his behest.
19
decide when he starts the operation, and after he has
20
reviewed the imaging.
21
431
Q.
The
He can
Mr. Wheeler, upon which the case against you was
23
brought by the CEO, you will see that it is full of
24
references to delegation and non-delegation, and proper
25
delegation and adequate delegation, isn't that right?
26
432
28
29
433
14:23
Well I suppose when you got the report from
22
27
14:22
A.
Delegation is a very important part, as we have agreed.
Q.
Yes.
A.
It is.
Q.
Yes.
That report is full of it, isn't that right?
You will have seen then the conclusions of the
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1
report involving your good self, Professor, page 9 of
2
the report.
3
"In this case, Prof. Corbally delegated
the operation to Mr. Paran. The
Tribunal may find that delegation of
operative surgery is a part of the
accepted custom."
4
5
6
7
Then so on.
8
"Furthermore, the Tribunal may find
that as part of the process of
delegation, the delegate accepts the
responsibility.
9
10
11
14:24
If these two facts are found,
Prof. Corbally's failure to review the
notes and imaging and reports before
the nephrectomy was due to delegation
of these tasks, and would not amount to
a serious falling short by omission or
commission of the standards expected
amongst doctors."
12
13
14
15
14:24
16
Mr. Wheeler goes on:
17
"However, if the Tribunal finds in the
alternative, that there is no accepted
practice of delegation and furthermore,
no accepted understanding that with the
operation also goes the responsibility
to review the images, then
Prof. Corbally's failure to make this
review would amount to a serious
falling short...."
18
19
20
21
22
23
And so on.
24
is dated February, which I think is only just shortly
25
after the letter, that delegation was absolutely
26
crucial?
27
28
29
14:24
434
14:24
So you knew when you got that report, which
A.
Yes, delegation is a crucial part of this.
Q.
Yes.
Yes.
As far as Mr. Wheeler was concerned, your
evidence to the effect that Mr. Sri Paran was given at
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14:25
1
least thirty minutes before the operation would also be
2
very important, isn't that right?
3
A.
Well can I just say that, you know, delegation happens
4
on a very fluid basis in pressured service practices.
5
I still maintain that Mr. Paran, whether it was half an
6
hour, or two hours, or what, that Mr. Paran had time to
7
actually review the imaging.
8
435
9
Q.
Yes.
A.
That it is his prerogative as delegated surgeon to
10
11
review the imaging.
436
12
14:25
Q.
Yes.
A.
And the start time of the procedure is not dependent on
13
any auto start button, it is dependent on the surgeon
14
deciding that he is comfortable with proceeding with
15
what he has been asked or requested to do.
16
437
Q.
talking about various times concerning delegation,
18
isn't that right?
20
438
A.
That's correct.
Q.
He was talking of times of an hour, an hour and a half,
21
439
A.
That's correct.
Q.
You have a very experienced and competent solicitor,
24
and an extremely experienced and competent barrister.
25
Did you not suggest to them that maybe they ask
26
Dr. Wheeler "well, in my case I actually gave Mr. Paran
27
thirty minutes."?
28
29
14:26
maybe as short as fifteen minutes, isn't that right?
22
23
14:26
You were in here yesterday listening to Mr. Wheeler
17
19
14:25
440
A.
I do not, I did not suggest that to my legal team, no.
Q.
Did you even tell them about it?
125
Gwen Malone Stenography Services Ltd.
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1
2
441
A.
They were already aware of that before yesterday.
Q.
Okay.
Now I want to now -- you say there were two
3
conversations before the operation was transferred,
4
isn't that right?
5
6
442
A.
That's correct.
Q.
One you say at least thirty minutes, and the second one
14:27
7
less than five minutes, is that right?
8
less than five minutes.
9
disagreeing with that?
10
A.
Mr. Paran says
You don't seem to be
I am not -- I cannot be firm about the actual time of
11
the first conversation.
12
o'clock.
13
after Mr. Paran had catheterised the patient.
14
have been half past eleven, or it may have been twenty
15
five past eleven, it may have been twenty five to
16
twelve, but the patient was now asleep in the operating
17
theatre at the time, at the time of the second
18
conversation.
19
443
Q.
Yes.
I know it was before 11:00
The second conversation would have happened
It was post anaesthesia.
That may
14:27
Are you disagreeing, I
20
mean we will cut to the chase, are you disagreeing with
21
Mr. Paran when he says it was less than five minutes
22
before the start?
23
24
444
A.
I am not disagreeing with that aspect of it, no.
Q.
Okay.
Thank you.
So then we have got two times.
have got one time of more than thirty minutes and a
26
second time of less than five minutes.
27
you are saying?
29
445
A.
No, I am not saying that at all.
Q.
Oh?
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Gwen Malone Stenography Services Ltd.
14:27
We
25
28
14:27
That is what
14:27
1
A.
I am saying a total time, and I think it should be
2
viewed as a total time rather than as two separate
3
times.
4
446
Q.
Oh, I see.
I thought you told me it was more like
5
thirty minutes, but in fact it is more twenty five
6
minutes now you are talking about?
7
A.
No.
What I have said is that, and what is evident, is
8
that the start time of the operation was 11:40 or
9
thereabouts.
10
447
11
12
448
13
Q.
This is the nephrectomy?
A.
The nephrectomy.
Q.
It wasn't, it was 11:09?
A.
That is not correct.
14
15
14:28
Correct.
The patient arrived in the
theatre reception at 11:05 or 11:09.
449
16
17
450
Q.
I see.
A.
And it would have taken...(INTERJECTION).
Q.
Just so we are not at cross purposes on this.
14:28
18
sheet you produced this morning says "Start
19
Anaesthetic: 11:09."
20
A.
21
22
451
Well, my understanding was the patient arrived at the
14:28
Q.
Oh, I see.
So this appears to be at variance then with
your recollection, is that right?
24
A.
25
Well that is not my recollection, that is what is
written on that, on that sheet.
452
Q.
27
I see.
Very well.
So this may be wrong then, is that
right?
28
29
The
reception area shortly after 11:00.
23
26
14:28
453
A.
Well, I cannot comment on that.
Q.
Well anyway you produced it.
You tell me.
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Gwen Malone Stenography Services Ltd.
14:28
1
A.
No, I am sorry, I did not produce that.
That is a
2
hospital document.
3
hospital of when the patient actually went into theatre
4
and had the anaesthetic.
5
454
Q.
That is an official record from the
Sorry, Professor, this was a document put into evidence
6
on your behalf.
7
querying the accuracy of this document, that is fine.
8
It is not my document?
9
A.
10
11
Now if you are telling me that you are
No, I am sorry, I thought when you said "produced it" I
thought you meant I actually produced it myself.
455
12
Q.
No, of course not.
A.
No, okay.
The patient came to theatre around 11:00
o'clock and was brought into the theatre suite and
14
anaesthetised.
15
o'clock.
456
17
18
19
457
14:29
No.
13
16
14:29
That would have been after 11:00
14:29
Q.
All right.
It is 11:09?
A.
Sorry, 11:09.
Q.
All right.
A.
I wouldn't be aware precisely, from my own
After 11:00.
20
recollection, of what time the patient came into
21
theatre, nor would I be aware of what time precisely
22
the anaesthetic began, but I do know from Dr. Mannion's
23
testimony, he is the Consultant Anaesthetist, he said
24
that the surgical time was around 11:40.
25
the patient arriving in theatre to the theatre
26
reception area and then going to sleep, there is about
27
thirty minutes or so.
28
suggest that it is very difficult to be precise about
29
that time.
So between
So I think, I would respectfully
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Gwen Malone Stenography Services Ltd.
14:29
14:29
1
458
Q.
2
Yes.
Well you were precise by at least, when you were
referring to at least thirty minutes, isn't that right?
3
A.
Well with respect, I don't think at least is quite
4
precise.
5
be thirty five minutes or more.
6
459
Q.
7
All right.
It could
14:30
You say that conversation took place some
time between 10:30 and 11:00, is that right?
8
9
I think that is an approximation.
460
A.
That's correct.
Q.
That is the first conversation.
During the course of
10
that conversation you said to Mr. Paran, you asked him
11
would he like to do the nephrectomy, is that correct?
12
13
461
A.
I asked him would he like to do the nephrectomy, yes.
Q.
Yes, okay.
Then the second conversation, which you
14
accept occurred less than five minutes before the
15
operation, was to the effect; " would you like to
16
proceed with the nephrectomy?", isn't that right?
17
18
462
19
A.
I said are you okay to proceed with the nephrectomy.
Q.
All right.
A.
That may have been five minutes before the actual start
20
time or it may have been ten minutes.
21
about that.
22
463
Q.
I cannot be sure
but.
24
conversation with him if, in your view, he was already
25
delegated to do the operation?
A.
14:30
14:30
No, I thought we had agreed less than five minutes,
23
26
14:30
Why was it necessary to have that second
14:31
Well it wasn't necessary to have that conversation, but
27
I was there in theatre and it was just something to
28
discuss with him.
29
query of his ability or anything.
That is all.
It wasn't actually a
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Gwen Malone Stenography Services Ltd.
1
464
2
3
465
Q.
No, no, no.
A.
Or his reluctance to do it or not.
Q.
I have never suggested there was a query of ability or
4
anything like that, but I am just wondering, if you are
5
firm in your own mind that some thirty minutes before
6
the operation you had delegated to him, why did you
7
consider it necessary for him to say some five and a
8
half, less than five minutes before the operation; "are
9
you ready to proceed?"?
10
A.
I didn't say "are you ready to proceed?", I asked him
11
was he okay with proceeding.
12
intended in that comment.
13
466
Q.
Nothing intended.
Okay.
Now, I just want to go back
now to Mr. Paran's movement on that morning.
15
Mr. Paran, as you know, was operating in No. 7, isn't
16
that right?
18
467
19
A.
That's correct.
Q.
And you were in No. 5?
A.
Well we were in and out.
20
21
5 as well.
468
Q.
Yes.
He wasn't solely in Theatre 7.
23
and correct me if I am wrong at this stage, that this
24
conversation, this is some thirty minutes before the
25
nephrectomy, you say that conversation with Mr. Paran
26
occurred at the end of the hypospadias fistula repair,
27
is that right?
469
14:32
Well that is exactly now what I want to deal
with, because I think your evidence this morning was,
29
14:31
He was in and out to Theatre
22
28
14:31
There was nothing
14
17
14:31
A.
Yes, that's correct.
Q.
You are saying it occurred at the end of that
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14:32
1
operation?
2
3
470
A.
Towards the end of that operation, yes.
Q.
Are you saying that Mr. Paran was present at the
4
beginning, the middle and the end of that operation, or
5
what are you saying?
6
A.
14:32
Well what happens, there is a tremendous fluidity
7
between surgeons moving around between the two
8
theatres.
9
in and out of theatre during that.
So it is quite possible that Mr. Paran was
He did assist me
10
with the fistula repair, as I understand it.
11
him after that, or during that time, in that timeframe
12
between 10:30 and 11:00 o'clock, was he happy, would he
13
like to do this procedure?
14
471
Q.
15
472
A.
Sorry.
Q.
Is it your evidence to the Committee that it was at the
18
conclusion of that fistula operation that you asked
19
Mr. Paran to do the nephrectomy?
20
A.
21
22
473
474
Q.
After the procedure is finished.
A.
The hypospadias repair fistula, yes.
Q.
How did Mr. Paran, in your recollection, come to be
25
present in the fistula operation at all?
26
27
475
A.
I think he was free from his Theatre 7 commitment.
Q.
You think he was free.
28
29
I believe it was after the procedure had
14:33
14:33
finished...(INTERJECTION).
23
24
14:32
Could I possibly ask you that question again,
Prof. Corbally, maybe you misunderstood it?
16
17
Yes.
I did ask
So he had nothing to do in
Theatre 7?
A.
Well I know very busy otherwise but, yes, he had
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14:33
1
2
nothing else to do on that list.
476
3
4
477
Q.
Did you call him?
A.
I cannot recall if I called him or not.
Q.
Do you think he wasn't, as it were, do you think he was
5
free?
6
A.
7
8
478
Q.
Indeed.
He will always want to be present.
Yes, you are absolutely right.
in, is that right?
11
A.
12
14:34
It is more likely that Mr. Paran just came into
theatre.
479
14
480
Q.
You think it is more likely he wandered in?
A.
More likely, yes.
Q.
All right.
Mr. Paran has a very specific recollection,
16
Professor, of those events.
17
now?
18
going to call it the fistula operation.
19
20
You cannot
remember whether you called him or he simply wandered
10
15
Well Mr. Paran is very helpful in a list, and a very
flexible.
9
13
14:33
481
14:34
Can I just put them to you
At that stage, when you were doing this, I am
Okay?
A.
Yes.
Q.
He, at the time, was involved in the operation of a
21
Hickman/Broviac removal.
22
just before the fistula on this document here.
23
When he was completing that he got a call to say -- it
24
is operation number 515562.
25
CHAIRMAN:
In fact it is the operation
Okay.
Sorry to interrupt you,
26
14:34
Mr. Meenan.
Would it be
27
possible that the Committee might get a brief
28
explanation as to what that Hickman/Broviac is?
29
brief description of what sort of an operation it is.
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Gwen Malone Stenography Services Ltd.
Just a
14:35
1
MR. MEENAN:
Yes, I think I know what it
2
is.
Removal of a central
3
line, which I understand is not a massive procedure.
4
CHAIRMAN:
Central veinous line say in
5
the neck where you would
6
just take it out.
7
MR. MEENAN:
So it is a simple operation.
I wonder, maybe Mr. Paran
8
could probably answer that.
9
MR. PARAN:
This is left in for months
10
for chemotherapy and it has
11
a cuff which gets anchored.
12
simple pull, you have to release the cuff and pull,
13
more or less about five minutes as opposed
14
to...(INTERJECTION)
15
CHAIRMAN:
be fine.
482
Q.
MR. MEENAN:
In any event,
Mr. Paran was completing
19
that when he got a call to say the Professor wanted to
20
see him, and he went over to 5, and in 5 you were
21
involved in this hypospadias fistula -- sorry.
22
23
14:35
Yes, thank you.
Thank you.
18
14:35
So again it is not just
I think that is, that will
16
17
14:35
483
A.
Hypospadias fistula.
Q.
Yes.
Sorry, I am sorry, one small detail.
14:36
After the
24
call that the Professor wanted to see him, a nurse came
25
in to bring him, to summons him over to Theatre 5.
26
he went over to Theatre 5, and as I say you were
27
involved in this hypospadias fistula repair.
28
has a very good recollection of what happened.
29
firstly, contrary to your recollection, Mr. Paran did
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Gwen Malone Stenography Services Ltd.
So
Mr. Paran
So
14:36
1
not wander in.
2
Now, in the light of that, do you wish
3
to...(INTERJECTION)?
4
A.
He was actually summoned by yourself.
No I cannot comment on that, because there is such an
5
amount of fluidity in movement between theatres that it
6
would be impossible to recollect that with accuracy.
7
484
Q.
You, Professor, wanted to seek Mr. Paran's advice on a
8
recurrent fistula and asked Mr. Paran to, as it were,
9
scrub in, which I understand in layman's terms means
10
gets involved in the operation?
11
12
485
13
14
486
14:37
A.
That's correct.
Q.
Do you remember that, do you?
A.
I know that Mr. Paran helped me with that procedure.
Q.
Yes.
Okay.
I think you explained to him that the
15
patient, this particular patient, in this particular
16
case the patient's father was a doctor, or you said
17
words to that effect.
18
that?
19
20
487
Is that right?
A.
I cannot recall that.
Q.
So in any event, Mr. Paran assisted in the operation
but then left, and left before the end of the
22
operation.
A.
I cannot recall Mr. Paran leaving the case, or if I
closed that particular case myself, but I do remember
25
talking to Mr. Paran after the case had finished in
26
Theatre 5, when there was no patient there, before
27
11:00 o'clock, to discuss the delegation to the
28
nephrectomy patient.
488
Q.
14:37
So, do you recall that?
24
29
14:37
Can you recall
21
23
14:37
Yes.
So if, as I understood your evidence to be, you
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Gwen Malone Stenography Services Ltd.
14:38
1
had this, as it were, what I will call the thirty
2
minute conversation at the conclusion of the fistula
3
repair, I am suggesting to you that on Mr. Paran's
4
account you couldn't have, because in fact he wasn't
5
there at the end of the operation?
6
A.
With respect, I cannot accept that.
14:38
I would point out
7
to you that movements are very fluid between theatres
8
and surgeons involved in the one list trying to get
9
through the patient commitment.
It is quite common for
10
surgeons to move in and out of theatre during the
11
course of a procedure, and the theatres in fact in
12
question, Theatre 7 and Theatre 5, are quite close.
13
489
14
Q.
Yes, indeed.
A.
So movement across the two theatre areas would be quite
15
16
common and quite frequent.
490
Q.
Yes.
Mr. Paran, at the conclusion of the operation, had in
18
some sense come back to No. 5, is that right?
20
491
A.
That's correct.
Q.
I see.
21
Okay.
That is my recollection.
So he left No. 5 during the operation
A.
Well that is, because I, my recollection is that we had
23
a conversation there was no patient in the theatre at
24
the end of that procedure.
492
Q.
I see.
So presumably he would have come back to No. 5
26
because he had nothing else to do anywhere else, is
27
that right?
28
29
14:39
and then came back to No. 5, is that right?
22
25
14:39
Sorry, I had understood you to say that
17
19
14:38
A.
Well, no.
Mr. Paran was busy on the day, and he had
other commitments for his own consultant, Prof. Puri.
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14:39
1
So, I would never imagine that Mr. Paran would be was
2
wasting time.
3
clinical importance.
4
493
Q.
I think he was doing something else of
Well, Mr. Paran's evidence in this will be that, yes,
5
he did of course assist you in the operation, left
6
before the end of the operation, went back to Theatre 7
7
and asked Michelle Cullinane, I think that name is
8
correct, to send for the next patient for the operation
9
in No. 7.
10
A.
I believe there was a delay with that patient and
11
Mr. Paran came back to Theatre 5 with that information,
12
which was on the basis of that that I realised that he
13
will be free, and therefore I asked him to do the
14
nephrectomy.
15
494
Q.
Ah, well you see isn't this one of the problems,
16
because what Mr. Paran will say, and I think you are
17
probably agreeing, if he had been told, at least thirty
18
minutes before the nephrectomy, that he would be doing
19
a nephrectomy, he would have never sent for another
20
patient to be dealt with in Theatre 7?
21
22
495
23
A.
Well, I can see the logic of that.
Q.
Yes.
A.
Of your case there, but in fact there are other people
24
to do procedures too on the list.
25
necessarily be mutually exclusive.
26
patient had been sent for for a nephrectomy, we would
27
anticipate at least half an hour for the patient to be
28
prepared.
29
496
Q.
14:39
14:40
14:40
14:40
So it wouldn't
In addition, if the
Yes.
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Gwen Malone Stenography Services Ltd.
14:40
1
A.
And that half an hour would allow another patient with
2
a minor problem to be dealt with.
3
mutually exclusive.
4
497
Q.
5
Well I thought you told me a moment ago that you
thought it might be?
6
7
So it is not
498
14:41
A.
I don't recall me saying it might be exclusive.
Q.
Well what I am suggesting to you is this, and I thought
8
you were agreeing, but maybe you are not, that if
9
Mr. Paran had been told, as you said he was told some
10
thirty minutes before the nephrectomy that he was going
11
to be doing this nephrectomy, he would never have gone
12
back to 7 and sent for the next patient?
13
A.
Well, Mr. Paran was requested to do the procedure, and
14
I think it is quite likely within his ambition to get a
15
list finished that he might do that.
16
that as being necessarily impossible.
17
499
Q.
I couldn't see
telling you, I want to suggest to you that for a junior
19
doctor it is highly implausible that when he is asked
20
to do an operation like a nephrectomy, which Mr. Paran
21
will say for him was a serious operation, that his
22
reaction to that would be to go back to the other
23
theatre and ask for another patient to be sent down?
A.
there was a significant delay with getting the patient
26
into No. 7.
500
28
29
501
14:41
Well, my recollection is that Mr. Paran came and said
25
27
14:41
Well it may not be necessarily impossible, but I am
18
24
14:41
Q.
Yes, there was.
A.
And therefore he was available.
Q.
Yes, but that was clearly well after thirty minutes.
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Gwen Malone Stenography Services Ltd.
14:42
1
Wasn't it?
2
3
502
A.
I cannot actually put the timeframe into that, sorry.
Q.
So, Mr. Paran then went back to 7, and as I say he
4
asked for the next patient, which as you know we say he
5
would never have done if he was going to be doing a
6
nephrectomy.
7
the parents, and that conversation took place.
8
came back and went back to 7 and saw that his patient
9
was still not there, and he went off to see four
He then was called to go out to speak to
He then
10
patients in the intensive care unit.
11
you suggest to you, yet again, if calling for another
12
patient is inconsistent with being told you are doing a
13
nephrectomy in thirty minutes, going off to the
14
intensive care unit to see four more patients is even
15
more inconsistent.
16
A.
17
18
Now, I want to
Would you agree with that?
14:43
Well I would agree with that, but I know that Mr. Paran
503
Q.
Yes.
A.
I would, that is part of Mr. Paran's personality,
20
surgical personality, to try and be as helpful as
21
possible.
504
23
Q.
Yes, yes.
A.
Since the patient for nephrectomy was not actually in
24
theatre at that time, it is quite reasonable to assume
25
that one could do one more case in Theatre 7 before the
26
nephrectomy actually arrived in theatre and was
27
anaesthetised and prepped and everything else.
28
there is a...(INTERJECTION).
29
14:42
is anxious to get through significant workloads.
19
22
14:42
505
Q.
Sorry, sorry.
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Gwen Malone Stenography Services Ltd.
So
14:43
14:43
1
2
506
A.
Sorry.
Q.
Sorry, I didn't mean to interrupt you, Professor.
3
Sorry.
4
A.
5
6
There is a potential to actually deal with another
patient before the nephrectomy is ready to start.
507
Q.
Yes.
Well presumably the reason you say you told
7
Mr. Paran that he would be doing a nephrectomy in at
8
least thirty minutes was so that he could prepare for
9
it, isn't that right?
10
A.
No, I anticipated the preparation would be done when
11
Mr. Paran was ready to do it.
12
timeframe of thirty minutes or more in that context.
13
508
Q.
Yes, and calling for another patient and going off to
the ICU to see four more patients, it doesn't really
15
fit in with that, does it?
17
509
14:44
I did not consider the
14
16
14:43
14:44
A.
That is just efficient use of time.
Q.
I see.
All right.
So he went to the intensive care
18
unit, saw the patients there, spent some time there,
19
and went become to Theatre 7 to see had the patient
20
arrived, and the patient hadn't arrived because the
21
patient had to get a premed which somewhat delayed that
22
operation.
23
inconsistency then, doesn't it?
24
done is, Mr. Paran has sent for the next patient, not
25
there.
26
see four more patients.
27
nephrectomy, but gone back to 7 to try and do the
28
patient which he had sent for.
29
isn't it?
14:44
So, that really sort of adds to the
Because what he has
He has gone off to the intensive care unit to
Not gone back to do the
It is all very odd,
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Gwen Malone Stenography Services Ltd.
14:45
1
A.
No, I think it is within keeping of an efficient
2
surgeon trying to get through a list.
3
it as odd at all.
4
the pressures that we are under, and we have to try
5
and, you know, we are under pressure to deal with
6
numbers, and we are trying our best to get through a
7
list.
8
510
9
Every surgeon in Crumlin is aware of
Q.
Well of course...(INTERJECTION)?
A.
Mr. Paran -- sorry, Mr. Paran has been exemplary in his
10
11
I don't regard
ability to try and do that.
511
12
Q.
Yes.
A.
I would think that sending for an additional patient
13
would be Mr. Paran's, I would absolutely agree that
14
that would be part of the way he would work.
15
512
Q.
16
He doesn't turn down work, is that what you are
A.
18
time.
513
Q.
Yes.
Yes, you are right.
So you don't think then it
was out of order in Crumlin Hospital at the time, in
21
the space of some twenty five minutes, because we know
22
he was there some five minutes before the operation,
23
maybe even a little bit before that, because we know he
24
had to catheterise the patient and position the
25
patient, which all takes a little bit of time, isn't
26
that right?
27
29
14:45
No, Mr. Paran is an extremely generous person with his
20
28
14:45
saying?
17
19
Yes.
14:45
514
A.
That does take time, yes.
Q.
So he would certainly have been there, although he says
he was only told about the operation less than five
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Gwen Malone Stenography Services Ltd.
14:46
14:46
1
minutes beforehand, he would certainly have been
2
present in the theatre probably about ten minutes.
3
Would that be right?
4
A.
5
6
Would that be right?
I cannot comment on when he entered the
theatre...(INTERJECTION).
515
Q.
14:46
Yes, but presumably it takes a bit of time to position
7
a patient and to catheterise the patient.
8
suggesting to you about ten minutes?
9
A.
I cannot comment if he was there fifteen minutes, or
10
ten minutes, or five minutes.
11
arrived in Theatre 5.
12
516
Q.
So I am
I don't know when he
Yes, I know you don't know when he arrived.
I am just
13
looking at what he did when he arrived, to try and fix
14
a time for it?
15
A.
16
17
Well it would take two or three minutes to catheterise
517
518
Q.
Yes.
A.
It would take a minute or two to position the patient.
Q.
Okay.
So we will say in around ten minutes.
So that
20
would probably leave him twenty minutes then after
21
being told that he was doing a nephrectomy, isn't that
22
right?
23
A.
24
25
14:46
the patient.
18
19
14:46
14:47
Twenty minutes before he was -- I don't understand the
question.
519
Q.
All right.
Okay.
Well let's just work it forward.
26
You say he had at least thirty minutes, you have told
27
him at least thirty minutes before the operation that
28
he was going to be doing a nephrectomy.
29
you are saying?
141
Gwen Malone Stenography Services Ltd.
That is what
14:47
1
A.
Well, I have a problem with your choice of words.
2
apologise for that.
3
I did not tell him to do the operation.
4
520
Q.
5
I asked him to do the operation.
All right.
Okay.
521
14:47
A.
He absolutely agreed to do it.
Q.
So that is, we will say, thirty minutes before the
8
A.
Well, it was about before 11:00 o'clock, and the
10
operation started at 11:40.
11
forty minutes.
522
Q.
13
523
16
17
Oh, it is 40 minutes.
So that would be, it is
524
18
So the thirty minutes is now
A.
I am sorry, I don't mean to be disrespectful.
Q.
All right.
A.
You said at least thirty minutes...(INTERJECTION).
Q.
Well no, I am sorry...(INTERJECTION)?
A.
And I have said that it was before 11:00 o'clock and
14:47
19
that the patient went, the surgical time was actually
20
11:40.
21
14:47
becoming 40 minutes?
14
15
He was very willing.
operation, is that right?
9
12
Yes, and you say he
agreed to do it?
6
7
All right.
I do
525
Q.
14:48
Look Professor, I won't beat about the bush with you.
22
What I am putting to you is simply this; that on your
23
evidence he had at least thirty minutes before the
24
operation, more thirty minutes.
25
operating theatre ten minutes before the operation,
26
which left him twenty minutes, and I want to know is it
27
your evidence to this Council that in the space of
28
twenty minutes in Crumlin Hospital you would carry out
29
an operation, go to the ICU and see four patients?
He was in the
142
Gwen Malone Stenography Services Ltd.
14:48
1
A.
What I am suggesting is that Mr. Paran will use the
2
time very efficiently, and if there is a hiatus in
3
time, Mr. Paran will actually try and see patients and
4
fill in that time appropriately.
5
is able to see all four patients, or even do a minor
6
procedure in that case, is something
7
different...(INTERJECTION).
8
526
9
Now whether or not he
Q.
Well I can tell you what the -- sorry.
A.
Sorry, but the patient, if the patient was asleep in
10
Theatre 5 and waiting for Mr. Paran to start, Mr. Paran
11
could be a few minutes late coming to theatre.
12
possible to actually at least have the ambition to do
13
that, and I think also the potential to do that in that
14
timeframe.
15
527
Q.
I am suggesting to you, and the patient who was being
waited upon in Theatre 7 was a circumcision operation
17
which took, "started anaesthesia 11:55.
18
12:24".
19
lengthy enough operation?
A.
So that is not a huge operation, but clearly a
Well the start and finish times reflect, they are a
combination of both anaesthetic and surgical times, and
22
also -- which patient is that?
528
Q.
Yes, I can tell you that.
If you go to the first page
of this document you produced, you introduced I suppose
25
I should in fairness say, it is the fourth one down;
26
535570?
A.
Yes, yes.
14:49
Sorry.
24
27
14:49
Finished
21
23
14:48
It is
16
20
14:48
That was done by Badrul Yeap, who is quite
28
an accomplished surgeon in his own right, but in a
29
general sense a circumcision surgically takes eight to
143
Gwen Malone Stenography Services Ltd.
14:49
1
ten minutes to perform.
2
pre and post surgical time interwoven in that.
3
529
4
Q.
All right.
A.
I have no doubt Mr. Paran could have done a
5
6
There is an anaesthetic time
Okay.
circumcision in eight minutes, or ten minutes.
530
Q.
14:50
Yes, and also seen the four patients in the intensive
7
care unit, and gone to the intensive care unit, seen
8
his four patient, and come back from the intensive care
9
unit?
10
A.
I think, with respect, when Mr. Paran went to the
14:50
11
intensive care unit he could have seen one patient.
12
may have been his ambition to see four patients, but if
13
he hadn't been able to see his four patients, he would
14
have seen what he would have been able to see and come
15
back to theatre to complete the nephrectomy.
16
531
Q.
over of patients from Mr. Mortell.
18
that?
20
532
Are you aware of
A.
No, I wasn't aware of that.
Q.
That was all going on in this thirty minutes where you
21
A.
Well, I don't wish to detract from that.
Mr. Paran is,
23
as I have said, very accommodating of his time, but he
24
is also extremely conscientious.
26
14:50
say he should have been preparing for this operation?
22
25
14:50
Also I think at the time Mr. Paran was taking a hand
17
19
It
533
Q.
Yes.
A.
He would taken, if that was the case, Mr. Mortell would
14:50
27
have passed on the hand over.
But in fact, I have no
28
information about Mr. Mortell's hand over involvement
29
with Mr. Paran at that time.
144
Gwen Malone Stenography Services Ltd.
1
534
Q.
Can I go back to the narrative anyway.
You are right,
2
after the intensive care unit, Mr. Paran went back to 7
3
to see that his patient hadn't arrived, and he had some
4
ten minutes to spare.
5
5, where you were, or sorry, where the anaesthetist
6
was, and the patient was on the table being
7
anaesthetised.
8
anaesthetist asked, as you know, Mr. Paran, would he
9
catheterise the patient, and Mr. Paran did that, and
He then called over to Theatre
He had some ten minutes to spare.
10
also then positioned the patient.
11
Mr. Paran's recollection, looking at the notes.
12
that right?
13
14
535
536
Q.
The notes, of course what you were looking at would be
14:52
A.
I looked at the consent and I looked at the patient ID.
Q.
Yes.
Okay.
I think you said to him; "left side Sri"
and he answered "yes", is that right?
19
537
A.
That's correct.
Q.
Mr. Paran says that as he was leaving you said to him;
21
"are you happy to go ahead?", and you said it to him
22
not once but twice, because I think Mr. Paran was quite
23
surprised to hear you saying that to him at all?
24
A.
Sri?", twice.
26
actually Mr. Paran was he happy with the selection of
27
the site, and Mr. Paran said yes.
29
538
Q.
14:52
I cannot recall saying; "are you okay to go ahead,
25
28
14:51
Is
That's correct.
18
20
You were present, in
your own notes?
16
17
The
A.
15
14:51
But in asking him "left side", I was
Well his evidence will be just you said; "left side,
Sri", and his answer was yes, and you were looking at
145
Gwen Malone Stenography Services Ltd.
14:52
1
the notes?
2
A.
That was a question, and Mr. Paran answered yes.
I
3
then asked him was he okay to go ahead.
4
reason to ask a surgeon of Mr. Paran's experience
5
twice, in any way question his ability, or put him
6
under pressure to do that, and I would not, I don't
7
recall asking him twice.
8
539
Q.
9
I have no
14:53
Well Mr. Paran, who has a very, very clear recollection
of this, as you might well understand, says it was said
10
to him twice, because Mr. Paran really probably
11
couldn't believe what he was hearing when you said it
12
to him the first time?
13
A.
14:53
Well, I don't think I was actually intending to put
14
Mr. Paran under pressure by asking him.
15
just confirming that he was happy in his own mind to
16
proceed.
17
540
Q.
I was merely
We are agreed I think anyway that that event took place
18
less than five minutes before the operation began.
19
have indicated to the Tribunal, or the Council, that
20
"well, if Mr. Paran was unhappy to proceed with the
21
operation he should have said no, I need more time, or
22
words to that effect", is that right?
23
A.
option to say he was unhappy to proceed.
25
had the option and time available to look at the
26
imaging at that time, which he did not.
28
29
541
You
14:54
If Mr. Paran had been unhappy to proceed he had the
24
27
14:54
Q.
Yes.
A.
That's correct, I did not.
But also he
You didn't either?
I assumed that Mr. Paran
would.
146
Gwen Malone Stenography Services Ltd.
14:54
1
542
2
Q.
You assumed that.
A.
I gather -- I mean my impression of delegation at that
3
level to someone of Mr. Paran's experience is that
4
Mr. Paran would have looked at the imaging.
5
543
6
Q.
I presume you are talking about the thirty minutes now?
A.
Within the timeframe of being asked to do the procedure
7
8
and starting the procedure.
544
9
10
545
Q.
Yes.
A.
Yes.
Q.
Yes.
11
Mr. Paran's evidence will be that you pointed out
A.
I asked Mr. Paran what incision he was going to use,
13
and he suggested that he should use the previous site
14
of colostomy closure, which was just below the
15
umbilicus, perhaps a little bit lower than that, but
16
around that area.
17
going to be an easy operation to do through that
18
incision and that perhaps he would considered, and I
19
suggested, that the left upper quadrant transverse
20
incision was more appropriate to easily access the
21
kidney, and he agreed with that.
546
Q.
23
Yes.
I suggested to him that that was not
547
A.
That's correct.
Q.
So therefore, I am suggesting to you, that you were
saying the incision should be made on the left hand
27
side, is that not right?
29
14:55
You were pointing out the left hand side, isn't
26
28
14:55
that right?
24
25
14:55
to him where the incision was to be made?
12
22
14:55
A.
I was -- it was a left hand sided incision whether you
used the colostomy incision or whether you used the
147
Gwen Malone Stenography Services Ltd.
14:55
1
2
incision that I pointed out to Mr. Paran.
548
Q.
There was absolutely no doubt then, as far as Mr. Paran
3
was concerned was, that this operation was to be
4
carried out on the left hand side, isn't that right?
5
6
549
A.
That's correct.
Q.
You were pointing out the left hand side too, weren't
7
14:56
you?
8
A.
9
The patient was listed for a left nephrectomy and it
wouldn't make any sense to approach the operative site
10
through the right hand side.
11
go through the left hand side.
12
decision, based on a left nephrectomy.
13
550
14
15
551
So the intention was to
That was an appropriate
Q.
Yes, but you were pointing the left hand side?
A.
That's correct.
Q.
Your counsel told us yesterday that it was your
16
invariable practice to check radiographs before
17
commencing operations, isn't that right?
18
19
552
A.
If I was doing the procedure, yes.
Q.
Yes.
14:56
Well I want to suggest to you that it would be
20
entirely reasonable for Mr. Paran to believe that you
21
had looked at the radiography and you were satisfied
22
that it was a left hand side, otherwise you would not
23
have pointed out the left hand side?
24
A.
14:56
14:57
I pointed out the left hand side on the basis of the
25
listed procedure, which was a left nephrectomy.
26
asked Mr. Paran at the outset a question, was it the
27
left side, left side, and Mr. Paran said yes.
28
believe Mr. Paran was taking that information from the
29
consent, like I did subsequently, but I was not aware
148
Gwen Malone Stenography Services Ltd.
I
I
14:57
1
that Mr. Paran had not looked at the imaging.
2
not aware that he had no intention of looking -- did
3
not look at the imaging until after I had gone into
4
theatre...(INTERJECTION).
5
553
Q.
Sorry, I just want to stop you there.
I was
What do you mean
6
by "I was not aware that he had no intention of looking
7
at the imaging"?
8
9
554
Well he had not looked at the imaging.
Q.
No.
A.
12
555
Yes.
14:57
I had no awareness that Mr. Paran had not looked
Q.
Yes.
A.
And that Mr. Paran did not look at the imaging prior to
15
making the incision.
556
Q.
17
14:58
No, no, you told us a moment ago that he had no
intention of looking at it.
18
19
Could you just
at the imaging at the outset.
14
16
Well you said he had no intention.
explain that for a minute?
11
13
What do you mean by that?
A.
10
557
A.
I take that word back.
Q.
Yes.
All right.
Can you just explain that?
That is not an acceptable term.
Very good.
Yes, you are absolutely
20
right, it is not.
21
that in fact you were the one who directed where the
22
incision was to be made, and so therefore you were the
23
one who has to take responsibility for operating on the
24
left hand side?
25
14:57
A.
I want to put to you, Professor,
I think Mr. Paran, as an experienced surgeon, and one
26
to whom many of my colleagues would delegate similar
27
procedures, would be expected to detail the imaging
28
prior to surgery, and also during surgery if an event
29
occurred, would be expected to review the imaging.
149
Gwen Malone Stenography Services Ltd.
14:58
14:58
1
That reflects his experience and his training to date.
2
So I would expect that Mr. Paran actually should have
3
looked at the imaging, and the whole situation would
4
have been avoided.
5
558
Q.
I want to say to you, Prof. Corbally, that that
14:59
6
conversation, some thirty minutes or so before the
7
operation, did not take place, and that you are
8
incorrect in your recollection of it taking place?
9
10
559
A.
I would have to disagree with that.
Q.
I also want to say to you again, that the occurrence of
11
that conversation is entirely inconsistent with the
12
movements of Mr. Paran after, when you say that
13
conversation took place?
14
15
560
A.
I would have to disagree with that too.
Q.
All right.
16
561
19
A.
That's correct.
Q.
So Mr. Paran had to go and get an assistant?
A.
Well, that is normal practice for a surgeon.
The
20
surgeon is aware that an assistant is required.
21
either he asks an SHO to come to theatre or he asks one
22
of the nurses to ask an SHO to come to theatre, but it
23
is a standard practice that the operating surgeon has
24
the responsibility to ensure he has an assistant.
25
562
26
27
14:59
the operation, isn't that right?
17
18
There was no assistant at the beginning of
14:59
563
Q.
Yes.
A.
There is nothing unusual in that situation.
Q.
Okay.
So
14:59
15:00
But if Mr. Paran is correct in his recollection
28
of events, that he had less than five minutes, he had
29
less than five minutes to get an assistant, isn't that
150
Gwen Malone Stenography Services Ltd.
1
right?
2
A.
That depends on whether or not it was actually five
3
minutes, but in fact it was more than thirty.
4
Mr. Paran had an opportunity to get an assistant.
5
564
Q.
So
So really in that thirty minutes, not only should he
6
have been looking at the radiographs, he also should
7
have been trying to find an assistant, is that right?
8
A.
9
11
It wouldn't necessarily be asked of Mr. Paran to get
the assistant.
10
He merely has to ask the nurse in the
theatre to call for an assistant.
565
Q.
12
He also said that there was no cross-matching or group
A.
I believe that to be incorrect.
The nursing records
14
clearly state that when the patient arrived in hospital
15
the day before, that a request was made for a group and
16
hold.
17
that blood was group and held, but that he was made
18
aware by Nurse Beata Suska, an anaesthetic nurse,
19
whilst the patient was in Theatre 5, that there was a
20
problem with the blood bank and that they were
21
requesting an additional sample, which Dr. Mannion sent
22
down to the blood bank.
23
practice to group and cross-match a patient, which
24
would be wasteful of blood resources, but it would be
25
normal practice, and is standard operational policy and
26
protocol to have a group and hold done when the patient
27
arrives in the hospital.
29
15:00
and hold?
13
28
15:00
566
15:00
I believe Dr. Mannion's statement also reflects
15:01
It would not be normal
However...(INTERJECTION)
Q.
Well -- yes, sorry, go on.
A.
Sorry.
Sometimes there will be a problem with the
151
Gwen Malone Stenography Services Ltd.
15:01
1
blood sample and the blood sample will have -- a repeat
2
blood sample will have to be sent down.
3
unusual.
4
course of the evolution of the list.
5
567
Q.
It is normal practice.
That is not
It is part of the
But also I think it is something that has to be
6
attended to, isn't that right, the availability of
7
cross-matched blood?
8
9
568
10
A.
Sorry, we don't routinely cross-match nephrectomies.
Q.
Yes.
A.
Because we expect blood loss to be minimal in
11
nephrectomies.
12
minimal.
13
issue of blood group, and safe, or if that was his
14
intention to cross-match, that either all he has to do
15
is, in a normal situation, is to ask the anaesthetist
16
to take a blood sample.
17
569
Q.
So Mr. Paran did not have to attend to the
19
which he had received from the A&E, because as you know
20
he was on-call at the time?
but, and I don't not wish to undermine Mr. Paran's role
23
in this, Mr. Paran is very adept at being efficient and
24
dealing with many things at the one time.
26
570
15:02
I wasn't aware that he had a call to deal with in A&E,
22
25
15:02
I think at the same time another matter which Mr. Paran
had to attend to was to determine the urgency of a call
A.
15:02
In simple nephrectomies blood loss is
18
21
15:01
Q.
Yes.
A.
That is standard practice amongst doctors in Crumlin.
15:02
27
It is a very busy place, and people have adapted to
28
being, not quite in two places at one time, but also to
29
deal with many things at the one time.
152
Gwen Malone Stenography Services Ltd.
1
571
2
Q.
Yes.
A.
So he would have, he would have wanted to go to A&E to
3
deal with that patient, but he may have delegated that
4
to somebody else if he was busy.
5
572
Q.
6
7
573
Q.
Yes.
We will just break for the Stenographers.
CHAIRMAN:
Okay, we can resume.
MR. MEENAN:
Yes, thank you.
8
Yes, I
think you are absolutely
9
correct when you describe Mr. Paran as being more than
10
willing to take on patients, and I want to suggest to
11
you that in fact Mr. Paran would never have been in
12
theatre 5 attending the patient, the subject of this
13
inquiry, if in fact the patient which he had sent for
14
number 7 had actually not required a pre-med and
15
arrived on time?
16
A.
I think that Mr. Paran would probably have finished the
circumcision very quickly, and been in theatre 5, but
18
can I also say that if he was doing the case that the
19
patient could wait a few minutes more in theatre 5,
20
anaesthetised, waiting for Mr. Paran to come to
21
theatre.
22
surgeon, and he sets the pace.
574
Q.
24
A.
26
So again the start time is dependent on the
Yes, and what were you doing while all this was going
I actually had quite a large number of charts to sort
out.
575
28
29
15:05
on?
25
27
15:04
15:04
17
23
15:03
576
Q.
Charts to sort out, yes.
A.
I was sitting in the dictation room.
Q.
Yes, you were doing a bit of paperwork?
153
Gwen Malone Stenography Services Ltd.
15:05
1
2
577
A.
Well, a lot of paperwork.
Q.
A lot of paperwork, yes.
So while Mr. Paran was
3
sending for another patient in theatre 7 and going off
4
to the ICU to see 4 more patients, and going back to
5
theatre 7 to see if a patient arrived and making sure
6
that everything was all right in the A&E, you were
7
there doing your paperwork, is that right?
8
A.
9
Well, can I just say that, as I have said this morning,
there is no allocated time for consultants to do
10
11
paperwork.
578
12
15:06
Q.
Yes.
A.
We contribute 75; 72, 75, 80 hours a week of normal
13
working hours.
14
month, ten to 12 nights a month on-call every month, in
15
addition to having an oncology commitment of 24/7 since
16
2005.
17
between cases to do essential paperwork.
18
579
19
In addition, I am on-call ten nights a
Q.
Right.
A.
To answer patients' queries.
To call patients with
whatever concerns they have if I can, and occasionally
21
then to run in and out between cases and see the
22
patients in ICU or whatever.
23
in a hospital setting is equally as
24
important...(INTERJECTION).
580
26
28
Yes.
A.
As seeing patients in out-patients or in fact
29
15:06
operating.
581
Q.
15:06
So I think that paperwork
Q.
27
15:06
I don't have the time to -- I have to find time
20
25
15:05
Of course I do not want to take from that.
course it is important, yes.
Yes, of
Mr. Paran his evidence
154
Gwen Malone Stenography Services Ltd.
1
will be first of all he is hearing for the first time
2
today after all these terrible events have been going
3
on now for in excess of 2 years; hearing for the first
4
time today that he was allegedly told he had some 30
5
minutes to prepare for this operation?
6
A.
Well, the timing never became a crucial issue in my
7
report, as I have said.
8
delegation and the process of delegation.
9
582
Q.
I was more concerned about the
Yes, and Mr. Paran will say that if he had been given
10
30 minutes he would have dealt with matters entirely
11
differently.
12
review the radiographs and the records?
13
MS. BARRINGTON:
I am terribly sorry to
interrupt Mr. Meenan, but I
15
think in fairness to the witness he did not say that he
16
told Mr. Paran he had 30 minutes, but he said that he
17
asked Mr. Paran would he like to do the surgery at
18
least 30 minutes in advance.
19
MR. MEENAN:
thing.
Well, if it is not,
21
it is not. I mean I am prepared to go with that, yes.
22
MS. BARRINGTON:
I just wanted it clarified.
MR. MEENAN:
But if Mr. Paran had been
Q.
15:07
Yes, that is the same
20
583
15:07
He would have had an opportunity to
14
23
15:07
24
15:08
asked to do the surgery
25
some 30 minutes beforehand and had said, yes, I will,
26
he would have dealt with matters entirely differently.
27
Firstly, he would never have gone back to theatre 7 to
28
get another patient.
He would never have gone to the
29
intensive care unit.
He would have reviewed all the
155
Gwen Malone Stenography Services Ltd.
15:08
1
documentation, including the radiography?
2
A.
I cannot comment on Mr. Paran's thought processes at
3
that time, but I do know from my extensive dealings and
4
experience of Mr. Paran that he will try to help the
5
list along as quickly as possible.
6
584
7
Q.
Yes.
A.
He will try to be efficient.
He will try to use his
8
time efficiently and, where possible, he will be as
9
helpful as possible.
10
585
11
Q.
Yes.
A.
And I think that in this context his ambition was to
15:09
12
try and do another case before the actual nephrectomy
13
started.
14
586
15
Q.
I see.
A.
And he has always been regarded as extremely helpful in
16
17
587
Q.
Yes.
I think you heard the report, Mr. Wheeler was
giving evidence yesterday, and I just want to ask you
19
to comment on something which Mr. Wheeler said, both in
20
direct-evidence and indeed on further examination not
21
by either side here, but by I think it was Mr. O'Neill
22
on the Committee, and it is on the first page of the
23
report dealing with Mr. Paran?
24
588
A.
Sorry, could you tell me what page that is?
Q.
Yes, of course, it is page 4 of Mr. Wheeler's report?
26
MR. CROSS:
It is on the report,
27
Professor, not of the
28
transcript yesterday, Mr. Meenan is referring to.
29
15:09
that regard.
18
25
15:08
A.
Sorry, I do not know where that is.
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Gwen Malone Stenography Services Ltd.
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1
589
Q.
MR. MEENAN:
I am sure your solicitor
2
will give it to you.
"In
3
the circumstances of elective surgery", sorry, are you
4
with me?
5
6
590
A.
Yes, page 4.
Q.
Page 4:
7
15:10
"In the circumstances of elective
surgery, a surgeon would be expected to
review the patient and discuss the
forthcoming surgery with the parents
before commencing surgery".
8
9
10
15:10
11
Now I am not going to deal with that, and then it goes
12
on:
13
"However, it must be acknowledged that
trainees are constrained by the
hospital system in which they work. If
a trainee works within a system whereby
operations are allocated to trainees
only very shortly before the operation
commences, it would be unreasonable to
expect the trainee to insist that the
operation was delayed until the normal
process of clinical review and
consultation was completed. To insist
on such delay would put a trainee at
odd with his seniors and would make his
position within a surgical department
exceedingly difficult".
14
15
16
17
18
19
20
21
22
591
25
26
592
A.
No, I do not agree with that.
Q.
You do not agree with that?
A.
Well, there are aspects I don't agree with.
Q.
You might just tell me the aspects -- well, could you
27
28
29
15:11
Do you agree with that?
23
24
15:10
first of all tell me the aspects you do agree with?
A.
I think if trainees felt under pressure and that there
might be a repercussion for delaying or disagreeing,
157
Gwen Malone Stenography Services Ltd.
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1
yes, that would be true, but that is not the case on
2
the situation that applies in Crumlin.
3
regarded myself as Mr. Paran's friend, his mentor and
4
his colleague, and I know that I would never in any way
5
censure or criticise a trainee for telling me that
6
there was a problem with a patient.
7
welcome that because that would prevent any adverse
8
outcome to the patient.
9
593
10
Yes.
A.
So Mr. Paran would know that raising a flag to dispute
594
Q.
I have to say, Professor, I do not know what you are
talking about in respect of raising flags in
14
laterality, but we are actually dealing with a very
15
specific point here, which is that:
16
18
19
20
595
22
596
A.
I could not agree with that, I am sorry.
Q.
Could not or would not?
A.
Neither, I cannot agree with that.
Q.
Well, I mean Mr. Paran will say that in the hierarchal
24
system of the medical profession, of course you would
25
be well familiar with, there was no earthly way, that a
26
registrar of Mr. Paran's status and experience, could
27
possibly say to a senior like yourself, no, I can't do
28
this operation or I won't do this operation?
29
15:12
"To insist on any delay would put a
trainee at odds with his seniors and
would make his position within a
surgical department exceedingly
difficult?"
17
23
15:12
laterality would only, in my mind, be welcome.
13
21
15:11
I would in fact
Q.
11
12
I would have
A.
I find that difficult to understand and believe.
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Gwen Malone Stenography Services Ltd.
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1
Mr. Paran, apart from what I have already mentioned
2
about our relationship over many years, Mr. Paran had
3
been admitted to the specialist register in the Medical
4
Council of Ireland.
5
hard working fellowship in Sloan-Kettering in New York
6
City.
7
of paediatric surgery, at least one, if not one and a
8
half years was in pure paediatric urology.
9
his European State Board exams in paediatric surgery.
10
Had the support and respect of all his colleagues and
11
still has in Crumlin for his technical ability, and his
12
conscientiousness.
13
anticipated that Mr. Paran would feel in any way under
14
threat or pressure or in any way uncomfortable with
15
saying that he himself was uncomfortable with dealing
16
with an operation like this.
17
expectation that that would be what Mr. Paran would
18
think or feel.
19
597
Q.
Had returned from a very distinct,
15:13
Had worked for at least 8 years in the practice
Had passed
15:13
I would never have expected or
15:14
It would never be my
I am sure Mr. Paran is very encouraged to hear all this
20
praise being heaped on him, but what he will say is
21
this:
22
5 minutes beforehand and he simply was not in a
23
position to say, no, and would you agree with me that
24
not reading -- you have in the few moments, spent the
25
last few moments praising Mr. Paran to the heights.
26
Would you agree with me that not looking at
27
radiological slides before an operation would be
28
totally out of keeping with the Mr. Paran you know and
29
have praised so highly?
15:14
That he was asked to do this operation less than
159
Gwen Malone Stenography Services Ltd.
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1
A.
2
3
I would, I would agree with that, yes, and I think this
is a very unusual situation.
598
Q.
4
Yes, particularly as you say that he would have had
some 30 minutes to do so before the operation?
5
A.
Irrespective of the time, it takes a minute to review
6
an x-ray, and Mr. Paran I know would have normally done
7
that and that was my competent expectation.
8
599
Q.
9
And I take it it is your -- I take it, I am sure
Ms. Barrington was entirely correct when it was put to
10
Mr. Wheeler yesterday, that it is your invariable
11
practice to review radiographs before operations, is
12
that right?
13
14
600
A.
In situations where an organ is to be removed, yes.
Q.
Yes, okay, and that is something which the junior
15
doctors who work under you would know, that is your
16
invariable practice?
17
A.
18
19
15:15
in surgery.
601
Q.
Yes.
To return to the issue of the conversations, as
you know which took place with the parents of the child
21
involved, you have heard the evidence on that, is that
22
right?
23
602
A.
I have.
Q.
And I take it you heard the evidence from Nurse Anna
25
Davey yesterday, is that right?
26
27
15:15
That is the practice, that is standard recommendations
20
24
15:15
603
A.
Yes, I did.
Q.
And you heard that she recorded at the time that the
28
parents in her, I suppose virtually contemporaneous
29
note says, "seemed satisfied after speaking with
160
Gwen Malone Stenography Services Ltd.
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15:16
1
Dr. Sri Paran".
2
3
604
A.
I did.
Q.
And you have no reason to believe that that is anything
4
other than accurate do you?
5
6
You heard that?
605
A.
I have no reason to doubt that.
Q.
So I suggest to you on the basis of that note,
15:16
7
Mr. Paran was entirely satisfied, well, was satisfied
8
that he had put to rest the concerns of the parents?
9
10
606
A.
That was Mr. Paran's -- that is his perception, yes.
Q.
Okay, and if that was his perception, which it was,
11
would you not agree then it would follow that there was
12
not a duty on him to inform you of what had taken
13
place?
14
A.
That is very difficult to answer Mr. Meenan.
I think
15
that in the normal context if parents raise a concern,
16
that one has to be sensitised to that and one has to
17
act upon that.
18
607
19
Q.
Yes?
A.
And in any situation of surgery, especially when an
20
organ has to be removed, one has to revert back to the
21
core reference point, which is the imaging.
22
would have been appropriate to review the imaging at
23
that point or to, if he had reviewed the imaging and he
24
was happy with that, then that was fine.
25
608
26
28
Yes?
29
15:17
A.
But to tell me it was an easy thing to do, I would
15:18
regard myself as approachable.
609
15:17
I think it
Q.
27
15:17
Q.
Yes.
A.
And at that point the imaging would have been
161
Gwen Malone Stenography Services Ltd.
1
2
thoroughly reviewed.
610
Q.
Of course the imaging was not present when the child
3
was taken to the operating theatre, is that not
4
correct, it only arrived later?
5
A.
I think when Nurse Anna Davey was there the x-rays were
6
actually there on the trolley.
7
understand brought the imaging from the x-ray
8
department, and Mr. Paran was still there with the
9
parents when the x-rays were on the trolley.
10
611
Q.
It was Mr. Mortell I
I think there may be a dispute in connection with that,
11
but certainly from Mr. Paran's point of view he was
12
looking at the records and when he was doing that, the
13
imaging or the radiography was not present?
14
15
612
A.
That is not my understanding of -- sorry.
Q.
But in any event I mean to come back to the question,
16
would you agree that Mr. Paran was satisfied, as he
17
said he was, that the concerns of the parents had been
18
addressed and obviously Mr. Paran would be fully aware
19
of the sensitivities involved concerning parents in
20
this very difficult time, wouldn't he be?
21
A.
22
23
15:18
15:19
15:19
I think Mr. Paran would be very very aware of parents'
sensitivities, yes.
613
Q.
And with the sensitivity that you accept that he had,
24
and what was noted by the nurse at the time, that the
25
parents seemed satisfied, that therefore I would
26
suggest to you that there was not a duty upon Mr. Paran
27
to inform you of what he had discussed with the
28
parents?
29
15:18
A.
If Mr. Paran was completely happy in himself that the
162
Gwen Malone Stenography Services Ltd.
15:19
1
parents' anxiety had been allayed, I would agree with
2
that, yes.
3
614
Q.
4
615
A.
Yes.
Q.
I think you were present towards the end of that, is
7
616
A.
I was present when the kidney had been removed.
Q.
Yes, and it is correct that Mr. Paran did not look at
10
the radiography at that time?
11
12
15:19
that not correct?
8
9
I want to move on to the point at which the
kidney was removed?
5
6
Okay.
617
A.
That's correct.
Q.
But he will say every over factor there was pointing
13
towards it being the correct operating site, the
14
left-hand side?
15
A.
I think the consent was, the note that I had
16
erroneously dictated to the GP was, and also my
17
discussion with him over the left side, yes, all
18
pointed to the left side.
19
618
Q.
anaesthetic registrar also, and also his recollection
21
of what the mother had said to him about left-hand
22
side?
A.
queried the right side and the patient's father was
25
convinced it was the left side.
27
619
15:20
I believe that the patient's mother had actually
24
26
15:20
Yes, and also conversations which he had with an
20
23
15:20
Q.
Yes?
A.
And I believe that when Mr. Paran consulted with the
28
anaesthetic registrar, it was on the basis of his
29
perception that the kidney looked more normal than it
163
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1
should for 9% function and he asked for the consent to
2
be shown to him again.
3
the consent at the theatre reception when the parents
4
were checking in with this patient.
5
620
Q.
I gather that he had looked at
And in addition to that also, what Mr. Paran thought he
6
was dealing with what is referred to as being a baggy
7
kidney?
8
A.
9
Yes, in occasions of significant vesicoureteral reflux,
you can have hydronephrosis, where the ureter and the
10
pelvis of the kidney are dilated and floppy.
11
when you palpate the kidney, if it was a
12
hydronephrotic, a reflux of hydronephrosis with a
13
poorly functioning kidney, one would expect the kidney
14
substance, the meat, if I might call it that, or the
15
parenchyma of the kidney, would be very thin.
16
to palpate the kidney when you take it, when you
17
attempt to tie off the vessels.
18
inspection it might be possible to look at the kidney
19
and say, this looked hydronephrotic and that would fit
20
with the planned procedure.
21
621
22
However,
You have
Q.
Yes?
A.
But when one palpates the kidney I think that the
discrepancy should become obvious or will be obvious,
24
because the kidney would actually feel like a normal
25
kidney.
622
Q.
Are we agreed then anyway that a baggy kidney is not
inconsistent with a kidney which is caused by the
28
condition which the patient had in this case?
A.
15:22
15:22
15:22
27
29
15:21
So I think by visual
23
26
15:21
I think in some situations by inspection, yes, but not
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Gwen Malone Stenography Services Ltd.
1
2
by palpation.
623
Q.
I think you told us that you attended a lecture this
3
year or maybe it was last year by Prof. Youngson, is
4
that right?
5
6
624
A.
That's correct.
Q.
And in the course of that lecture did he deal with what
15:23
7
is called or what he will describe as "plan
8
continuation error"?
9
10
625
11
A.
Yes.
Q.
And so you know what it is?
A.
Well, it was a workshop which was most enjoyable and
12
13
very informative.
626
14
Q.
Yes?
A.
My understanding of plan continuation error is the
15
analogy taken from the aviation industry, where in
16
terms of airline, aircraft crashes or airline
17
incidents, that the majority of these are actually due
18
to human error.
19
627
20
Q.
Yes?
A.
And that maybe 20% or 20% to 30%, Prof. Youngson can
21
correct me, is due to technical errors in the aircraft,
22
and that plan continuation error means that the pilot
23
in situations of human error has a plan in mind, and
24
despite obvious signs to the contrary, fails to deviate
25
from that plan, even though it ultimately results in a
26
fatal outcome as an error.
27
28
29
15:23
628
Q.
Yes?
A.
I think Prof. Youngson had a very good example of a
South American plane approaching La Guardia some time
165
Gwen Malone Stenography Services Ltd.
15:23
15:23
15:24
1
ago, which ultimately crashed, and the pilot informed
2
the air traffic controller that he was out of fuel or
3
low in fuel, but ultimately said out of fuel.
4
traffic controller informed him that he should circle,
5
which he did, and ultimately crashed?
6
629
Q.
7
15:24
That lecture obviously made a big impression on you,
Professor, did it not?
8
9
The air
630
A.
It was a very worthwhile workshop, yes.
Q.
Yes, and I do not know if you wish to comment on this,
10
but what Prof. Youngson's evidence to this Council will
11
be, that the removal of the kidney when it was done,
12
and in the circumstances in which it was done, fitted
13
into this concept of a plan continuation error?
14
A.
I don't think I can comment in detail on that,
15
Mr. Meenan, but I would agree that that is a likely
16
explanation because this has to be regarded as an
17
aberrant unusual behaviour by Mr. Paran.
18
unusual set of circumstances, and not one that in any
19
way in Mr. Paran's training before this, was there any
20
concern whatsoever about his surgical performance.
21
631
Q.
15:25
Would you agree with Mr. Wheeler's evidence to the
effect that if this Council does find that Mr. Paran
23
only had less than 5 minutes before this operation,
24
that he did not have sufficient time to do the matters
25
which you said he should have done?
A.
15:25
It was a very
22
26
15:24
I don't agree that that five minutes is actually the
27
time, Mr. Meenan, but 5 minutes is a short time, if
28
that were the case, but again it takes one or 2 minutes
29
to actually look at a radiograph.
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1
632
Q.
2
Would you ever delegate an operation such as a
nephrectomy less than 5 minutes before it starts?
3
A.
If I had to rush away to do something.
If I was called
4
to the A&E department for a child in a trauma and the
5
delegee was of sufficient competence to do the
6
operation, yes.
7
633
8
Q.
You were not rushing anywhere here?
A.
No, but you asked would I ever, and would I ever -- the
9
10
answer to that is, yes, in that context.
634
Q.
Well, unfortunately, I have to suggest to you that
11
although you were not under pressure at the time, that
12
is unfortunately exactly what you did?
13
A.
14
15
15:26
Well, I don't accept that it was 5 minutes, it was
longer than that.
635
Q.
As you know, Mr. Paran is absolutely adamant in his own
16
evidence and clear, that he was never told 30 minutes
17
or more than 30 minutes, or even ten minutes before
18
this operation that he would be doing it.
19
turn to the conversation which you had with the
20
patient's parents after the event.
21
Mr. Paran to speak to the parents?
22
A.
Why didn't you ask
24
parents, just until things settled down certainly in
25
his own mind.
Q.
15:27
I felt that Mr. Paran was very upset at this event and
I felt that at that point he needed not to talk to the
636
15:26
Can I just
23
26
15:26
15:27
And in fact I think he was -- yes, I think Mr. Paran
27
was told that it was -- and he was the surgeon who you
28
say to whom you say you had delegated the operation.
29
He says, Mr. Paran will say that he was advised by the
167
Gwen Malone Stenography Services Ltd.
1
hospital not to speak to the parents.
2
come from you?
3
A.
Did that advice
I would have felt that that would be a reasonable
4
position at that time, but the advice it may have come
5
from the hospital, I do not know.
6
637
Q.
7
638
A.
That's correct.
Q.
And he did that of his on volition, are you aware of
10
that?
11
12
639
13
14
In fact Mr. Paran actually did speak to the parents on
the Sunday, which I think was Easter Sunday in fact?
8
9
15:28
640
15:28
A.
Yes, I am.
Q.
That he felt he had to speak to the parents?
A.
Yes.
Q.
I suppose you think that was an entirely appropriate
15
thing to do, wouldn't it?
16
A.
15:28
I think at that time the actual horror of the situation
17
had probably passed somewhat, and one was able to take
18
a breath I think and discuss this in more logical
19
terms.
20
641
21
22
642
Q.
The horror of what had passed?
A.
48 hours later, of having taken out a normal kidney?
Q.
Yes.
15:28
You see what I do not understand is that, you
23
know, if you are correct in your evidence, and you are
24
undoubtedly correct in your evidence in praising
25
Mr. Paran to the rafters, and your evidence that this
26
operation was passed over well in time; why you did not
27
send Mr. Paran directly to the parents to explain what
28
had happened.
29
was of experience, he had just about everything?
I mean you say he is of seniority.
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1
A.
I think that I wished to protect Mr. Paran at that
2
point, and I did not wish Mr. Paran to be certainly
3
talking to very anguished and grieving parents at that
4
time, up set parents, and I felt that it was my
5
responsibility as the admitting consultant to deal with
6
that personally myself.
7
come out in due course, and that it would be clear what
8
had happened, but I felt that I had a responsibility to
9
the parents to accept responsibility for this.
I knew that the facts would
To
10
explain what had happened in sufficient detail for them
11
to deal with it at that time and then to develop
12
further detail as time passed.
13
643
Q.
14
Whatever you said to the parents, you are certainly not
A.
No, I am accepting responsibility, as I have done
16
before, for overall -- as the consultant in overall
17
charge of the patient.
644
Q.
speak to the parents on Easter Sunday, they would not
20
have known that it was Mr. Paran who did the operation
21
rather than yourself, Professor, is that right?
22
645
A.
I think they would have known sooner or later, yes.
Q.
What was it going to be, was it going to be sooner or
24
A.
26
28
29
15:30
was it going to be later?
25
27
15:30
And if Mr. Paran had not of his own volition gone to
19
23
15:30
accepting responsibility today, is that not right?
15
18
15:29
It was not a matter of trying to hide the facts from
the parents.
646
Q.
When had you planned to tell the parents, Professor?
A.
I had no plan in mind in fact of when to tell the
parents.
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Gwen Malone Stenography Services Ltd.
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1
647
2
Q.
You had no plan at all?
A.
No, no I had no plan in mind at that time but
3
4
ultimately this would have happened.
648
Q.
I don't quite follow that.
Well, certainly it answers
5
the question sooner or later, we now know it is later
6
but when would you have planned?
7
A.
There would have been an anticipated inquiry in the
8
hospital, and this would have become clear at that
9
time.
10
649
Q.
All right.
So the parents would wait for the inquiry.
11
I think I am complete in that.
12
Professor.
13
14
A.
15:31
Thank you very much
Thank you Mr. Meenan.
MR. MEENAN:
I am nearly sure I am, yes.
15
16
15:31
15:31
END OF CROSS-EXAMINATION
17
18
CHAIRMAN:
Thank you.
19
Thank you
Prof. Corbally.
I would
20
propose maybe that we might take a short break just to
21
allow concentration to be restored.
22
questions from the Committee and Mr. Leonard may wish
23
to speak again.
24
Ms. Barrington?
25
MS. BARRINGTON:
I will have a few very
brief questions.
CHAIRMAN:
Okay.
28
29
There may be some
Did you want to say something
26
27
15:31
So I think we will
take about 5 minutes just
to let the brain rest.
Thank you.
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MS. BARRINGTON:
Thank you Chairman.
2
3
SHORT ADJOURNMENT
4
5
6
THE HEARING RESUMED AFTER THE SHORT ADJOURNMENT AS
7
FOLLOWS:
8
9
CHAIRMAN:
Okay.
10
Perhaps we will
resume.
11
First I would ask
15:40
member of the Committee have any questions.
12
13
PROF. M. CORBALLY WAS THEN QUESTIONED BY THE COMMITTEE
14
AS FOLLOWS:
15
16
CHAIRMAN:
Okay, perhaps we will
17
resume.
Maybe first I
18
would ask if the members of the Committee have any
19
questions?
20
650
Q.
MR. O'NEILL:
Just one thing as a lay
21
15:40
representative, Professor,
22
that strikes me is, we have heard a lot about
23
delegation.
24
the hospital standards, systems and so on.
25
senior surgeon.
26
roles, you have an administrative role in all of this.
27
To what extent do you have responsibility for devising
28
procedures for things like, which we have heard a lot
29
about, delegation, or for let us say acquiring an
We have heard a lot about responsibility,
You are a
You also have, apart from your medical
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assistant when a surgeon is required.
2
from the way it is described that it is very much on
3
the hoof, so to speak.
4
direct responsibility in that area?
5
6
7
651
It seems as if
Do you as a senior surgeon have
A.
I do, and so do all of my surgical colleagues.
Q.
In your own area?
A.
In my own area, yes, and that delegation arises from a
8
long and protracted, extended period of knowledge and
9
acquaintance and experience with the delegees, and with
10
Mr. Paran that was over 8 years, and we have never had
11
any issue whatsoever with his management.
12
much so that the collective surgical body wrote to the
13
Medical Council and recommended his admission to the
14
medical specialist register.
15
dissension, it was total agreement.
16
protocols there are no written protocols, but the
17
experience that one gains from interacting with junior
18
doctors and consultant hospital doctors is such that it
19
is accumulative, and that you form your opinion as to
20
what they can do, but you also take them through
21
procedures.
22
second year SHO in paediatric surgery was doing an
23
umbilical hernia, well, you might have to show them how
24
to do an umbilical hernia a few times, and that you
25
would assist them doing it when they are doing it the
26
first few times themselves.
15:41
15:41
In fact so
Unanimously, there was no
So in terms of
15:42
15:42
So if, for example, a first year SHO or a
27
28
We have a training commitment for basic surgical
29
trainees in the Royal College of Surgeons, that they
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15:42
1
get a certain number of procedures to do.
2
would be 6 hernias, for example, 6 circumcisions and so
3
forth, and that is the only structured protocol of what
4
we have.
5
Committee in paediatric surgery in the UK, of which we
6
are a part, actually has specific guidelines as to what
7
procedures an SPR or a senior registrar should do at
8
certain levels, as they progress along the 6 years of
9
training but that is a fairly recent addition.
10
652
Q.
11
Now more recently the Specialist Advisory
There are no protocols specifically in relation to at
A.
13
15:43
No, one takes judgment and experience from your
interaction with the trainee.
653
Q.
Yes, apropos, just you mentioned that your role as an
15
associate Professor in the Royal College of Surgeons.
16
You seem to have an extraordinary long working week, 80
17
hours, plus ten to 12 nights on-call, 24/7 oncology
18
commitments and so on.
19
actually teaching in the College of Surgeons?
20
15:43
what point or how a delegation is made?
12
14
So that
A.
15:43
How great is your commitment to
I am responsible for undergraduate surgical teaching
21
and paediatric surgery, and as such it is a series of
22
didactic lectures and tutorial based format in the
23
out-patients and/or the wards, and then setting the
24
surgical questions on the final medicine paper and
25
examining on the final medicine papers as well.
26
examine in the diploma for child health in UCD and the
27
Royal College of Surgeons, and in the membership, what
28
used to be the fellowship exams, both the first part
29
and the second part of the membership exams for the
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Gwen Malone Stenography Services Ltd.
I also
15:44
15:44
1
College of Surgeons.
2
MR. O'NEILL:
Thank you, doctor.
CHAIRMAN:
I just have a couple of
3
654
Q.
4
questions for you myself
5
Prof. Corbally.
6
the discussion with the expert witness, that fateful
7
page on the notes in the hospital notes where you made
8
a decision about the nephrectomy?
9
10
655
It came up a little bit yesterday in
A.
Yes.
Q.
And your notes they say, small left kidney and DMSA 9%
11
left kidney.
12
written, and it is small "l" with a circle around it
13
"kidney".
14
always be my own practice, that you should write the
15
word "left" or "right".
16
colleague of mine last night and asked him what was his
17
practice just as a check to see was it -- he said what
18
I do myself is that you always write down the word and
19
that you teach others to do the same thing, to the
20
extent that if a junior doctor was writing up an
21
operation procedure and wrote "l" circle around it, you
22
would correct them.
23
we do these things here, and to the best of my
24
knowledge I think it has been taught by say medical
25
insurance cover that that practice is likely to relate
26
to errors.
27
brain makes us unthinkingly write down the wrong
28
letter, and I have seen this in my own clinical
29
experience.
15:44
15:45
I raised a question about the way it was
Now the expert yesterday said, which would
In fact, I contacted a
15:45
15:45
You would say that is not the way
It is a very simple -- something in our
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Gwen Malone Stenography Services Ltd.
15:46
1
2
So there were many attempts to explain why you wrote
3
this down in regard to x-rays reports and so on, but
4
would you accept that the error may be a simple error
5
of scripting, and that that error may have led to a
6
sequence of events which we have been discussing over
7
the last few days?
8
A.
9
11
I think that is the root cause of the whole process,
yes.
10
I can accept that "left" as written, the word is
better than left as "l" in the circle, yes.
656
Q.
12
15:46
And as a teacher of medical students, would you not
have been aware of that?
13
A.
That has come into -- we certainly have adopted that in
14
our clinical risk management policy in the hospital
15
now, that we would try to write down words rather than
16
symbols, and I would accept that too.
17
657
Q.
Okay.
incident has occurred I suppose the Medical Council has
19
a responsibility towards the general public.
20
wondering if you could give us an outline of in what
21
way maybe your procedures have changed since this
22
incident?
23
time-out procedure for all surgical units, which we
24
would use, I would use in my hospital.
25
could describe maybe what you did, and do you think
26
that this time-out procedure would have prevented this
27
incident?
29
A.
15:47
Just the second question then was since this
18
28
15:46
I was
15:47
The Medical Council itself endorsed a
Perhaps if you
The time-out procedure is part of the WHO
recommendations, which I think were recommended in
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1
2007/2008, had not gained universal acceptance in
2
surgical units globally.
3
million surgical procedures per year performed
4
globally, with a complication rate of 5% to 15% and
5
approximately 45% of those being due to human error or
6
technical surgical error, then the application of the
7
time-out process where patients sign in, there is a
8
time-out before surgery and they sign out, is a very
9
appropriate response to minimise the actual risk of
The recognising that of 234
10
human error in theatre.
11
important in that it ensures that everyone in the
12
theatre knows the procedure that is to be done and
13
everything in theatre, or anybody in theatre is
14
empowered to raise their hand and say, I am sorry, we
15
have not reviewed the x-rays, or I am sorry we have not
16
got the cross-match, because we are anticipating blood
17
loss in this hepatectomy, for example, and we need
18
blood in theatre.
19
important aspect of safety in the theatre.
20
however, universally practised certainly in this
21
country in 2008, and I think it is now almost certainly
22
universally practised; universally practised throughout
23
the country.
24
for my patients in Crumlin.
25
658
Q.
Okay.
The time-out process is
15:48
I am 100% compliant with time-out policy
Yes, I mean are there any other measures that
27
happen again?
29
15:48
It was not,
you could offer some re-assurance that it would not
A.
15:48
So absolutely time out is a very
26
28
15:48
Well, I think that the issue of viewing the imaging is
crucially important, and I don't think that one should
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15:49
1
book a patient for a procedure until the images are
2
reviewed.
3
that were presented by Mr. Wheeler, the option of
4
sending the patients back if the imaging is not
5
available, that is an option I would use in the future.
6
CHAIRMAN:
So I think in the situation of the options
Okay.
7
That is all I have
to say.
8
15:49
Maybe one of you
would wish to proceed.
9
10
END OF QUESTIONING BY THE COMMITTEE
15:50
11
12
PROF. M. CORBALLY WAS THEN FURTHER CROSS-EXAMINED BY
13
MR. LEONARD AS FOLLOWS:
14
15
659
Q.
MR. LEONARD:
Just very briefly arising
16
out of something Mr. Meenan
17
raised with you Professor.
18
asking you why you did not tell the parents that
19
Mr. Paran had done the operation, and this afternoon
20
you seemed to say it was to protect or to help
21
Mr. Paran in some way.
22
response I think to Ms. Barrington, you had I
23
understood or perhaps it was on questioning from me,
24
you had said that you did not want to overload the
25
parents with information.
26
27
15:50
660
Professor, Mr. Meenan was
15:50
Whereas this morning in
A.
Yes.
Q.
And I am just trying to understand what exactly was
28
your motivation in keeping that or hiding that from the
29
parents?
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15:50
1
A.
I was not hiding it from the parents.
There was a lot
2
of motivational issues in fact at the time.
3
very distraught situation, and very disturbing for
4
everybody involved.
5
involvement at that time was not necessary in terms of
6
defining what had happened, apologising to the parents
7
for what had happened and the measures we had taken to
8
try and resolve that.
9
better to have that kind of discussion at a later date
10
11
It was a
I felt that Mr. Paran's
So I really felt that it was
when the facts would duly come out in the case.
661
Q.
should have done was be completely upfront and tell
13
them fully about Mr. Paran's involvement from the
14
beginning?
A.
That may have been a better option to use at the time.
16
I think that it is important that we do not blame our
17
colleagues, junior or senior, and I would have perhaps
18
seen that as an element of blame if I had said that
19
Mr. Paran had done the nephrectomy, and I did not
20
really want to apportion blame to Mr. Paran at that
21
time.
22
23
24
662
Q.
Of course you are doing it now aren't you?
A.
Well, I am merely describing the facts now.
MR. LEONARD:
15:51
15:51
END OF FURTHER CROSS-EXAMINATION
27
28
15:51
Thank you Professor.
25
26
15:51
Can I suggest to you that the better thing and what you
12
15
15:51
CHAIRMAN:
Ms. Barrington, yes.
29
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1
PROF. M. CORBALLY WAS THEN RE-EXAMINED BY
2
MS. BARRINGTON AS FOLLOWS:
3
4
663
Q.
MS. BARRINGTON:
Thank you Chairman.
5
One or
2 matters, timing and
15:52
6
relating to timing, Professor.
7
initial scheduling of the surgery on Master Conroy, you
8
indicated that it might perhaps have been in July.
9
think Ms. Stewart said in her evidence that the surgery
10
I
was initially scheduled for June?
11
12
In relation to the
664
15:52
A.
That is possible, yes, yes.
Q.
Mr. Meenan has suggested to you that your letter of
13
observations to the Medical Council should have
14
included reference to the fact that Mr. Paran had been
15
asked to conduct the nephrectomy at least 30 minutes
16
before he chose to start it.
17
there was some deficiency in your letter, insofar as
18
you did not address the question of timing.
19
remind you of the chronology of events, Professor.
20
letter of complaint in this case from the Chief
21
Executive of Crumlin hospital to the Medical Council
22
was in May 2009, is that right?
23
24
665
He suggested to you that
I want to
The
A.
That's correct, yes.
Q.
I think that letter is behind tab 6 of the core book.
25
The complaint consisted of forwarding to the Medical
26
Council the internal review report, and the Great
27
Ormond Street hospital or external report, is that
28
right?
29
A.
15:52
That's correct.
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Gwen Malone Stenography Services Ltd.
15:53
15:53
1
666
Q.
Is there any indication in the external report that
2
Mr. Paran was going to say that he did not have enough
3
time to prepare for this surgery, or that had he had
4
more time he would have looked at the imaging, that you
5
are aware of?
6
7
667
15:54
A.
Not that I am aware of.
Q.
The Great Ormond Street report deals with specialist
8
hours, workload and planning for cross-over.
That is,
9
if the Committee is looking for it, at page 9 of the
10
Great Ormond Street report, the external report?
11
MR. CROSS:
I don't think the Committee
12
has the letter of
13
complaint, but whether it is relevant or not.
14
MR. LEONARD:
Exhibit 3.
15
MR. CROSS:
Exhibit 3.
16
MS. BARRINGTON:
Thank you.
17
MR. CROSS:
Thank you.
MS. BARRINGTON:
The external report deals
18
668
Q.
19
15:54
at page 9, behind tab 6,
20
with specialist registrars, and I think I am correct,
21
Prof. Corbally, am I not, in saying that there is
22
nothing in that portion of the report or indeed
23
elsewhere, that says that the delegation in this case
24
was inappropriate because insufficient time was allowed
25
to Mr. Paran?
26
27
15:54
669
15:55
15:55
A.
I believe that is correct too, yes.
Q.
And therefore when you wrote your letter of
28
observations in response to the CEO's complaint, you
29
were responding to the report in general I think in
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1
September...(INTERJECTION)
2
MR. MEENAN:
This leading really.
3
MS. BARRINGTON:
As a matter of fact you
4
were responding to the
5
CEO's complaint, is that not correct?
6
MR. CROSS:
I think it is leading Ms.
7
Barrington, but --
8
MR. MEENAN:
I really do not want to be
9
obstructing, but I think it
10
is obviously an important point, and it is a problem
11
that could be corrected very straight forwardly.
12
MR. CROSS:
point.
670
Q.
MS. BARRINGTON:
Yes, the Notice of Inquiry
15
you received in this case,
16
671
A.
Yes.
Q.
So I am correct, am I not, in thinking that the
19
observations that you submitted, which are dated
20
September 2009, were submitted before the Notice of
21
Inquiry was formulated?
22
23
672
A.
I think that would be correct.
Q.
And the Notice of Inquiry at allegation 11 raises the
24
issue of inadequacy of timing in respect of the
25
delegation?
26
27
28
15:56
Prof. Corbally, is dated 1st March 2010?
17
18
15:56
Ms. Barrington has made the
13
14
15:55
673
15:56
15:56
A.
That's correct.
Q.
And Mr. Wheeler in his report...(INTERJECTION)?
MR. LEONARD:
I am just wondering if that
29
is more for submission?
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Gwen Malone Stenography Services Ltd.
1
MR. MEENAN:
I think so at this stage.
2
MS. BARRINGTON:
I am sorry, Mr. Meenan has
3
criticised Mr. Corbally.
4
MR. MEENAN:
I have.
5
MS. BARRINGTON:
On the basis that his
6
15:57
letter of September 2009
7
did not...(INTERJECTION)
8
MR. CROSS:
He has, Ms. Barrington, but
9
-- and you make the point
10
that the letter that he criticised should be take in
11
its context in time.
12
submission.
13
MS. BARRINGTON:
That is essentially a matter of
Very good, very good.
14
I
think it is nonetheless
15
fair
16
way of submission.
17
MR. CROSS:
Thank you.
MS. BARRINGTON:
The external report, Prof.
18
674
Q.
-- well, no, I will address this issue then by
19
Corbally, came with a
20
detailed time line prepared by the authors of the
21
report, is that correct?
22
23
675
A.
That's correct.
Q.
And that report puts a time on the conversation between
24
15:57
15:57
yourself and Mr. Paran, does it not?
25
A.
26
I would have to look at that to be sure.
MR. MEENAN:
If my friend could identify
27
the page, it would be a
28
29
15:57
great help.
676
Q.
MS. BARRINGTON:
Yes, it is behind tab 6 of
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15:58
1
the core book and it is a 3
2
page document which is the time line prepared by the
3
external reviewers.
4
5
677
Have you got that Professor?
A.
I have.
Q.
I do not know if the Committee has that.
It is perhaps
6
a little difficult to manage because it is split up,
7
but there is an entry for 21st March at 11:00 a.m.
8
think that is on probably the fifth page in the
9
version, the way the Committee and yourself have it
10
Prof. Corbally.
11
A.
12
13
I
Have you identified that?
15:59
At page 19, 21st March 10:55, following the last column
is it?
678
Q.
I made the error of stapling this together, so it is
14
not in the format that you have it.
15
the first row of boxes along the top of the page you
16
should have the date of 21st March, and the second
17
column is headed 21st March, 11:00 a.m.
18
Committee have that?
19
CHAIRMAN:
There is boxes,
15:59
Does the
I think our columns may be
20
a little bit different.
21
think it might be the last column, but some of the
22
writing is missing because of a photocopying problem.
23
MR. MEENAN:
I
16:00
Does it begin
24
"anaesthetised by
25
anaesthetic"...(INTERJECTION)
26
CHAIRMAN:
Does it say, "arrival in
27
28
15:58
theatre".
MS. BARRINGTON:
It says "anaesthetised by
29
anaesthetic SPR", and under
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16:00
1
that, about ten lines down:
2
5
"The consultant surgeon enters the
theatre and checks the note and
verbally confirms that it is a left
sided procedure, and asks the SPR if he
is happy to do the procedure and he
agrees".
6
And the Great Ormond Street...(INTERJECTION)
7
MR. MEENAN:
3
4
I wonder could my friend
8
9
possibly read the first
part of that because I think it is important.
10
MR. CROSS:
Just a second now.
11
CHAIRMAN:
I don't think the Committee
12
16:00
have this at all.
13
MS. DURKAN:
We cannot find it.
14
MR. CROSS:
We cannot find it at least.
15
It may be that the top of
16
the page has been cut off.
17
MS. BARRINGTON:
I see.
18
16:00
Well, it is
something that perhaps I
19
can leave over and deal with with Mr. Paran and we can
20
ensure that the Committee has proper copies for the
21
morning.
22
aware that there was something missing.
23
MR. LEONARD:
I apologise for the confusion.
16:01
I was not
I have got a clean copy of
24
25
16:00
that.
MS. BARRINGTON:
We will prepare a full copy
26
for the Committee for the
27
morning.
28
you.
I have no further questions, Professor, thank
29
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16:01
1
END OF RE-EXAMINATION
2
3
CHAIRMAN:
Thank you.
4
things.
I just raise 2
There was
5
discussion about dates for a future inquiry, and I just
6
thought I would give it out to the legal people for
7
their consideration.
8
suggesting would be the 15th and 16th of December.
9
Principally one of the expert witnesses is not
Dates that the Committee are
10
available until very late in the time.
11
suppose that can be decided on maybe at the end of
12
today's proceedings or tomorrow.
13
MR. CROSS:
Or tomorrow.
14
CHAIRMAN:
I wonder, Ms. Barrington,
15
Anyway, I
if you could give us an
16
outline as to how you propose to go on now.
17
o'clock, and how many witnesses you have and so on.
18
MS. BARRINGTON:
Yes, Chairman.
19
who will be very brief.
21
CHAIRMAN:
It is 4:00
I have one
16:02
Corbally could be excused.
A.
Thank you very much.
CHAIRMAN:
Yes, thank you very much.
25
26
16:02
Maybe I think Prof.
22
24
16:01
expert witness, Mr. Murphy,
20
23
16:01
16:02
THE WITNESS THEN WITHDREW
27
28
MS. BARRINGTON:
Mr. Murphy...(INTERJECTION)
29
CHAIRMAN:
Sorry, just one witness.
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MS. BARRINGTON:
Will be very brief and then
2
there are two very short
3
character witnesses, who will not take longer than 5
4
minute each.
5
with because they have been here for the day.
6
Mr. Murphy's evidence, certainly insofar as his
7
direct-evidence is concerned, will not take very long
8
at all.
9
CHAIRMAN:
I would be anxious to have them dealt
Okay.
10
I think
16:02
Well, would you
prefer that your 2 people
11
who have been waiting all day to be dealt with first or
12
Mr. Murphy first, whatever you wish?
13
MS. BARRINGTON:
16:02
I am happy to do it that
14
way.
I am sure they would
15
be happy also, if Mr. Meenan has no objection?
16
MR. MEENAN:
16:03
Absolutely, I mean I would
17
be very anxious to keep an
18
eye on tomorrow as to the conclusion.
I think as much
19
as can be done today I think would be desirable.
20
CHAIRMAN:
Okay, whatever way you wish
21
16:03
to do it then
22
Ms. Barrington.
23
MS. BARRINGTON:
Yes, in that case I will
24
take your suggestion,
25
Chairman, and I will ask the 2 short witnesses to give
26
evidence first.
27
prepared, which we will hand into the Committee.
28
CHAIRMAN:
A booklet of testimonials has been
I think we will call this
29
number 19, exhibit number
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16:03
1
19.
2
MS. BARRINGTON:
Thank you Chairman.
3
Those
testimonials are something
4
that I will address by way of submissions, but added to
5
it has been a testimonial prepared by Mr. Oslizlok, and
6
I propose calling him now.
16:04
Mr. Oslizlok please.
7
8
MR. P. OSLIZLOK, HAVING BEEN SWORN, WAS THEN
9
DIRECTLY-EXAMINED BY MS. BARRINGTON, AS FOLLOWS:
10
11
16:04
679
Q.
MS. BARRINGTON:
Thank you Mr. Oslizlok.
12
I
know you have prepared a
13
testimonial which has been handed in to the Committee,
14
and they may like to take a minute to read through
15
that.
16
CHAIRMAN:
16:05
Okay, we have read it.
17
18
Thank you.
680
Q.
MS. BARRINGTON:
Mr. Oslizlok, you are a
19
consultant paediatric
20
cardiologist?
21
22
681
A.
Yes, yes.
Q.
And you worked since 1992 in Crumlin hospital, is that
23
right?
24
A.
25
26
16:07
Yes.
I have been a consultant paediatric cardiologist
there, yes.
682
Q.
16:07
And you have prepared a detailed testimonial on behalf
27
of Prof. Corbally saying things that he could not say
28
for himself.
29
the various qualities that you have noted, that
Could I ask, you have indicated amongst
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1
Prof. Corbally is generous with his time, not just to
2
his patients but also to his fellow colleagues.
3
I ask you to elaborate on your testimonial for the
4
Committee, with emphasis on Prof. Corbally's
5
interaction with his colleagues, and in particular
6
perhaps his more junior colleagues?
7
A.
Could
16:07
Yes, well, thank you for the opportunity of addressing
8
the Committee.
9
Prof. Corbally.
It has been a pleasure to work with
I think it is important to state at
10
the outset that Crumlin is an extremely busy hospital,
11
probably I think generally recognised as being grossly
12
understaffed from many aspects, and certainly that is
13
true of paediatric surgery.
14
man.
15
work as a cardiologist and indeed as many of the other
16
disciplines within the hospital, that his opinion has
17
been available to us at all times by day and by night,
18
whether he has been on-call or not.
16:08
He is an extremely busy
Nevertheless, I think it has been vital to my
16:08
19
20
He has been very generous with that.
His opinion is
21
expert.
22
available not just to me as a fellow consultant, but
23
indeed to the junior staff in the hospital, he is
24
equally available to them, approachable, and I think
25
that is important to point out because that has not
26
always been the case amongst my fellow consultants,
27
particularly where I have worked abroad.
28
very approachable and that is a vital part I think of
29
what makes a hospital work, albeit with the number of
16:08
It is much sought after, and that opinion is
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16:09
1
2
staff, the under staffing that existed there.
683
Q.
3
4
Is there anything else you would like to add to the
testimonial that you have prepared?
A.
Well you have read it, and I won't bore you by going
5
over it.
As anyone who works in a hospital will
6
recognise one of the things that I think is a telling
7
point is that when you ask yourself:
8
if my child was ill within the hospital?
9
whether it is the consultants, the junior hospital
16:10
Who would I go to
If you ask
10
staff, the nurses, others who work in the hospital who
11
would they go to for a surgical opinion within Crumlin
12
if they were concerned about their own child and it is
13
Prof. Corbally who would be the person, not just
14
because he is expert at what he does but because he is
15
approachable and he is there, he does the work.
16
works extraordinary hours and I think has been
17
instrumental in seeing that the many inter-disciplinary
18
aspect of Our Lady's Hospital have worked.
19
MS. BARRINGTON:
16:10
Thank you very much
20
21
He
16:10
Mr. Oslizlok.
I don't know
16:10
if the Committee has any questions for you.
22
23
END OF EXAMINATION OF MR. OSLIZLOK BY MS. BARRINGTON
24
25
CHAIRMAN:
No.
Thank you very much.
26
27
(The Witness Withdrew)
28
29
MS. BARRINGTON:
Mr. Finn Breathnach please.
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1
2
MR. FINN BREATHNACH, HAVING BEEN SWORN, WAS EXAMINED,
3
AS FOLLOWS BY MS. BARRINGTON
4
5
MS. BARRINGTON:
Thank you very much,
6
Mr. Breathnach, you have
7
also prepared a testimonial on behalf of Prof. Corbally
8
which the Committee will find at page 8 of the book
9
that has been provided to the Committee, and they may
10
like to take one moment, Mr. Breathnach, just to read
11
through that.
12
CHAIRMAN:
We have read that, thank
you.
14
MS. BARRINGTON:
Mr. Breathnach, you were
15
a Consultant Paediatric
16
684
19
685
A.
That's right.
Q.
You retired a number of years ago?
A.
That's right, in the Summer of 2008.
Q.
You therefore worked with Prof. Corbally for a very
21
686
A.
Yes, I did since 1994 up until 2008, so 14 years.
Q.
The reference that you have kindly prepared speaks for
24
itself.
25
Prof. Corbally's work how you perceived he interacted
26
with his colleagues and in particular with junior
27
staff?
28
29
16:12
considerable number of years?
22
23
16:12
Oncologist in Crumlin from 1981 onwards, is that right?
17
20
16:11
(Pause)
13
18
16:11
A.
Could I just ask you in your observation of
In relation to my involvement in the care of children
with cancer -- and I am very glad to have retired from
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16:13
1
the Hospital and no longer responsible for that group
2
of patients because the task was onerous, to say the
3
least -- it requires an input from so many different
4
specialists in so many different areas within the
5
Hospital in terms of investigating patients, in terms
6
of determining the exact diagnosis, operative
7
procedures, radiation, oncology and the administration
8
of chemotherapy, dealing with parents and dealing with
9
siblings, etc. My role as a paediatric oncologist was
10
almost like the conductor of the orchestra and I called
11
in various elements to manage various problems at
12
different stages and I set up a multi-disciplinary care
13
team, a Tumour Board, which met every week to discuss
14
every single new patient and every aspect. Prof.
15
Corbally became a part of that in 1994 when he joined
16
with the surgeon at the time who was involved with
17
paediatric oncology, Prof. Ray Fitzgerald, and from
18
that time his role within that Committee from the
19
surgical perspective continued to grow and grow.
20
16:13
16:14
16:14
16:14
21
Many a time I have stood with him by the bedside of
22
sick patients of mine at 3 o'clock in the morning where
23
he unhesitatingly gave his time, I would pick up the
24
'phone and call him and he would be there.
25
incredible in the way that he makes himself available,
26
and has done so probably to his own detriment, to the
27
detriment of his health and that of his family, but
28
that is the commitment that he gives and has given over
29
the years, and I think will continue to give into the
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He is
16:14
1
future.
2
He has always dealt with me in a very cordial way.
3
has dealt with my patients and parents in a very caring
4
way and given them time, something maybe surgeons
5
aren't very well known for, but very very caring in his
6
approach.
He
16:15
7
8
I always saw him as being focused on teaching of his
9
junior staff and I never saw him mistreat any of them,
10
and if he did so he did so in private, I was
11
never aware of that, of any mistreatment of any sort,
12
and I would expect that over the 14 years we worked
13
together I would have been aware of that from the point
14
of view of the junior doctors because I was seen as
15
quite approachable within the Hospital and people would
16
have come to me with their complaints and problems.
17
687
Q.
18
19
certainly
16:15
Thank you, Dr. Breathnach, is there anything you wanted
to add to the testimonial you prepared?
A.
Apart from working in the hospital in Crumlin
20
Prof. Corbally has also worked with me Tanzania and he
21
had also worked in Vietnam and in Cambodia and given
22
his time there and his expertise to the children there
23
in our efforts to try and improve the care for children
24
with cancer.
25
MS. BARRINGTON:
I don't know if the
26
27
16:15
Committee may have any
questions for you.
28
29
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16:16
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END OF DIRECT-EXAMINATION OF MR. BREATHNACH BY
2
MS. BARRINGTON
3
4
MR. BREATHNACH WAS CROSS-EXAMINED, AS FOLLOWS, BY
5
MR. MEENAN
6
7
688
8
9
689
10
Q.
MR. MEENAN:
Do you know Mr. Sri Paran?
A.
Yes, I do.
Q.
Do you have any views of him?
A.
I certainly have, I think he is a superb doctor, very
11
very caring.
12
Mind you my contact with him would not have been any
13
way near as close a relationship as I have had with
14
Prof. Corbally.
15
690
Q.
I have always enjoyed working with him.
Of course. I take it you have also always found him to
16
be a careful and conscientious surgeon, is that
17
correct?
18
19
691
A.
Absolutely, yes, indeed.
Q.
I presume you have also in your experience never found
20
21
him to rush into operations, would that be right?
A.
16:16
16:16
Again in my time with Sri he would have been a junior
22
colleague, a registrar, I would have known him at a
23
much earlier stage in his career than now.
24
MR. MEENAN:
Thank you.
25
16:16
26
END OF CROSS-EXAMINATION OF DR. BREATHNACH BY
27
MR. MEENAN
28
29
16:16
CHAIRMAN:
Thank you very much
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Dr. Breathnach.
2
3
(The Witness Withdrew)
4
MS. BARRINGTON:
Dr. Feilim Murphy please.
5
MR. LEONARD:
Just before the next
6
16:17
witness is called I want to
7
flag this in advance, I don't recall, perhaps
8
Ms. Barrington will correct me, Ms. Barrington putting
9
to Mr. Wheeler any evidence that an expert was going to
10
give that differed from anything that he said.
11
not sure in circumstances where no differing expert
12
evidence at all seems to have been put to Mr. Wheeler I
13
am unclear as to what evidence is going to be given to
14
this Committee.
15
MS. BARRINGTON:
Yes.
16
I am
Mr. Leonard is
16:17
16:17
correct that differing
17
versions were not put to Mr. Wheeler because
18
Mr. Wheeler expressed the view on a number of occasions
19
that his views were dependent on practices in Crumlin
20
Hospital and Mr. Murphy has expertise from his role as
21
a paediatric urologist having also worked in Crumlin
22
Hospital.
23
relating to images and the viewing of images and the
24
practice in relation to the viewing of images and a few
25
other confined issues.
26
MR. CROSS:
16:18
His evidence will be confined to issues
16:18
Is he giving factual
27
evidence as to what happens
28
in Crumlin or is he giving expert evidence?
29
MS. BARRINGTON:
I think he is giving both,
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1
in relation to his
2
experience in Crumlin and elsewhere in relation to the
3
viewing of images.
4
will be giving evidence that differs significantly from
5
the evidence given by Mr. Wheeler.
6
MR. LEONARD:
I am even more alarmed now.
7
MS. BARRINGTON:
I am entitled to call my
I don't believe that Mr. Murphy
8
9
16:19
own witness and then
Mr. Leonard can make an objection if he thinks that Mr.
10
Murphy gives evidence that I should have out to Mr.
11
Wheeler.
12
MR. CROSS:
That is fair, Mr. Leonard.
13
MR. LEONARD:
Very well.
14
MR. CROSS:
One would be very reluctant
15
to stop any evidence being
16
given and if you were in difficulty we will have to
17
consider recalling your witness but...(INTERJECTION)
18
MR. LEONARD:
16:19
16:19
Well given that he has
19
flown back to Southampton I
20
might have a different application, I might object to
21
the Committee taking evidence.
22
difficult either.
23
MS. BARRINGTON:
16:19
I don't want to be
Mr. Leonard can object as
24
the questioning progresses
25
if he thinks there is an issue that I should have
26
raised with Mr. Wheeler.
27
MR. CROSS:
That is fair enough.
28
MS. BARRINGTON:
Mr. Murphy please.
29
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MR. MURPHY, HAVING BEEN SWORN, WAS EXAMINED, AS
2
FOLLOWS, BY MS. BARRINGTON
3
4
692
Q.
MS. BARRINGTON:
Thank you, Mr. Murphy, we
5
are handing in a copy of
6
your CV to the Committee.
7
Consultant Paediatric Surgeon and Urologist, is that
8
right?
9
A.
(Handed) You are I think a
Yes, I am a full-time paediatric urologist in
10
St.
11
CHAIRMAN:
This will be Exhibit 20.
MS. BARRINGTON:
Exhibit 20.
12
693
Q.
George's Hospital in London.
13
16:20
Your
qualifications are set out
14
at page 4 of your CV.
15
Ireland, is that right?
16
A.
I think you qualified in
Ireland.
18
here. I commenced with paediatric surgery in this
19
country and then went abroad for a number of years. I
20
then came back to continue my specialist training here
21
before leaving to finish my final super specialist
22
training in Great Ormond Street, and I have remained in
23
the United Kingdom since then.
694
Q.
25
27
695
28
29
I did some of my basic surgical training
696
16:21
How many years in total did you spend working in
Crumlin Hospital?
26
16:20
Yes, I am a graduate of the College of Surgeons in
17
24
16:20
16:21
A.
I spent four years in Crumlin Hospital.
Q.
Did you work with Prof. Corbally?
A.
I worked with Prof. Corbally.
Q.
Did you also work with Mr. Paran?
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Gwen Malone Stenography Services Ltd.
1
2
697
A.
And Mr. Paran, yes.
Q.
How many years did you spend in Great Ormond Street
3
Hospital?
4
A.
I spent nearly two years in total in Great Ormond
5
Street between a role as being a senior registrar and
6
being a consultant in that position as well.
7
698
Q.
You are aware, Mr. Murphy, that the allegations are now
8
more confined than they were at the outset in relation
9
to Prof. Corbally, one of the allegations in relation
10
to Prof. Corbally, allegation number two, is an
11
allegation in respect of which Mr. Wheeler expressed
12
the view that Prof. Corbally should not have listed
13
Master Conroy for surgery unless the images would be
14
viewed prior to surgery.
15
say from your time in Crumlin what the practice was for
16
an operating surgeon in relation to the reviewing of
17
images prior to surgery?
18
A.
20
surgery.
22
23
700
24
16:22
Q.
By the operating surgeon?
A.
By the operating surgeon.
Q.
In your experience elsewhere is that also the practice?
A.
It is, and a very element of the operating surgeon's
25
position to ensure that the images are there and that
26
you actually use them as a guide for the operation
27
itself.
28
29
701
Q.
16:22
From my time in Crumlin it was normal practice for the
images to be reviewed prior to the commencement of
699
16:21
I want to ask you if you can
19
21
16:21
It has been suggested in the cross-examination of
Prof. Corbally that Mr. Paran would have reviewed the
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1
images in this case had he had more time, do you have
2
any observation to make on that?
3
A.
To be honest I am a little confused about this concept
4
of more time, it gives the implication that there is an
5
automatic start time for a procedure.
6
any operating surgeon to be 100% comfortable when
7
starting a procedure, and part of that would be
8
familiarising themselves with the images, looking at
9
the radiology and looking through the notes.
One would expect
So, yes,
10
it would be a normal part of practice to look at the
11
radiology.
12
MS. BARRINGTON:
other principle issues that
14
Mr. Wheeler was called upon to address was the question
15
of delegation.
16
Prof. Corbally...(INTERJECTION)
17
MR. MEENAN:
The CEO has suggested to
written report or is this
19
just being done orally?
20
MS. BARRINGTON:
I didn't propose providing
21
16:24
a written report.
MR. CROSS:
He doesn't have to have
23
one.
MR. MEENAN:
I appreciate that.
25
Just to
confirm that there isn't a
26
written report.
27
MS. BARRINGTON:
There isn't a written
28
29
16:24
Does this witness have a
18
24
16:23
As you are aware one of the
13
22
16:23
report that I propose
providing to the Committee.
A number of the
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1
allegations no longer arise so this witness is dealing
2
with the only live points that are left.
3
MR. MEENAN:
But there is a report.
4
5
Okay. Very
MR. LEONARD:
I wonder would the report
6
16:24
with the remaining
7
allegations be provided?
8
MR. CROSS:
Mr. Leonard that is really
9
a matter for Ms.
10
Barrington, she doesn't have to do it, it is usually
11
done, but if there is a report dealing with matters
12
that are not now before the Committee it may be
13
difficult to get a redacted report, or whatever, and it
14
really is a matter for herself.
15
of help to you, presumably, and may be to the Committee
16
but she doesn't have to do it.
17
MS. BARRINGTON:
Yes.
18
16:24
Obviously it would be
16:25
Mr. Murphy is dealing
with a discrete number of
19
issues, which I think he won't be much longer in
20
dealing with.
21
MR. MEENAN:
16:25
The difficulty about all of
22
this is what Mr. Murphy is
23
now being asked to do is to respond to various matters
24
which were put in cross-examination, and of course that
25
is entirely appropriate when he is dealing with an
26
expert report, but what neither Mr. Leonard or myself
27
have any idea about is what Mr. Murphy's initial views
28
are and have those views changed on the basis of
29
cross-examination.
It seems to me that is why I would
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1
have thought it is important.
2
MR. CROSS:
You can ask him.
3
I don't
think counsel when
4
presenting evidence is obliged to produce expert
5
reports.
6
MR. MEENAN:
16:25
That may be but I think at
7
the same time if there is a
8
written report which deals with allegations which are
9
still current it really, I would have thought, should
10
be produced.
11
MR. CROSS:
It is not a requirement.
12
MS. BARRINGTON:
In relation to the question
16:26
13
of delegation, Mr. Murphy,
14
it was suggested, and I know you were here earlier on
15
in the day, by Mr. Leonard that having regard to the
16
list as it was on the day it was unusual or perhaps
17
indeed inappropriate for Prof. Corbally to have
18
delegated the nephrectomy as that was of the operations
19
appearing on the list that was provided to the
20
Committee the most complex of the operations.
21
you have to say about the appropriateness of delegating
22
an nephrectomy in circumstances where the other
23
procedures listed may be less complicated
24
MR. LEONARD:
What do
16:26
Before the witness answers
25
that question, that is
26
exactly a point that Mr. Wheeler gave evidence on.
27
MR. CROSS:
Mr. Wheeler said that it
28
29
16:26
depends on the view the
Committee takes as to the competence
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1
of...(INTERJECTION)
2
MR. LEONARD:
He also said under no
3
circumstances would he
4
delegate that operation and nor would the people that
5
he worked under.
6
one of the hospitals he also worked in.
7
the type of issue, I submit, that this
8
witness...(INTERJECTION)
9
MR. CROSS:
In fact I think this witness works in
16:27
It is exactly
I don't think, Mr. Leonard,
10
that you are taken short on
16:27
Your expert said inter alia that it
11
this point.
12
depends on the expertise of the person to whom he has
13
delegated, I am speaking from memory now.
14
that normally such matters would and should be put to
15
experts but I don't see how there is a fundamental
16
unfairness yet.
17
that she will be short and they won't be asking much
18
more.
19
MR. LEONARD:
I register my objection
20
MS. BARRINGTON:
I note the objection that
I appreciate
16:27
Ms. Barrington has indicated twice
21
16:28
is registered by
22
Mr. Leonard but I don't accept it.
Mr. Wheeler said as
23
a matter of fact that he wouldn't delegate a
24
nephrectomy.
25
in cross-examination was whether it was appropriate
26
having regard to the fact that he perceived the other
27
procedures on the list to be less complicated to
28
delegate a nephrectomy.
29
as to whether in the factual circumstances of this case
What Mr. Leonard asked Mr Prof. Corbally
I am asking Mr. Murphy's view
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1
he considered it appropriate to delegate the
2
nephrectomy.
3
A.
It is important as a surgeon that you delegate
4
appropriate operations to the appropriate trainees.
5
would be inappropriate to delegate a significant
6
operation -- but I would take argument that there is
7
significant and less significant operations --
8
operations that require more expertise to a junior
9
trainee, but it is very appropriate that senior
It
10
trainees get more appropriate operations for them to
11
operate on otherwise we would produce a generation of
12
surgeons that were only able to do minor operations.
13
It is normal practice that we would delegate the most
14
appropriate operation to an appropriate trainee.
15
702
Q.
Mr. Murphy, if the delegate considers he has
16
insufficient time to prepare himself what do you
17
believe that delegate should do?
18
A.
the delegating surgeon, the surgeon taking control of
20
the case, they have control of the case and therefore
21
they have to be 100% happy before they would commence
22
the case. It would be the equivalent, as we have
23
discussed the airline industry, of a captain on the
24
airplane handing over controls to the first mate, the
25
first mate still has to have an understanding of what
26
is going to happen and go through all of the necessary
27
checks.
29
703
Q.
16:29
16:29
If the operation surgeon, which I presume one means by
19
28
16:28
It as simple as that really.
One of the issues that Mr. Leonard has also raised is
the question of the responsibility of a consultant.
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16:29
1
Prof. Corbally has accepted that he is responsible for
2
the patients on his list.
3
that as he was responsibile for the patients on his
4
list he should also take responsibility in terms of
5
accepting guilt for professional misconduct for
6
mistakes on the part of his team.
7
say about that?
8
question of responsibility of the consultant?
9
A.
It was suggested by the CEO
16:30
What do you have to
Can you assist the Committee in this
The consultant is ultimately responsible, but that term
10
is very loosely applied.
I would use once again an
11
analogy about a ship's captain, a ship's captain is
12
ultimately responsible for the ship but if there is a
13
fundamental problem within the ship itself they cannot
14
take the blame because there was a problem with the
15
building or the construction of the systems that were
16
put in place.
17
responsibility for each step along the way there are
18
other people who share that responsibility with that
19
individual and to produce a safe environment for a
20
child, or anybody having an operation, it is not just
21
the consultant's responsibility but it is every single
22
person's responsibility in that room. The WHO
23
guidelines and the WHO time-out procedures that we have
24
now, and we had had for a number of years in the united
25
Kingdom, are very clear that every single person in
26
that room is responsible to ensure that that child is
27
having a safe procedure. So everybody is responsible,
28
it is not just one person with all of the
29
responsibility or one person with all of the blame.
16:30
16:31
So even though the consultant has
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16:31
1
704
Q.
Is there a valid distinction to be drawn between
2
responsibility for a patient on the list and liability
3
for professional misconduct in your view?
4
A.
You can do the very best you can and you can have an
5
error occur under your watch by your actions or by the
6
actions of your team but that does not make you a bad
7
doctor, that does not make you professionally
8
incompetent or of poor practice that could be
9
negligence or bad luck but it is a different issue from
10
11
professional competence.
705
Q.
16:32
Mr. Leonard and to some extent Mr. Meenan have
12
criticised the conversation Prof. Corbally had with the
13
parents after the operation insofar as Prof. Corbally
14
didn't address Mr. Paran's role in the surgery, do you
15
have a view as to the appropriate of the conversation?
16
A.
16:32
16:32
It was very appropriate that Prof. Corbally went to the
17
parents, he is the consultant in charge and it was his
18
job, his duty to go to those parents and explain that
19
something catastrophic had occurred, a truly terrible
20
thing had occurred.
21
take responsibility at that stage, and that is
22
perfectly reasonable, I know Prof. Corbally personally
23
and I know that is the kind of thing he would do, take
24
personal responsibility.
25
as a consultant surgeon fro me to go and tell a family
26
that such a disastrous thing has occurred and then, by
27
the way it wasn't me that did it. I think that would be
28
immensely difficult for the family to deal with at that
29
time. He was right to go, he was right to take
I understand that he decided to
16:33
It would seem very very harsh
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1
responsibility and at the right time the hospital and
2
the family would have go through all of the issues, at
3
and appropriate time go through all of the issues and
4
explain exactly what is going on.
5
MS. BARRINGTON:
Thank you very much,
6
16:33
Mr. Murphy I don't have any
7
further questions.
8
9
END OF DIRECT EXAMINATION OF MR. MURPHY BY
10
MS. BARRINGTON
16:34
11
12
MR. MURPHY WAS CROSS-EXAMINED, AS FOLLOWS, BY
13
MR. LEONARD
14
15
706
Q.
MR. LEONARD:
Mr. Murphy, you prepared a
16
written report in this
17
case, is that right?
18
19
707
20
21
708
22
23
709
24
A.
Yes.
Q.
Do you have that report with you?
A.
Not all of it.
Q.
I am sorry?
A.
Not on my person right now.
Q.
What date did you prepare that?
A.
I prepared that written report in July of this year, it
25
26
27
16:34
16:34
was finalised, the last version was in July this year.
710
Q.
That is to say after the first day's evidence?
A.
The report was mostly completed before that but there
28
was a number of other issues that were added to it
29
after that.
205
Gwen Malone Stenography Services Ltd.
16:34
1
711
2
3
712
4
5
713
Q.
When were you instructed to do it?
A.
When was I initially instructed to do the report?
Q.
Yes.
A.
In February/March this year.
Q.
Did you see the Notice of Inquiry prior to preparing
6
your report?
7
8
714
9
10
715
A.
The original Notice of Inquiry?
Q.
Yes.
A.
Yes.
Q.
Did you receive instructions as to what Prof. Corbally
11
716
14
A.
No.
Q.
No instructions at all?
A.
I wasn't instructed as to what Prof. Corbally's
15
statements were going to be prior to writing my report.
16
I wrote my report based on the evidence that was
17
available to me, which was the case reports, the
18
detailed report from the Hospital, the external report,
19
the internal review, Rob Wheeler's opinion.
20
report on the evidence I was given, I wasn't aware of
21
exactly what Prof. Corbally was going to say.
22
717
Q.
24
little longer to Mr. Paran to do the operation must
25
have come as a surprise to you this morning?
A.
27
29
No, in discussions we have had since before my report
was finished that did come up in conversation, yes.
718
Q.
16:35
The evidence that was given today about
Prof. Corbally giving at least half an hour, perhaps a
26
16:35
I based my
23
28
16:34
would say at the Inquiry?
12
13
16:34
I thought you said you were given no details as to what
he...(INTERJECTION)
206
Gwen Malone Stenography Services Ltd.
16:35
1
A.
I was given no details initially by Prof. Corbally or
2
by the team about what he was going to say and I wrote
3
my initial report on what was done.
4
conversations with the team or Prof. Corbally further
5
information came through, but that didn't particularly
6
change my report.
7
719
Q.
8
Only in
16:36
So you initially weren't given any details of that 30
minute...(INTERJECTION)
9
A.
No, but that is because I wasn't in conversation with
10
Prof. Corbally directly, I was communicating with his
11
legal team.
12
MR. LEONARD:
Thank you.
13
16:36
That is the
only question.
14
15
END OF CROSS-EXAMINATION OF MR. MURPHY BY MR. LEONARD
16:36
16
17
MR. MURPHY WAS CROSS-EXAMINED, AS FOLLOWS, BY
18
MR. MEENAN
19
20
720
Q.
MR. MEENAN:
I am little confused as to
21
what you are actually doing
22
here, you apparently discussed the matter with Prof.
23
Corbally, is that correct?
24
25
721
26
A.
No, I have discussed the matter with Prof. Corbally.
Q.
Have you taken a statement from him?
A.
I have discussed the situation in detail with
27
Prof. Corbally but not after I initially received the
28
request from his solicitors to deal with the matter.
29
16:36
722
Q.
Your report deals with the allegations that are made
207
Gwen Malone Stenography Services Ltd.
16:36
1
against Prof. Corbally but doesn't deal at the time
2
with anything that Prof. Corbally told you, is that
3
right?
4
5
723
6
A.
I am not really sure...(INTERJECTION)
Q.
For example, on delegation?
A.
On delegation, my report is quite clear on the matter
7
8
16:37
of delegation.
724
9
Q.
What does it say?
A.
To summarise, my report on delegation is no matter what
10
time you delegate an operation to an individual the
11
operating surgeon then takes control of the operation
12
so there is no start clock or stop clock, it is a case
13
of you now need to do an operation and you need to take
14
control of that situation and be fully aware of what
15
you need to do.
16
the commencement.
17
725
Q.
16:37
It is not a case of some countdown to
Therefore, I take it, you wouldn't agree with
18
Dr. Wheeler's evidence to the effect that delegation of
19
this particular operation in the circumstances of less
20
than five minutes was not proper or adequate?
21
A.
16:37
No, I agree with where Mr. Wheeler is coming from.
16:37
In
22
the NHS and in the United Kingdom system we have a very
23
structured approach towards cases, we have a much
24
smaller operating load than exists in Dublin and in the
25
Republic of Ireland and we have a very different way of
26
doing things because we have time and structure and
27
there is an awful lot more systems built in to prevent
28
things happening.
29
tradition case are discussed days before. So the
We are able to discuss cases and by
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Gwen Malone Stenography Services Ltd.
16:38
1
concept of delegation and a couple of days delegation
2
is extremely reasonable, and I understand Mr. Wheeler's
3
view on that.
4
been delegated to someone or once someone has taken
5
responsibility to do an operation you need to take full
6
responsibility for that operation and be 100%
7
comfortable that you are doing the right operation.
8
726
Q.
9
But at the same time once something has
You are not seriously suggesting to this Committee, are
you, Mr. Murphy, that a delegation time of less than
10
five minutes was appropriate or adequate in this case?
11
A.
minutes or any kind of minutes is somewhat redundant
13
because I don't understand the logic behind it, it
14
doesn't make sense to me in a way for you to say that
15
it is only a five minute delegation time.
16
take the amount of time that you need to do an
17
operation safely and to do an operation safely if you
18
need spend longer to start the operation you spend
19
longer to start the operation.
727
Q.
You have to
You were probably here for what was being put on behalf
21
of Mr. Paran to Mr. Wheeler and indeed to Prof.
22
Corbally which was to the effect that the first time
23
Mr. Paran knew he had to do this operation was after
24
the patient had been anaesthetised and catheterised and
25
less than five minutes before the incision.
26
giving expert evidence that that is appropriate?
27
A.
16:38
No, I am saying that the use of five minutes or 30
12
20
16:38
Are you
What I am saying to you is that if you are delegated an
28
operation you need to take the time to make sure you
29
are doing the operation correctly, there therefore
209
Gwen Malone Stenography Services Ltd.
16:39
16:39
16:39
1
isn't an automatic stop clock from the moment you have
2
been delegated the operation to say that you have five
3
minutes to get everything ready to do the operation.
4
That is my statement, it is as simple as that.
5
728
Q.
Well I must say I don't find it simple at all.
I take
6
you are talking about time, and I understand that, and
7
time means different things to different people, but
8
even in the circumstance of this case I have to suggest
9
to you that time of less than five minutes is wholly
10
inadequate for Mr. Paran to prepare himself properly
11
for that operation.
12
the circumstances of how Mr. Paran came to do the
13
operation?
14
A.
16:40
16:40
First of all are you familiar with
I am familiar with a number of different factual
15
concepts that have been given about the timeline for
16
that morning, I have listened today to what has been
17
going on.
18
saying to you is this concept of five minutes implies
19
that there is a stop clock and that the operation has
20
to start in five minutes' time, that would be the
21
equivalent of me saying to you if you are going to take
22
a plane off at an airport you have to take off in five
23
minutes and that therefore you don't do the necessary
24
checks. That doesn't make any sense to me, I am sure it
25
doesn't make any sense to other surgeons and probably
26
doesn't even make sense to Mr. Paran, I can't say that.
27
It makes no sense to me to say that there is an
28
automatic timeframe that things have to be done in.
29
You have to do it right and you have to be safe and you
16:40
I am not disagreeing with you, what I am
210
Gwen Malone Stenography Services Ltd.
16:40
16:41
1
have to take the time to do it.
2
five minutes.
3
729
Q.
I don't understand the
Mr. Murphy in the course of your practice would you
4
delegate a nephrectomy to a junior doctor less than
5
five minutes before the operation commences?
6
A.
16:41
As I said earlier I work in the NHS and we have a very
7
different situation in the NHS, it doesn't happen.
If
8
I was to delegate an operation to a junior doctor no
9
matter what the operation was, a nephrectomy, or
10
anything else, I would still expect him to be fully au
11
fait and up to speed with that operation before the
12
operation would commence and I would not accept that
13
you would not do that, that wouldn't be acceptable to
14
me at all.
15
MR. MEENAN:
That wouldn't be
16
acceptable.
17
16:41
16:42
Thank you
Mr. Murphy.
18
19
END OF CROSS-EXAMINATION OF MR. MURPHY BY MR. MEENAN
20
16:42
21
MS. BARRINGTON:
Mr. Murphy the Committee
22
may have some questions for
23
you.
24
25
MR. MURPHY WAS QUESTIONED, AS FOLLOWS, BY THE COMMITTEE
26
27
730
Q.
CHAIRMAN:
Maybe one just, personally
28
29
I don't find airport
analogies as a doctor myself very helpful.
211
Gwen Malone Stenography Services Ltd.
I think
16:42
1
when a plane goes up in the air most of the problems
2
are over, we are dealing with individual human beings.
3
The only one that appealed to me was the captain of the
4
ship and, as it were, the captain should probably go
5
down with the ship.
6
with you, we have had a lot of talk about the
7
protocols, whether you have a protocol for consent or
8
for blood, or whatever.
9
place in this case, maybe, for example, when they came
10
to the time when the kidney was exposed the doctor did
11
go back and check the notes, he sensed that there was
12
something wrong but whatever protocol was there was not
13
sufficient to prevent what was happening.
The only point I wanted to raise
16:42
There were some protocols in
16:42
14
15
It really was a question of thought, there were two
16
surgeons involved and neither of them seemed to have
17
got on to the idea that we better check the X-rays or
18
the scans, I was just wondering what is your opinion
19
about this, is this a failure of protocols, a systems
20
failure or a failure of human judgment.
21
are thinking about the cause and the responsibility of
22
the people.
23
A.
That is an excellent question.
I suppose we
16:43
16:43
The reality of the
24
situation is that it is a combination of all of those
25
things. The initial trigger was the laterality issue
26
that was documented incorrectly in the notes.
27
there is the subsequent data, that kind of
28
self-fulfilling prophecy of the letters that merely
29
reflected that error.
Then
I appreciate there was some
212
Gwen Malone Stenography Services Ltd.
16:43
1
radiology errors in the past and there was definitely
2
evidence on the radiology system and the fact that it
3
is not there on every step along the child's pathway is
4
not robust.
5
allowed the child to get basically to the hospital.
These were all the system errors that
16:44
6
7
Then the night before we have a number of human errors
8
and system errors for which there is no radiology
9
available, people aren't looking and thinking about: Is
10
this the right operation?
Am I doing the right thing?
11
They seem to be automatically doing their little bit
12
but not thinking:
13
check further?
14
report and expert testimony about people checking and
15
doing lots of wonderful checking, but all in isolation
16
and not communicating well enough with each other,
17
which is system related and people related.
Is something more?
16:44
Should I really
We have lots of people and lots of
16:44
18
19
Then the parents repeatedly asking questions, which is
20
a worry, a real real red flag.
16:44
21
22
Then you have them getting to theatre, people not
23
thinking, people making errors, people making mistakes
24
and getting caught down a particular path.
25
explain why what happened on the day happened on the
26
day at the moment in theatre but it is a definite
27
combination of the human and the system fatally
28
combined in the worse type of Swiss cheese analogy that
29
there is:
I cannot
The patient falling from a safe environment,
213
Gwen Malone Stenography Services Ltd.
16:45
1
falling through all of the holes which are due to
2
different people and different events and falling into
3
this terrible, catastrophic event.
4
5
There is a number of people and systems that are
6
responsible.
7
are the parents who have had to go through all of this,
8
and the child.
9
CHAIRMAN:
16:45
The only people who are not responsible
Thank you very much,
10
Dr. Murphy for that.
16:45
11
12
END OF QUESTIONING OF DR. MURPHY BY THE COMMITTEE
13
14
(The Witness Withdrew)
15
16
16:45
CHAIRMAN:
Ms. Barrington, is that
17
the end of your
18
presentation?
19
MS. BARRINGTON:
That is my evidence.
20
CHAIRMAN:
Mr. Meenan, I don't know
21
16:46
whether you propose to
22
start or what your proposal is, it may be getting a
23
little bit late.
24
MR. MEENAN:
If I did start it would be
25
simply to qualify Mr.
26
Paran, but I suppose that will be done in a matter of
27
minutes. The sensible thing to do is to commence in the
28
morning.
29
another witness, and that is it.
I can tell the Committee I have Mr. Paran and
214
Gwen Malone Stenography Services Ltd.
16:46
1
CHAIRMAN:
Just two witnesses.
2
We
should be all right for
3
time tomorrow.
4
MR. MEENAN:
I would think so yes.
5
CHAIRMAN:
Mr. Leonard?
6
MR. LEONARD:
I would have thought so,
7
yes.
In terms of
8
cross-examination I don't expect I would be any longer
9
than I was today.
10
CHAIRMAN:
We have the process of
11
16:46
submissions after the end
12
of the evidence.
13
MR. LEONARD:
Let us get through the
14
evidence and review where
15
we are on that.
16
CHAIRMAN:
16:46
We should be all right for
17
18
16:46
time.
at 9.30 tomorrow morning.
We will reassemble
Thank you all.
19
20
THE HEARING WAS THEN ADJOURNED TO FRIDAY 3RD SEPTEMBER
21
AT 09.30 A.M.
22
23
24
25
26
27
28
29
215
Gwen Malone Stenography Services Ltd.
16:47
'
'02 [1] - 88:15
'08 [1] - 88:16
'parallel' [1] 94:15
'phone [1] 191:24
0
09.30 [1] 215:21
1
1 [6] - 24:19,
78:7, 84:2, 107:6,
109:21, 115:23
1,200 [1] - 9:3
10 [10] - 41:23,
42:16, 78:6,
78:11, 78:16,
94:13, 97:3,
116:25, 116:28,
116:29
10% [1] - 70:12
10.45 [1] - 96:3
100% [5] - 74:26,
176:23, 198:6,
202:21, 209:6
103 [2] - 49:18,
102:6
107 [1] - 3:7
108 [1] - 3:7
10:00 [1] - 23:26
10:06 [1] - 44:15
10:30 [5] - 45:6,
45:8, 45:29,
129:7, 131:12
10:40/10:45 [1] 44:6
10:45 [1] - 44:6
10:50 [2] - 43:15,
44:4
10:55 [1] 183:11
10th [3] - 17:18,
120:5, 120:7
11 [9] - 7:18,
74:6, 74:10,
78:12, 78:13,
78:14, 88:27,
96:4, 181:23
112 [1] - 103:1
11:00 [14] 45:29, 53:13,
126:11, 127:21,
128:12, 128:14,
128:17, 129:7,
131:12, 134:27,
142:9, 142:18,
183:7, 183:17
11:05 [2] - 53:11,
127:14
11:09 [5] 127:12, 127:14,
127:19, 128:16,
128:17
11:35 [1] - 49:22
11:40 [7] - 47:23,
47:26, 53:9,
127:8, 128:24,
142:10, 142:20
11:55 [1] 143:17
12 [6] - 7:21,
77:24, 78:20,
82:21, 154:14,
173:17
12:00 [2] - 23:26,
23:28
12:24" [1] 143:18
13 [3] - 5:2, 83:1,
83:2
13th [2] - 14:13,
15:4
14 [7] - 11:10,
11:11, 11:15,
12:27, 190:22,
192:12
15 [11] - 11:10,
11:14, 11:15,
14:29, 16:2,
41:23, 41:29,
42:16, 44:8,
59:18, 97:3
15% [1] - 176:4
15th [1] - 185:8
16 [3] - 41:1,
78:29, 98:18
16th [1] - 185:8
17 [2] - 65:20,
65:21
170 [1] - 3:7
171 [1] - 3:8
177 [2] - 3:8, 3:8
178 [1] - 3:8
179 [1] - 3:9
17th [3] - 19:8,
19:15, 24:24
18 [1] - 76:18
18,000 [2] 69:18, 86:13
185 [1] - 3:9
187 [1] - 3:11
189 [1] - 3:11
17:22, 40:8,
87:28, 88:12
2007/2008 [1] 176:1
2008 [8] - 8:10,
8:12, 10:4, 19:8,
83:17, 176:21,
190:19, 190:22
2009 [4] 120:24, 179:22,
181:20, 182:6
2010 [6] - 1:15,
4:2, 8:10, 77:12,
120:7, 181:16
205 [2] - 3:17,
3:17
207 [2] - 3:17,
3:18
20th [4] - 29:29,
30:22, 57:14,
58:7
21 [3] - 17:13,
79:5, 79:12
211 [2] - 3:18,
3:18
214 [1] - 3:18
21st [8] - 30:13,
40:27, 57:12,
82:6, 183:7,
183:11, 183:16,
183:17
22 [5] - 18:3,
57:14, 79:1, 79:5,
87:29
22nd [1] - 18:2
23 [1] - 17:22
234 [1] - 176:2
24/7 [3] - 9:9,
154:15, 173:17
25 [2] - 41:24,
41:29
25/35 [1] - 56:26
250 [2] - 49:18,
102:7
252 [1] - 102:14
28 [2] - 18:25,
19:14
29 [2] - 18:25,
19:14
291 [1] - 103:1
2ND [2] - 1:15,
4:1
19 [3] - 183:11,
186:29, 187:1
190 [1] - 3:14
192 [1] - 3:14
193 [1] - 3:14
196 [1] - 3:17
1978 [1] - 5:21
1981 [1] - 190:16
1984 [1] - 6:3
1992 [1] - 187:22
1993 [1] - 5:11
1993/1994 [1] 7:1
1994 [5] - 5:11,
9:7, 24:11,
190:22, 191:15
19th [1] - 13:8
1:30/2:00 [1] 23:21
1st [1] - 181:16
2
2 [30] - 1:18,
11:5, 11:20,
11:21, 14:29,
17:13, 24:19,
49:1, 53:2, 59:29,
71:20, 74:17,
77:26, 77:27,
78:6, 78:15,
78:18, 78:22,
84:11, 102:4,
109:22, 115:24,
119:27, 119:28,
155:3, 166:28,
179:5, 185:3,
186:10, 186:25
20 [6] - 41:23,
41:29, 79:10,
97:3, 196:11,
196:12
20% [2] - 165:20
2002 [8] - 11:23,
12:13, 13:1, 13:5,
14:13, 69:4,
84:28, 87:12
2004 [2] - 13:8,
13:14
2005 [3] - 9:9,
88:2, 154:16
2005/2006 [1] 9:28
2006 [4] - 14:6,
14:27, 15:4,
15:29
2007 [10] - 1:4,
14:9, 16:5, 17:9,
17:18, 17:20,
3
3 [9] - 1:15,
24:19, 65:24,
74:17, 77:28,
180:14, 180:15,
183:1, 191:22
30 [17] - 8:4,
25:4, 53:8, 53:14,
53:23, 97:3,
155:4, 155:10,
155:16, 155:18,
155:25, 160:4,
167:16, 167:17,
179:15, 207:7,
209:11
30% [1] - 165:20
30th [4] - 84:12,
120:2, 120:16,
120:24
35 [3] - 10:21,
10:28, 23:1
360 [4] - 76:15,
76:25, 77:5, 77:8
3:30 [4] - 23:22,
66:20, 66:24
3RD [1] - 215:20
3rd [1] - 77:12
4
4 [11] - 3:6,
68:23, 68:29,
77:24, 78:4, 78:9,
154:4, 156:25,
157:5, 157:6,
196:14
40 [3] - 96:15,
142:12, 142:13
45 [4] - 10:22,
23:1, 63:27
45% [1] - 176:5
48 [1] - 168:21
481283 [1] - 43:5
483570 [1] 43:14
4:00 [2] - 66:20,
185:16
5
5 [49] - 5:20,
11:19, 37:26,
43:26, 43:27,
43:28, 44:2, 48:1,
48:15, 51:1,
59:18, 63:25,
64:1, 64:3, 74:17,
78:25, 94:16,
94:17, 94:18,
117:4, 117:5,
117:7, 130:18,
130:20, 133:20,
133:25, 133:26,
134:26, 135:12,
1
Gwen Malone Stenography Services Ltd.
135:18, 135:20,
135:21, 135:25,
136:11, 141:11,
143:10, 145:5,
151:19, 153:12,
153:17, 153:19,
159:22, 166:23,
166:27, 167:2,
167:13, 170:28,
186:3
5% [1] - 176:4
5's [1] - 64:3
50 [2] - 57:9,
96:15
515562 [2] 44:12, 132:24
52 [1] - 57:12
53 [1] - 57:13
535492 [1] 42:21
535570 [1] 143:26
542878 [1] - 43:1
56 [1] - 66:23
6
6 [13] - 68:23,
69:2, 71:20, 77:5,
77:11, 78:5,
87:20, 173:2,
173:8, 179:24,
180:19, 182:29
65 [2] - 84:2,
84:7
690 [1] - 16:3
6:30/7:00 [1] 23:13
7
7 [39] - 2:16,
4:12, 4:14, 37:26,
38:2, 38:6, 38:8,
44:1, 72:3, 78:9,
78:25, 92:19,
94:16, 94:16,
94:18, 117:4,
117:5, 117:6,
130:15, 130:20,
131:26, 131:28,
135:12, 136:6,
136:9, 136:20,
137:12, 137:26,
138:3, 138:8,
138:25, 139:19,
139:27, 143:16,
145:2, 153:14,
154:3, 154:5,
155:27
70 [1] - 62:4
72 [1] - 154:12
75 [2] - 154:12
75/80 [1] - 24:7
8
8 [10] - 1:3,
72:22, 77:24,
92:8, 92:12,
92:13, 92:18,
159:6, 172:10,
190:8
80 [4] - 3:6, 3:7,
154:12, 173:16
8:00 [4] - 23:23,
23:24, 30:7
8:36 [1] - 42:24
8:45 [1] - 42:24
8:54 [1] - 43:4
8th [2] - 11:23,
69:4
9
9 [7] - 77:26,
77:28, 78:7,
78:22, 124:1,
180:9, 180:19
9% [6] - 18:26,
25:8, 25:17,
81:20, 164:1,
174:10
9.30 [1] - 215:18
91% [2] - 25:17,
65:3
9:00 [1] - 23:25
9:07 [1] - 43:7
9:25 [1] - 43:15
9:27 [1] - 43:4
9:30 [1] - 23:15
9:35 [1] - 43:8
9:55 [1] - 44:12
A
A&E [5] 152:19, 152:21,
153:2, 154:6,
167:4
a...(
INTERJECTION)
[1] - 138:28
a.m [3] - 23:25,
183:7, 183:17
A.M [1] - 215:21
ABBEY [1] -
2:15
abdomen [2] 42:8, 66:5
abdominal [1] 64:10
aberrant [1] 166:17
ability [8] 39:26, 46:21,
122:19, 129:29,
130:3, 140:10,
146:5, 159:11
able [17] - 7:29,
10:27, 28:27,
29:2, 30:27,
74:12, 75:5, 75:7,
79:20, 80:5,
93:29, 143:5,
144:13, 144:14,
168:17, 202:12,
208:28
abnormal [3] 18:14, 23:17,
88:23
abnormalities
[1] - 15:19
abnormality [5]
- 15:12, 16:19,
16:29, 18:19,
18:20
above-named
[1] - 1:30
abroad [4] - 6:5,
6:29, 188:27,
196:19
absence [2] 25:12, 38:16
absent [1] 90:10
absolute [4] 33:11, 89:20,
104:15, 113:4
absolutely [23] 27:4, 38:14,
38:19, 48:18,
67:18, 68:26,
76:4, 87:9, 109:2,
112:29, 114:15,
122:2, 124:25,
132:8, 140:13,
142:6, 148:2,
149:19, 153:8,
167:15, 176:18,
186:16, 193:18
absorb [1] 102:18
academic [2] 36:16, 101:16
accept [33] 34:9, 34:27,
43:17, 62:23,
62:24, 62:28,
68:12, 84:14,
85:1, 85:22,
85:28, 86:6, 86:9,
86:15, 86:20,
86:24, 87:6, 87:9,
92:5, 100:11,
101:1, 104:1,
129:14, 135:6,
162:23, 167:13,
169:9, 175:4,
175:9, 175:16,
201:22, 211:12
acceptable [4] 37:15, 149:18,
211:13, 211:16
acceptance [1] 176:1
accepted [7] 43:20, 69:14,
87:3, 124:5,
124:18, 124:19,
203:1
accepting [6] 61:22, 85:15,
85:27, 169:14,
169:15, 203:5
accepts [2] 103:29, 124:9
access [5] 31:7, 60:17, 61:5,
61:14, 147:20
accommodatin
g [1] - 144:23
accompany [1] 20:7
accomplished
[3] - 38:26, 46:16,
143:28
account [2] 106:14, 135:4
accreditation [1]
- 76:27
accumulative
[1] - 172:19
accuracy [2] 128:7, 134:6
accurate [2] 1:28, 161:4
achieved [1] 66:29
achievement [1]
- 16:28
acknowledged
[2] - 44:26, 157:13
acquaint [2] 103:5, 120:29
acquaintance
[1] - 172:9
acquiring [1] 171:29
act [2] - 24:12,
161:17
ACT [1] - 1:4
acted [1] 110:13
acting [1] 51:21
action [2] - 1:30,
69:26
actions [4] 85:8, 85:25,
204:5, 204:6
active [1] - 7:13
actual [10] 20:27, 69:25,
85:11, 105:17,
117:27, 126:10,
129:19, 156:12,
168:16, 176:9
adamant [1] 167:15
adapted [1] 152:27
add [3] - 37:19,
189:2, 192:18
added [2] 187:4, 205:28
adding [1] 68:15
addition [12] 7:13, 9:5, 9:10,
9:12, 75:26,
92:28, 100:23,
136:25, 154:13,
154:15, 164:5,
173:9
additional [4] 9:23, 11:7,
140:12, 151:21
address [7] 9:27, 115:4,
179:18, 182:15,
187:4, 198:14,
204:14
addressed [7] 59:28, 75:4,
75:10, 75:19,
75:21, 110:12,
162:18
addressing [1] 188:7
adds [2] - 24:11,
139:22
adept [1] 152:23
adequate [11] 82:17, 82:19,
95:12, 97:4,
99:26, 115:15,
119:14, 123:6,
123:25, 208:20,
209:10
adequately [1] 99:28
adhered [1] 29:18
adjoining [1] 22:22
ADJOURNED
[1] - 215:20
ADJOURNMEN
T [6] - 80:16,
80:19, 107:14,
108:2, 171:3,
171:6
administration
[3] - 25:27, 75:5,
191:7
administrative
[2] - 105:25,
171:26
admission [13] 17:21, 17:22,
17:25, 30:1, 30:4,
30:5, 31:1, 39:8,
72:13, 75:3,
89:19, 111:22,
172:13
admitted [7] 29:25, 29:29,
56:14, 71:10,
72:11, 111:21,
159:3
admitting [4] 85:6, 85:22, 86:6,
169:5
adopted [1] 175:13
adults [1] - 6:12
advance [5] 39:1, 46:2, 98:1,
155:18, 194:7
adverse [1] 158:7
advice [6] 67:26, 75:18,
78:1, 134:7,
168:1, 168:4
advise [2] 67:21, 75:15
advised [3] 32:1, 67:8,
167:29
Advisory [1] 173:4
advocated [1] 73:9
Africa [1] - 5:27
2
Gwen Malone Stenography Services Ltd.
AFTER [3] 80:18, 108:1,
171:6
afternoon [2] 10:16, 177:19
age [3] - 15:11,
15:21, 15:25
aggressive [1] 55:15
ago [9] - 55:6,
76:23, 84:29,
123:11, 123:12,
137:4, 149:16,
166:1, 190:18
agree [45] - 27:4,
27:7, 28:10, 38:2,
45:22, 61:21,
68:25, 81:7,
81:17, 82:1,
82:21, 91:20,
95:10, 96:14,
96:19, 101:3,
101:5, 102:2,
102:19, 103:7,
106:13, 109:29,
111:9, 112:28,
138:15, 138:16,
140:13, 157:22,
157:23, 157:24,
157:25, 157:27,
158:20, 158:22,
159:23, 159:26,
160:1, 161:11,
162:16, 163:1,
166:15, 166:21,
166:26, 208:17,
208:21
agreeable [1] 107:7
agreed [11] 69:15, 77:29,
78:2, 121:16,
123:26, 129:22,
142:5, 142:6,
146:17, 147:21,
164:26
agreeing [2] 136:17, 137:8
agreement [1] 172:15
agrees" [1] 184:5
ahead [4] - 92:4,
145:21, 145:24,
146:3
air [3] - 166:2,
166:3, 212:1
aircraft [2] 165:16, 165:21
airline [3] -
165:16, 202:23
airplane [1] 202:24
airport [2] 210:22, 211:28
airway [1] 23:19
alarmed [1] 195:6
albeit [2] - 25:8,
188:29
alerted [2] 31:2, 31:4
alerting [1] 70:28
alia [1] - 201:11
alike [1] - 36:28
allayed [6] 33:14, 34:20,
34:22, 35:2, 35:3,
163:1
allegation [18] 81:17, 81:26,
82:3, 82:11,
82:15, 82:21,
82:24, 83:1, 83:2,
83:3, 83:4, 83:21,
83:22, 86:27,
181:23, 197:10,
197:11
allegations [12]
- 54:3, 70:5, 81:5,
81:6, 81:10,
81:13, 197:7,
197:9, 199:1,
199:7, 200:8,
207:29
allegedly [1] 155:4
allocated [4] 36:29, 73:26,
154:9, 157:15
allow [3] 100:23, 137:1,
170:21
allowed [6] 22:6, 25:10, 56:6,
69:24, 180:24,
213:5
alluded [3] 14:11, 14:12,
73:15
almost [2] 176:21, 191:10
alter [1] - 117:28
alternative [1] 124:18
amazed [1] 34:6
ambition [4] -
137:14, 143:12,
144:12, 156:11
American [1] 165:29
amount [6] 7:22, 110:19,
124:13, 124:21,
134:5, 209:16
ample [2] 93:27, 104:8
an...(
INTERJECTION)
[1] - 50:29
anaesthesia [17]
- 41:24, 42:3,
42:7, 42:12,
42:13, 42:15,
46:25, 47:18,
48:1, 48:13,
48:21, 49:8, 49:9,
96:11, 126:19,
143:17
anaesthetic [29]
- 24:16, 32:18,
41:20, 41:22,
42:4, 42:6, 42:23,
42:24, 43:3, 43:8,
43:15, 44:3,
44:12, 44:15,
47:25, 64:2, 64:3,
109:20, 112:3,
128:4, 128:22,
143:21, 144:1,
151:18, 163:20,
163:28, 183:29
Anaesthetic [1]
- 127:19
anaesthetic"...(
INTERJECTION
[1] - 183:25
anaesthetised
[13] - 41:25, 47:3,
60:8, 82:8, 94:19,
117:8, 128:14,
138:27, 145:7,
153:20, 183:24,
183:28, 209:24
anaesthetist [7]
- 47:24, 48:16,
58:1, 58:4, 145:5,
145:8, 152:15
Anaesthetist [1]
- 128:23
anaesthetist's
[1] - 46:24
analgesia [1] 41:26
analogies [1] 211:29
analogy [3] -
165:15, 203:11,
213:28
anastomosis [3]
- 66:29, 67:3,
67:4
anchored [1] 133:11
anguished [1] 169:3
Anna [2] 160:24, 162:5
annual [1] 90:11
anorectal [5] 12:10, 15:12,
16:19, 16:29,
61:11
answer [11] 71:7, 79:6, 79:16,
102:14, 115:22,
116:10, 133:8,
145:29, 154:19,
161:14, 167:9
answer...(
INTERJECTION
[1] - 62:22
answered [3] 34:29, 145:18,
146:2
answers [3] 5:16, 170:4,
200:24
antegrade [1] 12:6
Antibiotic [1] 18:12
antibiotics [3] 18:11, 18:29,
70:11
anticipate [1] 136:27
anticipated [4] 100:7, 139:10,
159:13, 170:7
anticipating [1]
- 176:16
antiquated [1] 22:19
anus [3] - 15:13,
15:15, 17:1
anxiety [2] 34:7, 163:1
anxious [4] 97:26, 138:17,
186:4, 186:17
anyway [5] 127:29, 145:1,
146:17, 164:26,
185:10
apart [4] -
104:22, 159:1,
171:25, 192:19
apologise [5] 68:5, 75:27, 84:4,
142:2, 184:21
apologised [5] 67:15, 68:1, 68:2,
83:28, 84:8
apologising [1]
- 178:6
apparent [2] 16:10, 65:2
appealed [1] 212:3
appear [4] 14:14, 30:24,
108:16, 119:7
appearance [1] 60:21
APPEARANCE
S [1] - 2:1
appeared [4] 90:8, 99:10,
105:7, 108:25
appearing [1] 200:19
appellant [1] 2:27
application [2] 176:6, 195:20
applied [3] - 4:7,
29:15, 203:10
applies [1] 158:2
apply [5] 37:27, 40:13,
40:14, 83:5,
106:25
appoint [2] 37:20, 69:20
appointed [3] 5:11, 9:29, 37:21
appointment [3]
- 13:28, 74:1,
74:2
apportion [2] 85:19, 178:20
appreciate [8] 49:14, 53:29,
65:17, 67:28,
81:9, 198:24,
201:13, 212:29
appreciated [1] 59:7
approach [3] 148:9, 192:6,
208:23
approachable
[7] - 55:10, 55:12,
161:27, 188:24,
188:28, 189:15,
192:15
approaching [1]
- 165:29
appropriate [31]
- 16:12, 32:2,
37:13, 77:28,
83:5, 83:24,
102:17, 117:29,
118:24, 119:13,
121:24, 123:16,
147:20, 148:11,
161:22, 168:14,
176:9, 199:25,
201:25, 202:1,
202:4, 202:9,
202:10, 202:14,
204:15, 204:16,
205:3, 209:10,
209:26
appropriately
[7] - 10:25, 33:17,
69:21, 78:25,
86:12, 106:25,
143:4
appropriatenes
s [1] - 200:21
approval [1] 20:20
approved [1] 39:8
approximation
[2] - 112:19, 129:4
April [3] - 13:14,
14:27, 15:4
apropos [1] 173:14
Arabia [1] - 72:5
archaic [1] 22:19
archive [1] 20:14
area [7] - 45:27,
127:21, 128:26,
147:16, 172:4,
172:6, 172:7
areas [2] 135:14, 191:4
argue [1] - 110:8
argument [1] 202:6
arise [3] - 56:19,
78:24, 199:1
arises [1] 172:7
arising [1] 177:15
arose [1] - 95:20
arranged [1] 17:20
3
Gwen Malone Stenography Services Ltd.
arrangement [2]
- 37:15, 39:3
arrival [1] 183:26
arrive [1] - 28:18
arrived [15] 45:27, 97:24,
127:13, 127:20,
138:26, 139:20,
141:11, 141:12,
141:13, 145:3,
151:14, 153:15,
154:5, 162:4
arrives [1] 151:27
arriving [2] 53:11, 128:25
arterial [2] 66:29, 67:3
artery [5] 65:22, 65:28,
65:29, 66:3,
66:13
articles [1] - 8:3
articulated [1] 64:16
AS [17] - 4:1,
4:25, 80:18,
80:24, 108:1,
108:12, 171:6,
171:14, 177:13,
179:2, 187:9,
190:3, 193:4,
196:1, 205:12,
207:17, 211:25
ascertain [1] 26:10
aside [1] - 82:3
asleep [4] - 47:8,
60:8, 126:16,
143:9
aspect [6] 16:18, 93:8,
126:23, 176:19,
189:18, 191:14
aspects [7] 36:4, 49:29, 50:3,
157:25, 157:26,
157:27, 188:12
assertion [1] 101:7
assessment [3]
- 76:25, 77:14,
78:12
ASSESSOR [1] 2:8
assign [1] 98:11
assigned [10] 12:24, 32:13,
38:2, 38:4, 38:12,
40:5, 58:19,
88:26, 91:7,
98:15
assignment [1] 33:4
assimilate [1] 102:23
assist [10] 43:28, 44:2,
58:14, 58:24,
94:18, 117:7,
131:9, 136:5,
172:25, 203:7
assistance [1] 58:12
assistant [14] 58:20, 58:22,
58:25, 59:2,
150:15, 150:18,
150:20, 150:24,
150:29, 151:4,
151:7, 151:9,
151:10, 172:1
assisted [3] 43:20, 59:4,
134:20
assisting [2] 10:26, 91:14
associate [1] 173:15
Associate [1] 5:8
associated [1] 12:11
association [1] 12:10
assume [1] 138:24
assumed [2] 146:28, 147:1
assuming [1] 30:25
assurance [1] 176:26
assured [6] 20:8, 31:25,
31:26, 35:4, 75:8,
75:19
AT [2] - 1:16,
215:21
atresia [1] 23:16
attached [1] 66:6
attack [1] 54:11
attempt [4] 10:2, 19:2,
109:17, 164:17
attempted [3] 34:1, 66:28,
67:14
attempts [3] 66:17, 67:15,
175:2
attend [4] - 8:14,
23:27, 152:12,
152:18
attendance [3] 16:2, 16:4, 67:7
attended [7] 8:5, 8:10, 8:12,
24:25, 70:26,
152:6, 165:2
attending [1] 153:12
attention [1] 103:24
attitude [1] 122:15
attractive [1] 60:23
attributing [1] 12:1
au [1] - 211:10
audit [1] - 23:24
augment [1] 40:19
Augmentin [1] 18:11
August [3] 16:5, 40:8, 77:12
authored [1] 8:4
authoritarian [1]
- 55:15
authority [3] 32:3, 101:8,
101:17
authors [1] 182:20
auto [3] - 95:27,
122:23, 125:13
auto-start [1] 95:27
automatic [3] 198:5, 210:1,
210:28
automatically
[1] - 213:11
availability [3] 25:26, 78:1,
152:6
available [35] 19:14, 19:16,
19:17, 20:9,
20:12, 21:22,
21:26, 22:1, 26:8,
32:23, 32:26,
32:28, 33:12,
35:24, 37:2,
37:22, 38:22,
39:4, 58:14,
68:11, 72:25,
73:19, 89:14,
89:19, 110:9,
137:28, 146:25,
177:5, 185:10,
188:17, 188:22,
188:24, 191:25,
206:17, 213:9
average [1] - 9:3
aviation [1] 165:15
avoided [1] 150:4
aware [34] 17:16, 33:25,
59:11, 68:28,
88:22, 97:24,
98:14, 104:12,
113:12, 126:1,
128:19, 128:21,
140:3, 144:17,
144:19, 148:29,
149:2, 149:6,
150:20, 151:18,
152:21, 162:18,
162:21, 168:9,
175:12, 180:5,
180:6, 184:22,
192:11, 192:13,
197:7, 198:12,
206:20, 208:14
awareness [1] 149:11
awful [1] 208:27
awoken [1] 42:7
24:12, 82:11
balanced [1] 55:5
bank [3] - 57:19,
151:20, 151:22
barely [1] 22:20
Barrington [16] 4:7, 84:17, 160:9,
170:24, 177:22,
178:28, 181:7,
181:12, 182:8,
185:14, 186:22,
194:8, 199:10,
201:16, 214:16
BARRINGTON
[80] - 2:18, 3:6,
3:9, 3:11, 3:14,
3:17, 4:9, 4:16,
4:20, 4:25, 4:27,
11:11, 11:16,
11:21, 34:27,
41:2, 48:8, 48:28,
49:10, 54:28,
62:23, 62:28,
65:11, 65:21,
76:20, 79:25,
155:13, 155:22,
170:25, 171:1,
179:2, 179:4,
180:16, 180:18,
181:3, 181:14,
182:2, 182:5,
182:13, 182:18,
182:29, 183:28,
184:17, 184:25,
185:18, 185:28,
186:1, 186:13,
186:23, 187:2,
187:9, 187:11,
187:18, 189:19,
189:23, 189:29,
190:3, 190:5,
190:14, 192:25,
193:2, 194:4,
194:15, 194:29,
195:7, 195:23,
195:28, 196:2,
196:4, 196:12,
198:12, 198:20,
198:27, 199:17,
200:12, 201:20,
205:5, 205:10,
211:21, 214:19
barrister [1] 125:24
based [7] - 7:26,
19:12, 31:6,
148:12, 173:22,
206:16, 206:19
B
background [1]
- 69:6
backlog [1] 69:22
backtracking [1]
- 97:8
bacteria [1] 12:8
bad [2] - 204:6,
204:9
Badrul [1] 143:27
baggy [4] 64:17, 64:18,
164:6, 164:26
balance [2] -
basic [2] 172:28, 196:17
basis [14] - 24:9,
33:21, 54:11,
55:10, 60:18,
89:4, 117:15,
125:4, 136:12,
148:24, 161:6,
163:28, 182:5,
199:28
bear [3] - 85:24,
114:11, 116:26
beat [1] - 142:21
Beata [1] 151:18
Beaumont [2] 66:18, 67:7
became [7] 15:5, 17:6, 17:14,
89:18, 119:19,
155:6, 191:15
become [10] 13:23, 15:19,
16:26, 16:27,
24:14, 96:17,
119:17, 139:19,
164:23, 170:8
becomes [2] 37:2, 101:16
becoming [1] 142:13
bedside [1] 191:21
BEEN [4] - 4:24,
187:8, 190:2,
196:1
beforehand [4] 119:3, 141:1,
155:25, 159:22
beg [1] - 122:18
began [3] 97:25, 128:22,
146:18
begin [1] 183:23
beginning [3] 131:4, 150:15,
178:14
begins [1] 74:28
behalf [6] 108:16, 116:23,
128:6, 187:26,
190:7, 209:20
behaviour [2] 77:10, 166:17
behest [1] 123:18
behind [5] 68:22, 179:24,
4
Gwen Malone Stenography Services Ltd.
180:19, 182:29,
209:13
beings [1] 212:2
belief [3] - 52:9,
52:11, 82:19
below [4] 24:19, 61:13,
83:13, 147:14
beside [2] 64:3, 105:17
best [11] - 25:25,
33:11, 35:2,
51:22, 54:12,
58:27, 67:12,
103:11, 140:6,
174:23, 204:4
better [12] 34:13, 61:3,
79:20, 85:17,
96:19, 96:21,
104:19, 175:10,
178:9, 178:11,
178:15, 212:17
between [36] 22:7, 25:15,
25:19, 36:23,
41:6, 41:14,
45:29, 48:29,
53:5, 53:12,
54:16, 85:10,
85:26, 89:5, 94:4,
94:17, 96:3,
100:28, 103:13,
104:14, 106:1,
106:4, 111:28,
117:6, 128:24,
129:7, 131:7,
131:12, 134:5,
135:7, 154:17,
154:21, 182:23,
197:5, 204:1
beyond [5] 67:2, 83:10,
83:19, 90:21,
114:22
bifida [1] - 10:15
big [1] - 166:6
bigger [1] 11:18
birth [1] - 41:5
bit [14] - 16:14,
20:3, 50:6, 55:15,
121:2, 140:23,
140:25, 141:6,
147:15, 153:29,
174:5, 183:20,
213:11, 214:23
bizarre [1] 106:22
BL [3] - 2:11,
2:18, 2:22
bladder [9] 12:7, 19:3, 19:4,
19:6, 70:17,
70:18, 70:19,
70:21, 71:4
blame [15] 68:8, 82:4, 84:22,
84:25, 84:26,
85:12, 85:19,
86:18, 88:14,
178:16, 178:18,
178:20, 203:14,
203:29
blamed [1] 84:29
blaming [1] 68:16
bleeding [2] 63:26, 64:8
blood [33] 56:12, 56:14,
56:16, 56:19,
56:21, 56:22,
56:24, 56:26,
57:1, 57:2, 57:3,
57:19, 57:21,
64:5, 65:13,
66:13, 67:1,
108:29, 151:17,
151:20, 151:22,
151:24, 152:1,
152:2, 152:7,
152:10, 152:11,
152:13, 152:16,
176:16, 176:18,
212:8
bloods [1] 56:10
board [1] - 23:27
Board [5] 23:27, 39:20,
69:14, 159:9,
191:13
body [3] - 13:10,
60:26, 172:12
book [6] - 17:23,
18:3, 177:1,
179:24, 183:1,
190:8
Book [1] - 11:4
booked [6] 10:21, 29:4,
30:18, 89:29,
90:2, 90:12
booking [3] 33:3, 83:8, 89:12
Booklet [1] 119:29
booklet [12] 11:14, 14:28,
17:13, 25:4, 62:4,
68:22, 81:1, 81:3,
84:12, 87:13,
92:8, 186:26
booklets [5] 11:7, 11:18,
11:19, 12:27,
16:1
bore [1] - 189:4
born [1] - 15:12
bottle [1] - 64:5
bottom [6] 16:4, 92:8, 92:13,
92:18, 94:13,
116:29
bowel [3] 14:24, 15:10,
16:13
box [8] - 50:16,
50:23, 50:27,
50:28, 51:7, 51:8,
64:26
boxes [2] 183:14, 183:15
brain [2] 170:29, 174:27
brakes [3] 29:14, 106:25
break [8] - 80:7,
80:9, 80:11,
80:14, 107:7,
107:10, 153:5,
170:20
breath [1] 168:18
Breathnach [6] 189:29, 190:6,
190:10, 190:14,
192:17, 194:1
BREATHNACH
[5] - 3:13, 190:2,
193:1, 193:4,
193:26
brief [5] 132:27, 132:29,
170:26, 185:20,
186:1
briefing [1] 98:2
briefly [6] - 8:18,
66:26, 68:20,
73:7, 93:25,
177:15
bring [3] - 55:29,
103:23, 133:25
bringing [1] 22:28
brings [1] -
70:25
brought [11] 29:27, 45:3, 45:5,
52:6, 52:17, 63:7,
71:22, 97:14,
123:23, 128:13,
162:7
Broviac [1] 98:22
building [1] 203:15
BUILDING [1] 2:15
built [1] - 208:27
Burke [1] - 43:19
BURKE [1] 2:22
bush [1] 142:21
busy [17] 22:18, 22:25,
23:1, 23:6, 23:28,
24:13, 24:14,
88:20, 95:21,
97:1, 106:3,
131:29, 135:28,
152:27, 153:4,
188:10, 188:13
but...(
INTERJECTION
[1] - 195:17
button [1] 125:13
BY [25] - 2:12,
2:19, 2:24, 4:25,
80:24, 107:2,
108:13, 171:13,
177:10, 177:12,
179:1, 187:9,
189:23, 190:3,
193:1, 193:4,
193:26, 196:2,
205:9, 205:12,
207:15, 207:17,
211:19, 211:25,
214:12
46:1, 46:2, 71:7,
75:2, 77:2, 85:7,
86:9, 86:14, 90:3,
95:6, 96:5,
126:10, 127:28,
129:20, 132:3,
132:8, 134:4,
134:19, 134:23,
135:6, 138:2,
141:4, 141:9,
145:24, 156:2,
158:22, 184:13,
184:14, 203:13,
213:24
canvassed [1] 76:23
capability [1] 46:15
CAPEL [1] - 2:15
captain [5] 202:23, 203:11,
212:3, 212:4
cardiac [1] 7:29
cardiologist [3]
- 187:20, 187:24,
188:15
Care [1] - 8:9
care [19] - 57:6,
57:13, 59:14,
79:10, 79:21,
86:8, 138:10,
138:14, 139:17,
139:25, 144:7,
144:8, 144:11,
145:2, 155:29,
190:28, 191:12,
192:23
career [2] - 29:2,
193:23
careful [1] 193:16
carers [1] 78:15
caring [3] 192:3, 192:5,
193:11
carried [5] 18:24, 19:10,
84:19, 100:13,
148:4
carry [1] 142:28
cascade [1] 33:25
case [88] - 11:3,
16:18, 17:21,
20:10, 21:15,
23:9, 23:11,
23:12, 23:20,
C
cage [1] - 60:28
Cambodia [1] 192:21
Cancer [2] - 6:8,
6:10
cancer [3] 6:12, 190:29,
192:24
cannot [32] 43:25, 45:25,
26:7, 27:9, 30:12,
33:6, 38:8, 43:24,
43:29, 44:24,
45:12, 45:14,
49:15, 49:27,
49:29, 50:2, 50:3,
52:1, 52:10,
53:13, 53:28,
57:5, 57:17,
60:14, 70:23,
71:29, 76:3, 81:8,
81:9, 90:19,
91:26, 92:22,
94:20, 94:22,
95:10, 95:13,
96:20, 101:13,
102:10, 103:4,
103:19, 117:9,
117:11, 118:29,
119:15, 122:13,
123:22, 124:3,
125:26, 134:16,
134:23, 134:24,
134:25, 136:23,
138:25, 143:6,
144:26, 153:18,
156:12, 158:1,
164:28, 166:28,
178:10, 179:20,
180:23, 181:15,
186:23, 188:26,
198:1, 201:29,
202:20, 202:22,
205:17, 206:17,
208:12, 208:15,
208:29, 209:10,
210:8, 212:9
cases [11] 25:24, 38:7,
72:17, 72:18,
99:12, 106:1,
154:17, 154:21,
208:23, 208:28
catastrophic [2]
- 204:19, 214:3
catch [4] 60:25, 65:8, 99:8,
105:28
catheter [1] 41:26
catheterise [5] 48:17, 140:24,
141:7, 141:15,
145:9
catheterised [2]
- 126:13, 209:24
catheterising [1]
- 60:9
caught [2] 52:14, 213:24
5
Gwen Malone Stenography Services Ltd.
caused [2] 75:28, 164:27
cava [1] - 56:28
caveat [1] 101:7
censure [1] 158:5
central [3] 112:4, 133:2,
133:4
Centre [2] - 6:8,
6:10
centre [2] - 6:9,
24:16
centres [2] 83:21, 83:22
CEO [7] - 2:11,
83:2, 116:23,
120:14, 123:23,
198:15, 203:2
CEO's [3] 117:22, 180:28,
181:5
certain [8] 27:14, 36:16,
46:26, 91:21,
103:8, 106:9,
173:1, 173:8
certainly [23] 28:13, 31:9, 54:9,
54:14, 94:28,
96:17, 97:3,
99:23, 119:19,
140:28, 141:1,
162:11, 167:24,
169:2, 169:13,
170:4, 175:13,
176:20, 176:21,
186:6, 188:12,
192:10, 193:10
certify [1] - 1:27
cetera [1] - 82:6
chairman [1] 34:24
Chairman [8] 4:9, 4:17, 108:9,
171:1, 179:4,
185:18, 186:25,
187:2
CHAIRMAN [53]
- 2:4, 4:4, 4:10,
4:18, 11:9, 11:15,
11:20, 40:29,
65:20, 76:17,
80:6, 80:13,
80:21, 84:5,
107:5, 107:11,
108:4, 120:16,
132:25, 133:4,
133:15, 153:6,
170:18, 170:27,
171:9, 171:16,
174:3, 177:6,
178:28, 183:19,
183:26, 184:11,
185:3, 185:14,
185:21, 185:24,
185:29, 186:9,
186:20, 186:28,
187:16, 189:25,
190:12, 193:29,
196:11, 211:27,
214:9, 214:16,
214:20, 215:1,
215:5, 215:10,
215:16
challenging [1] 100:21
chance [2] 29:7, 29:8
chances [1] 20:17
change [2] 117:28, 207:6
changed [5] 26:4, 61:27,
61:28, 175:21,
199:28
channel [1] 15:16
character [1] 186:3
charge [13] 36:8, 41:8, 41:9,
41:11, 42:23,
43:2, 43:6, 44:20,
44:22, 103:26,
122:26, 169:17,
204:17
charge/
surgeon [2] 41:5, 41:7
chart [44] - 11:8,
12:16, 12:19,
14:18, 15:28,
19:17, 19:20,
19:21, 19:23,
20:10, 20:12,
20:23, 21:14,
21:19, 21:21,
21:27, 22:1, 25:7,
26:7, 26:9, 26:17,
27:16, 28:8,
30:27, 41:4,
42:21, 43:1, 43:5,
57:5, 57:9, 59:16,
62:7, 62:16,
63:10, 63:11,
63:13, 64:28,
88:17, 88:19,
89:2, 105:18,
105:29
charts [5] 10:24, 105:17,
105:22, 153:25,
153:27
chase [1] 126:20
check [10] 63:13, 63:25,
104:24, 104:25,
105:10, 148:16,
174:17, 212:11,
212:17, 213:13
checked [11] 62:8, 62:15,
64:13, 82:8, 92:4,
95:29, 104:2,
104:26, 105:8,
109:22
checking [5] 31:9, 105:10,
164:4, 213:14,
213:15
checks [3] 184:3, 202:27,
210:24
cheese [1] 213:28
chemotherapy
[2] - 133:10, 191:8
chest [2] - 23:9
Chief [3] - 39:14,
81:8, 179:20
child [20] 15:25, 22:21,
49:16, 67:25,
70:10, 75:24,
75:25, 75:27,
75:29, 100:12,
160:20, 162:2,
167:4, 173:26,
189:8, 189:12,
203:20, 203:26,
213:5, 214:8
child's [1] 213:3
children [5] 24:19, 76:1,
190:28, 192:22,
192:23
choice [1] 142:1
chose [1] 179:16
Christina [1] 7:25
chronology [2] 93:13, 179:19
circle [4] -
166:4, 174:12,
174:21, 175:10
circulating [1] 58:25
circumcision [4]
- 143:16, 143:29,
144:5, 153:17
circumcisions
[2] - 98:23, 173:2
circumstance
[2] - 91:16, 210:8
circumstances
[16] - 29:9, 30:2,
34:22, 58:6,
58:18, 78:24,
157:3, 157:7,
166:12, 166:18,
194:11, 200:22,
201:3, 201:29,
208:19, 210:12
City [1] - 159:6
clarification [2] 49:11, 49:19
clarified [6] 25:6, 48:2, 63:16,
63:20, 63:21,
155:22
clean [2] - 18:16,
184:23
clear [17] 27:26, 27:28,
32:17, 41:15,
47:29, 48:24,
49:4, 73:29,
102:25, 111:26,
119:12, 146:8,
167:16, 169:7,
170:8, 203:25,
208:6
clearer [1] 49:13
clearly [10] 12:1, 25:13,
28:24, 28:25,
33:7, 76:3,
103:25, 137:29,
143:18, 151:14
clerk [1] - 69:20
clerking [2] 92:24, 93:4
client [1] - 54:17
Clinic [2] 21:16, 22:3
clinic [13] 10:16, 10:19,
10:20, 10:22,
10:26, 15:22,
21:25, 22:21,
23:8, 23:26,
88:20, 92:23
clinical [11] 6:14, 7:13, 76:25,
77:5, 77:27, 83:5,
83:13, 136:3,
157:18, 174:28,
175:14
clinics [1] - 75:3
clock [4] 208:12, 210:1,
210:19
close [4] - 99:24,
105:16, 135:12,
193:13
closed [3] 42:9, 61:12,
134:24
closely [1] 39:23
closure [1] 147:14
coagulation [1]
- 67:2
Code [1] - 85:16
coercion [1] 104:5
colleague [11] 15:14, 55:24,
61:20, 70:16,
70:22, 77:14,
78:12, 86:15,
158:4, 174:16,
193:22
colleagues [23] 7:26, 12:3, 23:13,
24:6, 24:17,
37:28, 40:6,
59:22, 59:23,
67:22, 77:15,
78:9, 78:14,
78:18, 104:14,
149:26, 159:10,
172:5, 178:17,
188:2, 188:5,
188:6, 190:26
collective [1] 172:12
College [14] 5:9, 5:13, 5:21,
7:14, 7:24, 8:8,
9:27, 39:29,
172:29, 173:15,
173:19, 173:27,
174:1, 196:16
colon [4] 16:23, 16:25,
17:5
colostomy [6] 61:10, 61:12,
104:17, 147:14,
147:29
column [5] 41:4, 41:15,
183:11, 183:17,
183:21
columns [1] 183:19
combination [3]
- 143:21, 212:24,
213:27
combined [1] 213:28
comfortable [3]
- 125:14, 198:6,
209:7
coming [5] 22:27, 94:17,
117:6, 143:11,
208:21
commence [3] 202:21, 211:12,
214:27
commenced [4]
- 59:5, 111:19,
112:24, 196:18
commencemen
t [12] - 47:21,
47:23, 51:23,
62:9, 111:8,
111:12, 112:6,
112:17, 113:8,
114:3, 197:19,
208:16
commences [2]
- 157:16, 211:5
commencing [4]
- 11:13, 52:21,
148:17, 157:9
commended [1]
- 6:22
comment [14] 18:28, 61:19,
78:24, 94:12,
95:6, 127:28,
130:12, 134:4,
141:4, 141:9,
156:2, 156:19,
166:9, 166:14
comments [2] 84:10, 101:20
commission [1]
- 124:14
commitment
[16] - 7:10, 9:11,
9:20, 10:11,
10:18, 24:4,
35:22, 74:20,
78:5, 95:22,
131:26, 135:9,
154:15, 172:28,
173:18, 191:28
6
Gwen Malone Stenography Services Ltd.
commitments
- 9:5, 22:13,
23:7, 36:12,
74:13, 135:29,
173:18
COMMITTEE [8]
- 1:3, 2:4, 3:8,
3:18, 171:13,
177:10, 211:25,
214:12
Committee [82] 4:11, 4:29, 5:2,
5:5, 5:17, 6:8,
7:7, 8:17, 10:11,
11:3, 11:6, 11:28,
12:28, 14:17,
15:9, 17:10, 18:5,
18:25, 19:13,
22:13, 25:19,
30:1, 33:19,
33:20, 52:3,
53:28, 60:5,
63:29, 65:16,
66:26, 68:2,
76:13, 76:21,
81:10, 83:16,
85:1, 86:23,
87:18, 89:8,
91:12, 97:13,
101:2, 103:29,
113:10, 120:13,
131:17, 132:27,
156:22, 170:22,
171:11, 171:18,
173:5, 180:9,
180:11, 183:5,
183:9, 183:18,
184:11, 184:20,
184:26, 185:7,
186:27, 187:13,
188:4, 188:8,
189:21, 190:8,
190:9, 191:18,
192:26, 194:14,
195:21, 196:6,
198:29, 199:12,
199:15, 200:20,
200:29, 203:7,
209:8, 211:21,
214:28
common [5] 20:11, 73:7,
91:13, 135:9,
135:15
communicate
[1] - 31:10
communicated
[1] - 34:7
communicatin
g [3] - 31:28,
[7]
207:10, 213:16
communicatio
n [3] - 78:14,
78:15, 95:8
comparison [1]
- 99:17
compassion [1]
- 78:19
competence [5]
- 94:21, 117:10,
167:5, 200:29,
204:10
competency [1]
- 106:10
competent [7] 10:27, 71:25,
72:1, 75:11,
125:23, 125:24,
160:7
complaint [5] 179:20, 179:25,
180:13, 180:28,
181:5
complaints [1] 192:16
complement [1]
- 74:15
complementar
y [1] - 39:16
complete [3] 80:5, 144:15,
170:11
completed [2] 157:18, 205:27
completely [11] 31:25, 46:28,
82:29, 87:9,
94:22, 95:2,
103:16, 105:27,
117:10, 162:29,
178:12
completing [2] 132:23, 133:18
complex [4] 7:28, 77:27,
100:9, 200:20
complexity [1] 7:27
compliant [2] 74:26, 176:23
complicated [4]
- 85:4, 93:24,
200:23, 201:27
complication [1]
- 176:4
complications
[2] - 67:10, 72:6
components [1]
- 65:24
composite [1] -
96:10
computer [9] 22:6, 22:7, 26:13,
26:14, 26:18,
31:6, 31:8, 44:25,
72:9
computerised
[1] - 20:14
concentration
[1] - 170:21
concept [6] 64:24, 74:26,
166:13, 198:3,
209:1, 210:18
concepts [1] 210:15
concern [14] 30:22, 34:7,
34:16, 34:19,
35:5, 46:21,
51:17, 64:18,
94:10, 111:27,
111:29, 115:2,
161:15, 166:20
concerned [8] 55:25, 112:22,
113:19, 124:28,
148:3, 155:7,
186:7, 189:12
concerning [3] 110:19, 125:17,
162:19
concerns [21] 29:16, 29:17,
31:16, 33:13,
34:5, 34:20,
34:21, 35:1, 35:3,
60:3, 72:8, 94:5,
110:19, 110:23,
110:29, 111:7,
111:14, 111:25,
154:20, 161:8,
162:17
concluded [1] 44:5
conclusion [4] 131:18, 135:2,
135:17, 186:18
conclusions [1]
- 123:29
concur [1] - 95:9
condition [3] 23:20, 79:21,
164:28
conduct [3] 47:14, 60:1,
179:15
conducted [4] 32:6, 42:20,
76:16, 77:4
conducting [1] 33:8
conductor [1] 191:10
conduit [1] 15:16
cone [1] - 16:24
conference [4] 12:23, 14:11,
14:12, 14:13
confidence [4] 46:16, 46:17,
79:12, 105:26
confined [3] 194:22, 194:25,
197:8
confirm [8] 18:21, 33:5,
34:14, 35:10,
50:12, 101:18,
198:25
confirmed [1] 12:3
confirmed...(
inaudible [1] 67:3
confirming [1] 146:15
confirms [1] 184:3
confused [3] 89:3, 198:3,
207:20
confusing [1] 11:17
confusion [1] 184:21
congenital [4] 16:18, 18:20,
23:16, 61:11
connection [2] 23:18, 162:10
conroy [1] - 45:3
Conroy [18] 11:3, 13:24,
14:23, 14:26,
16:5, 17:14,
17:19, 19:7,
29:25, 29:29,
30:21, 32:19,
44:19, 45:4, 85:3,
106:19, 179:7,
197:13
Conroy's [5] 22:11, 24:25,
24:27, 66:25,
81:18
conscientious
[4] - 39:25, 77:29,
144:24, 193:16
conscientious
ness [1] - 159:12
conscious [3] 33:7, 51:20,
60:20
consciousness
[2] - 62:8, 62:18
consent [31] 30:23, 31:24,
50:9, 62:7, 62:16,
63:9, 71:24,
71:27, 71:29,
72:1, 72:3, 72:6,
72:13, 72:14,
72:19, 72:21,
75:9, 75:11, 82:9,
92:10, 92:24,
93:5, 105:8,
105:11, 145:16,
148:29, 163:15,
164:1, 164:3,
212:7
consenting [1] 31:15
consider [7] 18:16, 51:18,
89:24, 96:18,
130:7, 139:11,
195:17
considerable [2]
- 110:18, 190:21
considerably [1]
- 17:7
considerate [3] 78:16, 78:18,
79:2
consideration
[1] - 185:7
considered [12]
- 4:11, 18:14,
18:18, 28:16,
38:24, 63:1,
100:10, 101:27,
118:18, 121:25,
147:18, 202:1
considering [3]
- 16:29, 29:4,
53:8
considers [1] 202:15
consisted [1] 179:25
consistently [1]
- 9:22
constellation [1]
- 106:22
constitutes [1] 110:3
constrained [1]
- 157:14
constraints [2] 88:20, 122:6
constructed [2]
- 118:3, 118:8
construction [1]
- 203:15
consult [1] 21:29
consultant [39] 35:27, 36:1, 36:2,
36:6, 36:7, 36:22,
40:14, 41:8,
46:14, 70:3,
84:15, 85:6,
85:22, 86:6,
94:16, 94:20,
99:25, 101:29,
103:11, 105:24,
106:7, 106:8,
117:5, 117:8,
135:29, 169:5,
169:16, 172:18,
184:2, 187:19,
187:24, 188:22,
197:6, 202:29,
203:8, 203:9,
203:16, 204:17,
204:25
Consultant [9] 5:6, 10:4, 13:22,
13:25, 26:1,
32:12, 128:23,
190:15, 196:7
consultant's [1]
- 203:21
consultant.. [1]
- 98:4
consultants [7] 9:24, 40:13,
73:24, 154:9,
188:26, 189:9
consultation [3]
- 67:21, 79:20,
157:18
consulted [8] 64:19, 78:2,
78:28, 79:1,
108:29, 109:5,
109:9, 163:27
consulting [1] 22:8
contact [8] 8:20, 32:4, 58:23,
94:1, 94:2, 94:4,
111:28, 193:12
contacted [1] 174:15
contamination
[1] - 18:17
contemplate [1]
7
Gwen Malone Stenography Services Ltd.
- 96:20
contemporane
ous [1] - 160:28
content [2] 25:22, 72:5
contents [1] 27:8
context [13] 51:16, 51:29,
88:17, 91:23,
100:5, 100:19,
101:17, 121:6,
139:12, 156:11,
161:15, 167:9,
182:11
continence [3] 15:19, 15:24,
17:2
continent [5] 15:21, 16:26,
16:27, 16:28,
17:6
continuation [4]
- 165:8, 165:14,
165:22, 166:13
continue [5] 18:29, 71:27,
73:17, 191:29,
196:20
continued [1] 191:19
continues [2] 69:12, 78:12
contrary [2] 133:29, 165:24
contribute [1] 154:12
contributed [2] 69:7, 70:18
contributing [2]
- 18:17, 65:3
contribution [1]
- 78:8
contributions
[1] - 78:21
contributory [9]
- 68:19, 68:24,
68:29, 69:1, 69:9,
69:28, 71:9,
71:24, 72:20
control [7] 64:8, 85:9,
113:25, 202:19,
202:20, 208:11,
208:14
controller [2] 166:2, 166:4
controls [1] 202:24
conversation
- 45:10,
45:11, 45:17,
45:22, 47:13,
47:17, 47:27,
48:12, 48:20,
49:6, 60:4, 60:6,
60:7, 61:17,
61:26, 66:19,
67:17, 67:29,
114:2, 118:22,
123:5, 126:11,
126:12, 126:18,
129:6, 129:9,
129:10, 129:13,
129:24, 129:26,
130:24, 130:25,
135:2, 135:23,
138:7, 150:6,
150:11, 150:13,
167:19, 182:23,
204:12, 204:15,
206:27, 207:9
conversations
[7] - 47:10, 47:12,
59:29, 126:3,
160:19, 163:19,
207:4
conversing [1] 52:13
conveyed [1] 119:5
convinced [2] 104:27, 163:25
Coombe [2] 13:26, 13:29
coombe [1] 13:28
Cooney [3] 36:13, 37:9,
101:28
cope [1] - 69:22
copies [2] 20:17, 184:20
copy [13] - 4:29,
5:2, 19:18, 19:19,
69:10, 69:11,
80:28, 81:25,
120:14, 120:20,
184:23, 184:25,
196:5
COPYRIGHT [1]
- 2:25
CORBALLY [10]
- 1:9, 2:18, 3:5,
4:24, 80:24,
107:2, 108:12,
171:13, 177:12,
179:1
Corbally [56] 4:22, 14:28,
[44]
34:29, 54:2,
57:10, 65:18,
84:4, 91:4, 99:19,
103:25, 108:15,
115:5, 115:21,
124:3, 150:5,
170:19, 174:5,
180:21, 181:16,
182:3, 182:19,
183:10, 185:22,
187:27, 188:1,
188:9, 189:13,
190:7, 190:20,
191:15, 192:20,
193:14, 196:27,
196:28, 197:9,
197:12, 197:29,
200:17, 201:24,
203:1, 204:12,
204:13, 204:16,
204:22, 206:10,
206:21, 206:23,
207:1, 207:4,
207:10, 207:23,
207:24, 207:27,
208:1, 208:2,
209:22
corbally [2] 131:15, 197:10
Corbally's [5] 124:11, 124:20,
188:4, 190:25,
206:14
Corbally...(
INTERJECTION
[1] - 198:16
cordial [1] 192:2
Core [1] - 119:28
core [10] - 63:15,
68:22, 81:1, 81:2,
84:11, 92:7,
111:17, 161:21,
179:24, 183:1
Cork [1] - 5:24
corner [2] 92:13, 92:18
correct [155] 5:22, 5:25, 5:28,
6:2, 6:4, 6:19,
6:27, 7:2, 7:20,
12:17, 12:18,
13:6, 13:13,
13:20, 14:2, 14:5,
14:15, 14:16,
14:22, 14:25,
15:1, 15:3, 15:8,
17:23, 17:24,
18:27, 18:28,
22:7, 25:5, 26:3,
26:21, 27:6,
30:15, 33:5,
34:15, 35:4, 35:7,
35:13, 35:18,
36:9, 37:12,
37:27, 38:14,
40:6, 40:7, 42:26,
43:12, 43:22,
45:9, 47:3, 47:4,
47:6, 47:15,
47:16, 47:19,
50:12, 50:26,
52:18, 52:19,
57:16, 62:17,
66:14, 66:21,
69:5, 71:16,
72:26, 72:27,
73:9, 74:14,
76:11, 76:14,
82:2, 82:14,
82:29, 83:18,
84:16, 84:23,
86:25, 86:26,
87:2, 87:23,
87:27, 88:4,
89:10, 93:16,
101:19, 103:22,
109:2, 109:4,
109:6, 109:11,
109:24, 109:28,
111:10, 111:15,
111:19, 112:6,
112:7, 112:18,
112:24, 115:13,
115:25, 116:1,
116:13, 116:14,
116:16, 116:17,
125:19, 125:22,
126:5, 127:11,
127:13, 129:8,
129:11, 130:17,
130:23, 130:28,
134:11, 135:19,
136:8, 145:13,
145:19, 146:28,
147:24, 148:5,
148:14, 150:17,
150:27, 153:9,
160:9, 162:4,
163:7, 163:9,
163:11, 163:13,
165:5, 165:21,
168:8, 168:23,
168:24, 174:22,
179:23, 179:29,
180:20, 180:26,
181:5, 181:18,
181:22, 181:26,
182:21, 182:22,
193:17, 194:8,
194:16, 207:23
corrected [2] 69:3, 181:11
correctly [7] 21:17, 22:4, 33:7,
71:3, 87:5, 87:21,
209:29
corridor [1] 22:24
cosmetic [1] 104:21
cosmetically [1]
- 60:23
costs [1] - 75:4
couch [1] 22:19
coughing [2] 15:23, 67:4
COUNCIL [1] 1:2
Council [19] 39:8, 76:23,
76:26, 77:3,
84:11, 119:20,
119:22, 121:12,
142:27, 146:19,
159:4, 166:10,
166:22, 172:13,
175:18, 175:22,
179:13, 179:21,
179:26
Council's [1] 85:16
counsel [2] 148:15, 200:3
countdown [1] 208:15
country [6] 36:11, 37:13,
96:24, 176:21,
176:23, 196:19
couple [2] 174:3, 209:1
course [39] 5:5, 5:18, 8:5,
8:8, 21:2, 30:12,
35:11, 44:29,
59:6, 67:29, 68:9,
73:1, 87:20,
93:23, 93:26,
94:7, 116:8,
116:15, 116:27,
118:14, 119:21,
123:2, 128:11,
129:9, 135:11,
136:5, 145:14,
152:4, 154:28,
154:29, 156:25,
158:24, 162:2,
165:6, 169:7,
178:22, 193:15,
199:24, 211:3
Course [1] 8:14
course...(
INTERJECTION
[1] - 140:8
courses [2] 8:5, 8:10
cover [4] 38:16, 38:29,
72:23, 174:25
crashed [2] 166:1, 166:5
crashes [1] 165:16
create [2] 15:15, 61:8
crisis [1] - 75:18
critical [3] 31:27, 73:16,
78:4
critically [2] 35:23, 53:22
criticise [4] 115:21, 116:3,
116:8, 158:5
criticised [3] 182:3, 182:10,
204:12
criticism [4] 56:1, 63:10,
68:27, 92:6
CROSS [49] 2:8, 3:7, 3:7, 3:8,
3:14, 3:17, 3:18,
48:29, 49:5,
53:25, 54:7,
54:13, 54:21,
54:26, 80:24,
107:2, 108:12,
119:27, 120:8,
156:26, 170:16,
177:12, 178:26,
180:11, 180:15,
180:17, 181:6,
181:12, 182:8,
182:17, 184:10,
184:14, 185:13,
193:4, 193:26,
194:26, 195:12,
195:14, 195:27,
198:22, 199:8,
200:2, 200:11,
200:27, 201:9,
205:12, 207:15,
207:17, 211:19
cross [30] - 31:9,
37:1, 38:16,
38:29, 43:19,
49:2, 56:4, 56:18,
8
Gwen Malone Stenography Services Ltd.
56:20, 56:26,
57:2, 57:22,
57:25, 59:9,
72:23, 80:5,
108:7, 127:17,
151:11, 151:23,
152:7, 152:8,
152:14, 176:16,
180:8, 197:28,
199:24, 199:29,
201:25, 215:8
crosschecking [1] 31:9
cross-cover [1]
- 72:23
CROSSEXAMINATION
[6] - 107:2,
170:16, 178:26,
193:26, 207:15,
211:19
crossexamination [8] 56:4, 59:9, 80:5,
197:28, 199:24,
199:29, 201:25,
215:8
cross-examine
[1] - 108:7
CROSSEXAMINED [6] 80:24, 108:12,
177:12, 193:4,
205:12, 207:17
crossexamining [1] 43:19
cross-match [8]
- 56:20, 56:26,
57:2, 57:25,
151:23, 152:8,
152:14, 176:16
cross-matched
[1] - 152:7
crossmatching [3] 56:18, 57:22,
151:11
cross-over [1] 180:8
crossing [1] 101:10
crucial [17] 88:24, 110:29,
112:29, 113:3,
113:5, 114:15,
115:7, 115:26,
121:2, 121:4,
121:13, 121:16,
121:28, 122:2,
124:26, 124:27,
155:6
crucially [1] 176:29
crudely [1] 48:4
Crumlin [54] 5:7, 5:10, 6:3,
7:1, 7:5, 7:8, 7:9,
8:15, 9:15, 13:25,
13:28, 13:29,
22:8, 24:21,
25:27, 30:4, 32:1,
35:26, 36:10,
36:11, 36:24,
36:26, 37:28,
40:17, 57:27,
71:28, 73:18,
74:17, 83:12,
95:19, 96:23,
103:12, 105:24,
140:3, 140:20,
142:28, 152:26,
158:2, 159:11,
176:24, 179:21,
187:22, 188:10,
189:11, 190:16,
192:19, 194:19,
194:21, 194:28,
195:2, 196:25,
196:26, 197:15,
197:18
cuff [2] - 133:11,
133:12
Cullinane [1] 136:7
culminated [1] 106:22
current [1] 200:9
custom [1] 124:5
cut [2] - 126:20,
184:16
CV [8] - 4:29,
5:3, 5:20, 7:19,
8:4, 76:13, 196:6,
196:14
D
daily [1] - 77:6
damage [2] 12:9, 18:22
dangerous [1] 93:20
data [2] - 44:25,
212:27
date [12] - 29:27,
41:5, 51:14, 77:2,
78:6, 89:9, 90:1,
150:1, 178:9,
183:16, 205:23
dated [6] - 15:4,
120:7, 120:24,
124:24, 181:16,
181:19
dates [2] 185:5, 185:7
Davey [5] 33:15, 33:16,
52:4, 160:25,
162:5
DAY [1] - 1:15
day's [1] 205:26
days [12] - 8:23,
8:28, 9:1, 10:8,
17:6, 23:5, 24:2,
24:10, 67:26,
175:7, 208:29,
209:1
deal [22] - 7:18,
10:27, 17:11,
23:15, 24:9, 55:9,
69:14, 117:29,
130:21, 139:4,
140:5, 152:21,
152:29, 153:3,
157:11, 165:6,
169:5, 169:11,
184:19, 204:28,
207:28, 208:1
dealing [17] 6:11, 22:10,
32:29, 55:9,
152:24, 156:23,
158:14, 159:15,
164:6, 191:8,
199:1, 199:11,
199:17, 199:20,
199:25, 212:2
dealings [1] 156:3
deals [5] - 83:1,
180:7, 180:18,
200:8, 207:29
dealt [8] 136:20, 137:2,
155:10, 155:26,
186:4, 186:11,
192:2, 192:3
debate [1] 37:12
December [2] 90:28, 185:8
decide [3] 53:28, 122:11,
123:19
decided [5] 19:26, 20:5,
20:29, 185:11,
204:20
decides [1] 51:29
deciding [1] 125:14
decision [5] 46:28, 101:3,
110:6, 148:12,
174:8
decisions [1] 79:10
dedicated [1] 39:24
defect [1] 115:8
defects [1] 112:4
defence [3] 54:10, 54:12,
54:23
deficiency [1] 179:17
define [1] 111:20
defining [1] 178:6
definite [1] 213:26
definitely [13] 57:1, 79:2, 79:4,
79:5, 79:7, 79:8,
79:11, 79:12,
79:16, 79:18,
79:19, 79:22,
213:1
definitions [1] 36:17
degree [6] 12:8, 31:8, 73:16,
76:16, 76:25,
102:20
Delaney [12] 33:20, 33:21,
33:22, 38:2, 43:9,
43:20, 45:17,
45:23, 46:2, 52:4,
52:12, 101:27
Delaney's [1] 44:29
delay [6] - 69:9,
75:17, 136:10,
137:25, 157:19,
158:16
delayed [2] 139:21, 157:17
delaying [1] 157:29
delegate [24] 10:25, 83:24,
89:28, 90:15,
90:16, 91:28,
97:28, 102:17,
106:7, 124:9,
149:26, 167:1,
201:4, 201:23,
201:28, 202:1,
202:3, 202:5,
202:13, 202:15,
202:17, 208:10,
211:4, 211:8
delegated [24] 37:15, 41:10,
82:15, 95:15,
112:10, 112:22,
115:23, 115:27,
116:11, 118:16,
118:23, 119:2,
122:13, 124:3,
125:9, 129:25,
130:6, 153:3,
167:28, 200:18,
201:13, 209:4,
209:27, 210:2
delegates [1] 78:25
delegating [4] 113:22, 121:29,
200:21, 202:19
delegation [55] 56:7, 61:18,
61:22, 61:25,
83:23, 93:10,
93:18, 101:6,
103:4, 103:8,
106:4, 106:6,
119:13, 121:7,
121:13, 121:15,
121:21, 121:24,
121:27, 123:16,
123:24, 123:25,
123:26, 124:4,
124:9, 124:12,
124:18, 124:25,
124:27, 125:3,
125:17, 134:27,
147:2, 155:8,
171:23, 171:29,
172:7, 173:11,
180:23, 181:25,
198:15, 200:13,
208:5, 208:6,
208:7, 208:9,
208:18, 209:1,
209:9, 209:15
delegee [2] 95:25, 167:5
delegees [1] -
172:9
deleting [1] 82:10
delighted [2] 38:19, 45:15
deliver [5] 7:25, 9:16, 9:21,
24:4, 83:12
delivered [3] 36:2, 36:7, 64:9
demanding [3] 23:3, 23:28,
106:3
demands [1] 23:7
demonstrate [1]
- 62:18
demonstrated
[1] - 70:12
denied [2] 93:7, 99:27
denies [1] 35:11
Department [14]
- 10:10, 15:2,
15:29, 19:8,
19:18, 19:25,
20:5, 20:25, 21:6,
21:16, 21:19,
21:23, 22:14,
24:26
department [8] 74:7, 74:11,
74:12, 75:16,
157:20, 158:18,
162:8, 167:4
dependent [5] 82:26, 125:12,
125:13, 153:21,
194:19
describe [5] 50:28, 86:28,
153:9, 165:7,
175:25
described [6] 35:28, 101:20,
101:21, 101:27,
101:29, 172:2
describing [1] 178:23
description [3] 60:25, 72:6,
132:29
designated [2] 36:19, 56:21
desirable [2] 98:7, 186:19
desire [1] 76:10
desk [2] - 22:20,
9
Gwen Malone Stenography Services Ltd.
84:2
despite [1] 165:24
detail [13] 22:10, 22:11,
29:19, 43:17,
43:25, 85:14,
97:23, 133:23,
149:27, 166:14,
169:10, 169:12,
207:26
detailed [5] 85:18, 87:24,
182:20, 187:26,
206:18
details [6] 36:16, 43:24,
68:9, 206:28,
207:1, 207:7
determine [1] 152:18
determines [1] 114:24
determining [1]
- 191:6
detract [1] 144:22
detriment [2] 191:26, 191:27
devalue [2] 110:28, 111:2
devaluing [1] 111:5
devascularised
[2] - 65:5, 65:14
devastated [3] 67:18, 75:23,
76:4
devastating [1] 76:9
develop [3] 54:25, 54:27,
169:11
development [1]
- 17:1
deviate [1] 165:24
devising [1] 171:27
diagnosis [3] 14:4, 14:8, 191:6
diagnostic [1] 77:24
diagram [1] 65:22
dictated [2] 105:17, 163:16
dictates [2] 51:24, 51:25
dictating [1] -
105:22
dictation [3] 59:17, 105:16,
153:28
dictatorial [2] 55:13, 55:15
didactic [1] 173:22
differed [1] 194:10
difference [4] 25:19, 41:6,
54:16, 103:13
different [21] 13:15, 38:21,
50:24, 98:29,
100:8, 103:17,
105:1, 183:20,
191:3, 191:4,
191:12, 195:20,
204:9, 208:25,
210:7, 210:14,
211:7, 214:2
different...(
INTERJECTION)
[1] - 143:7
differential [1] 25:14
differentiate [1]
- 85:25
differently [3] 93:10, 155:11,
155:26
differing [2] 194:11, 194:16
differs [1] 195:4
difficult [25] 30:8, 31:22,
31:27, 60:14,
60:15, 67:11,
73:10, 85:21,
99:1, 99:2, 99:3,
100:5, 100:10,
100:15, 100:21,
100:27, 128:28,
158:18, 158:29,
161:14, 162:20,
183:6, 195:22,
199:13, 204:28
difficult" [1] 157:20
difficulties [2] 55:9, 59:11
difficulty [12] 5:14, 10:1, 19:24,
50:2, 53:20,
59:10, 59:24,
59:25, 98:20,
99:16, 195:16,
199:21
dignity [1] 79:19
dilated [1] 164:10
Dilly [1] - 67:6
diploma [3] 8:8, 76:12,
173:26
DIRECT [8] 3:6, 3:9, 3:11,
3:14, 3:17, 80:1,
193:1, 205:9
direct [7] - 5:16,
87:3, 87:11,
91:12, 156:20,
172:4, 186:7
directevidence [2] 156:20, 186:7
DIRECTEXAMINATION
[2] - 80:1, 193:1
directed [5] 58:4, 58:5,
103:28, 119:8,
149:21
directing [1] 104:15
direction [3] 4:7, 12:6, 104:7
directly [3] 58:22, 168:27,
207:10
DIRECTLY [1] 187:9
DIRECTLYEXAMINED [1] 187:9
Director [1] 32:1
disagree [5] 81:9, 89:22,
100:18, 150:9,
150:14
disagreeing [6] 126:9, 126:19,
126:20, 126:23,
157:29, 210:17
disastrous [1] 204:26
disciplinary [7] 12:23, 70:2, 70:6,
70:26, 78:22,
189:17, 191:12
disciplines [1] 188:16
discovered [1] 38:18
discreetly [1] -
63:25
discrepancy [1]
- 164:23
discrete [5] 17:12, 71:5,
85:11, 88:28,
199:18
discuss [12] 19:11, 34:16,
53:15, 98:14,
109:25, 123:6,
129:28, 134:27,
157:8, 168:18,
191:13, 208:28
discussed [11] 14:14, 28:1,
39:13, 70:2,
116:24, 162:27,
202:23, 207:22,
207:24, 207:26,
208:29
discussing [2] 19:9, 175:6
discussion [15]
- 61:24, 70:6,
70:22, 70:23,
70:29, 71:2, 71:3,
71:6, 84:18, 90:4,
110:19, 163:17,
174:6, 178:9,
185:5
discussions [1]
- 206:26
disease [1] 33:1
diseased [1] 103:21
dispute [8] 48:18, 48:27,
48:29, 49:23,
100:28, 102:21,
158:10, 162:10
disrespectful [1]
- 142:14
dissension [1] 172:15
distal [2] - 13:3,
23:18
distinct [1] 159:4
distinction [4] 41:13, 41:15,
41:17, 204:1
distinguish [2] 48:4, 85:9
distracted [3] 28:2, 89:5
distractions [1]
- 22:26
distraught [2] -
67:18, 178:3
disturbing [1] 178:3
divide [1] - 66:1
divided [3] 65:14, 65:26,
66:4
division [1] 42:22
DMSA [7] 17:26, 18:21,
65:3, 88:5, 88:11,
88:25, 174:10
doctor [26] 55:7, 79:1, 79:3,
79:4, 79:6, 79:7,
79:12, 79:15,
79:17, 79:18,
98:19, 109:26,
110:4, 116:4,
120:27, 122:13,
134:16, 137:19,
174:2, 174:20,
193:10, 204:7,
211:4, 211:8,
211:29, 212:10
doctors [7] 7:15, 124:14,
152:26, 160:15,
172:18, 192:14
document [7] 128:2, 128:5,
128:7, 128:8,
132:22, 143:24,
183:2
documentation
[3] - 50:7, 52:28,
156:1
documented [1]
- 212:26
done [49] - 6:17,
7:22, 30:28, 34:8,
34:11, 34:13,
36:29, 38:13,
45:28, 49:29,
50:4, 50:5, 50:10,
50:19, 52:22,
52:27, 55:20,
57:15, 58:7, 63:1,
64:17, 71:20,
90:6, 99:23,
100:27, 110:26,
115:9, 138:5,
139:10, 139:24,
143:27, 144:4,
151:26, 160:6,
166:11, 166:12,
166:25, 169:15,
176:12, 177:19,
178:12, 178:19,
186:19, 191:26,
198:19, 199:11,
207:3, 210:28,
214:26
door [4] - 22:22,
64:3, 64:4, 64:10
doting [1] 101:10
double [2] 19:4, 92:3
doubt [5] 37:17, 52:16,
144:4, 148:2,
161:5
doubts [1] 39:25
down [36] 16:14, 20:3, 27:8,
28:14, 33:16,
43:1, 43:5, 45:3,
45:5, 55:25,
57:23, 62:7,
75:24, 75:25,
75:27, 86:29,
87:8, 89:6, 92:2,
97:29, 102:14,
117:21, 123:17,
137:23, 140:15,
143:25, 151:22,
152:2, 167:24,
174:18, 174:27,
175:3, 175:15,
184:1, 212:5,
213:24
DR [5] - 1:9, 2:4,
2:21, 193:26,
214:12
Dr [48] - 11:12,
11:13, 12:28,
13:22, 13:29,
14:3, 14:7, 14:9,
15:6, 17:11,
17:28, 30:2,
30:23, 30:26,
31:2, 31:15,
31:24, 32:6, 32:7,
32:18, 32:20,
32:21, 38:16,
39:14, 39:15,
46:24, 46:28,
53:10, 58:12,
63:9, 63:24,
64:27, 72:2, 72:8,
84:28, 108:17,
112:16, 125:26,
128:22, 151:16,
151:21, 161:1,
192:17, 194:1,
194:4, 208:18,
214:10
10
Gwen Malone Stenography Services Ltd.
dr [1] - 59:4
Dr.White [1] 13:24
drawn [1] 204:1
drugs [1] - 42:15
Dublin [2] - 8:8,
208:24
DUBLIN [2] 1:18, 2:16
due [9] - 15:22,
67:4, 68:9,
124:12, 165:17,
165:21, 169:7,
176:5, 214:1
duly [1] - 178:10
duplicated [1] 21:11
during [14] 32:22, 39:17,
50:27, 57:28,
59:6, 67:28,
105:15, 105:21,
129:9, 131:9,
131:11, 135:10,
135:20, 149:28
DURKAN [2] 2:5, 184:13
duties [4] - 7:7,
7:9, 7:18, 23:3
duty [4] 112:11, 161:12,
162:26, 204:18
dynamic [4] 36:26, 37:5,
61:27, 61:28
E
ear [1] - 5:15
early [2] - 14:13,
90:6
earthly [1] 158:25
ease [1] - 34:12
easily [1] 147:20
Easter [2] 168:7, 169:19
easy [2] 147:17, 161:26
edit [1] - 117:28
education [3] 5:19, 78:8,
106:12
effect [11] 48:19, 60:21,
119:2, 121:18,
124:29, 129:15,
134:17, 146:22,
166:22, 208:18,
209:22
effectively [2] 16:26, 54:2
efficient [5] 61:25, 139:16,
140:1, 152:23,
156:7
efficiently [2] 143:2, 156:8
efforts [1] 192:23
eight [6] - 9:29,
39:21, 104:28,
143:29, 144:5
either [14] 18:22, 49:7,
58:22, 70:24,
72:14, 96:23,
111:29, 113:1,
120:14, 146:27,
150:21, 152:14,
156:21, 195:22
elaborate [3] 25:18, 68:3,
188:3
elective [4] 49:16, 51:26,
157:3, 157:7
electronic [1] 69:11
element [4] 113:3, 113:5,
178:18, 197:24
elements [1] 191:11
elevate [1] 60:11
eleven [3] 12:22, 126:14,
126:15
eligible [1] 40:12
elsewhere [3] 180:23, 195:2,
197:23
emerge [1] 68:9
emergency [3] 9:8, 24:8, 24:13
Emma [3] 36:13, 37:9,
101:28
empathy [1] 78:19
emphasis [1] 188:4
emphasise [1] 87:18
emphasised [1]
- 56:3
empowered [1] 176:14
empty [3] 16:13, 16:25,
19:3
enclosure [1] 104:17
encounter [1] 77:6
encountered [1]
- 59:19
encourage [1] 69:19
encouraged [2]
- 55:28, 159:19
END [13] - 80:1,
107:2, 170:16,
177:10, 178:26,
185:1, 189:23,
193:1, 193:26,
205:9, 207:15,
211:19, 214:12
end [33] - 23:18,
41:20, 41:21,
41:22, 42:2, 42:4,
42:11, 42:24,
43:4, 43:8, 43:15,
44:3, 45:2, 53:12,
79:19, 80:8,
90:28, 93:11,
99:15, 108:17,
108:22, 130:26,
130:29, 131:2,
131:4, 134:21,
135:5, 135:24,
136:6, 163:6,
185:11, 214:17,
215:11
ended [3] - 91:4,
109:12, 112:2
endorsed [1] 175:22
enema [1] 16:22
enforce [1] 73:11
enforced [2] 73:10, 73:11
English [1] 78:13
enjoyable [1] 165:11
enjoyed [1] 193:11
enrolled [2] 8:6, 8:7
ensure [11] 32:25, 33:2, 33:9,
33:12, 69:29,
104:2, 104:4,
150:24, 184:20,
197:25, 203:26
ensured [1] 32:27
ensures [1] 176:11
enter [1] 103:10
entered [5] 65:18, 66:3,
108:26, 121:10,
141:4
entering [1] 44:25
enters [1] 184:2
entire [2] 75:23, 76:5
entirely [10] 48:24, 90:6,
148:20, 150:11,
155:10, 155:26,
160:9, 161:7,
168:14, 199:25
entitled [2] 107:10, 195:7
entity [1] - 36:26
entries [1] 88:27
entry [2] - 57:14,
183:7
environment [3]
- 85:9, 203:19,
213:29
envisaged [1] 71:3
epidural [1] 41:25
equally [4] 38:7, 91:2,
154:23, 188:24
equation [1] 68:16
equivalent [2] 202:22, 210:21
erred [1] - 88:25
erroneous [1] 12:4
erroneously [5]
- 13:11, 25:2,
27:28, 81:19,
163:16
error [34] 12:13, 12:16,
13:4, 14:15,
14:20, 27:8, 28:4,
67:12, 68:6, 69:7,
83:8, 83:17,
86:29, 87:19,
95:8, 106:14,
109:10, 165:8,
165:14, 165:18,
165:22, 165:23,
165:26, 166:13,
175:4, 175:5,
176:5, 176:6,
176:10, 183:13,
204:5, 212:29
errors [10] 26:5, 33:3,
165:21, 174:26,
213:1, 213:4,
213:7, 213:8,
213:23
escalate [1] 34:19
escalated [1] 31:11
especially [3] 15:18, 76:7,
161:19
essential [1] 154:17
essentially [5] 16:21, 53:2, 77:5,
86:17, 182:11
establish [6] 7:29, 17:27,
76:27, 81:7,
81:11, 114:27
estimate [2] 53:10
et [1] - 82:5
etc [2] - 77:10,
191:9
ethically [2] 68:12, 84:21
European [2] 39:20, 159:9
evening [1] 30:22
event [21] 19:26, 20:4,
27:15, 33:27,
37:19, 59:23,
62:11, 75:23,
76:9, 99:13,
103:17, 110:14,
117:21, 133:17,
134:20, 146:17,
149:28, 162:15,
167:20, 167:22,
214:3
events [14] 14:21, 48:14,
49:24, 85:13,
85:14, 93:14,
96:9, 106:22,
132:16, 150:28,
155:2, 175:6,
179:19, 214:2
evidence [66] 1:29, 26:29,
27:24, 35:28,
44:29, 49:14,
54:16, 87:11,
91:12, 96:25,
97:8, 101:4,
104:1, 106:17,
112:15, 113:1,
114:1, 121:17,
124:29, 128:5,
130:22, 131:17,
134:29, 136:4,
142:23, 142:27,
145:28, 147:10,
154:29, 156:18,
156:20, 160:21,
160:24, 166:10,
166:21, 167:16,
168:23, 168:24,
168:25, 179:9,
186:6, 186:7,
186:26, 194:9,
194:12, 194:13,
194:22, 194:27,
194:28, 195:4,
195:5, 195:10,
195:15, 195:21,
200:4, 200:26,
205:26, 206:16,
206:20, 206:22,
208:18, 209:26,
213:2, 214:19,
215:12, 215:14
evident [1] 127:7
evolution [1] 152:4
exact [1] - 191:6
exactly [11] 9:25, 17:8, 89:11,
120:22, 130:21,
167:12, 177:27,
200:26, 201:6,
205:4, 206:21
examination
[11] - 18:14, 56:4,
59:9, 80:5, 87:3,
156:20, 197:28,
199:24, 199:29,
201:25, 215:8
EXAMINATION
[12] - 3:4, 80:1,
107:2, 170:16,
178:26, 185:1,
189:23, 193:1,
193:26, 205:9,
11
Gwen Malone Stenography Services Ltd.
207:15, 211:19
examine [4] 79:17, 108:7,
122:20, 173:26
EXAMINED [11]
- 4:24, 80:24,
108:12, 177:12,
179:1, 187:9,
190:2, 193:4,
196:1, 205:12,
207:17
examined [1] 79:18
examining [2] 43:19, 173:25
example [10] 23:7, 50:15,
56:29, 95:8,
165:28, 172:21,
173:2, 176:17,
208:5, 212:9
exams [3] 159:9, 173:28,
173:29
exceedingly [3]
- 102:10, 157:20,
158:18
excellent [1] 212:23
except [1] 85:17
exceptional [1] 24:7
excess [1] 155:3
exclusive [3] 136:25, 137:3,
137:6
excused [1] 185:22
Executive [2] 81:8, 179:21
exemplary [1] 140:9
exhibit [10] - 5:1,
11:11, 11:20,
65:19, 76:17,
98:16, 98:17,
180:15, 186:29,
196:12
Exhibit [13] 5:1, 11:5, 11:11,
11:14, 11:21,
12:27, 14:29,
16:2, 17:13,
40:29, 98:18,
180:14, 196:11
Exhibits [1] 11:9
existed [2] -
23:19, 189:1
existing [1] 105:20
exists [1] 208:24
exit [1] - 39:19
expect [12] 15:25, 49:26,
104:18, 104:29,
150:2, 152:10,
157:17, 164:13,
192:12, 198:5,
211:10, 215:8
expectation [12]
- 50:4, 90:13,
91:9, 94:8,
100:17, 101:18,
105:14, 106:7,
112:13, 115:27,
159:17, 160:7
expected [21] 49:27, 49:28,
50:1, 50:7, 50:10,
50:12, 59:21,
59:24, 64:6, 83:6,
83:14, 86:1,
86:21, 86:25,
90:1, 104:20,
124:14, 149:27,
149:29, 157:8,
159:12
experience [29] 6:15, 7:16, 40:18,
51:13, 52:23,
72:3, 83:6, 83:14,
86:16, 89:27,
99:29, 103:16,
104:11, 104:28,
106:9, 118:24,
146:4, 147:3,
150:1, 156:4,
158:26, 168:29,
172:9, 172:17,
173:12, 174:29,
193:19, 195:2,
197:23
experienced [6]
- 83:25, 89:25,
91:1, 125:23,
125:24, 149:25
expert [18] 53:21, 53:27,
54:3, 57:21,
174:6, 174:13,
185:9, 185:19,
188:21, 189:14,
194:9, 194:11,
194:28, 199:26,
200:4, 201:11,
209:26, 213:14
expertise [6] 83:7, 83:15,
192:22, 194:20,
201:12, 202:8
experts [1] 201:15
explain [18] 10:11, 11:28,
28:22, 67:12,
68:2, 68:6, 76:20,
79:7, 90:3, 121:6,
149:10, 149:17,
168:27, 169:10,
175:2, 204:18,
205:4, 213:25
explained [1] 134:14
explanation [4] 85:13, 89:4,
132:28, 166:16
exposed [3] 39:12, 100:4,
212:10
express [3] 29:16, 118:9,
121:21
expressed [4] 50:22, 74:5,
194:18, 197:11
extend [3] 61:4, 61:5,
114:21
extended [3] 90:21, 109:16,
172:8
extending [2] 56:27, 74:20
extensive [2] 6:15, 156:3
extent [8] 35:16, 35:26,
73:18, 79:11,
79:13, 171:27,
174:20, 204:11
external [11] 47:20, 73:16,
74:5, 74:22,
179:27, 180:1,
180:10, 180:18,
182:18, 183:3,
206:18
Extracts [1] 11:4
extracts [2] 11:7, 14:18
extraordinary
[2] - 173:16,
189:16
extremely [11] 38:9, 38:26,
39:16, 70:11,
125:24, 140:17,
144:24, 156:15,
188:10, 188:13,
209:2
eye [2] - 52:14,
186:18
F
faced [1] - 28:7
faceted [1] 55:22
facilitate [1] 74:2
fact [64] - 6:17,
12:4, 12:24, 13:8,
26:8, 27:26,
34:18, 35:12,
41:21, 53:5,
53:27, 55:28,
56:5, 63:24, 65:2,
65:4, 67:13,
69:28, 72:24,
73:18, 81:11,
81:17, 82:5,
85:10, 91:4,
91:25, 96:8,
97:20, 98:8,
101:3, 106:15,
111:18, 113:10,
113:13, 113:17,
114:20, 120:21,
120:22, 121:21,
127:5, 132:21,
135:4, 135:11,
136:23, 144:27,
149:21, 151:3,
153:11, 153:13,
154:26, 158:6,
167:26, 168:6,
168:7, 169:28,
172:11, 174:15,
178:2, 179:14,
181:3, 201:5,
201:23, 201:26,
213:2
factor [9] - 69:9,
69:28, 71:9,
71:24, 72:20,
72:23, 73:6,
118:18, 163:12
factors [2] 68:19, 68:29
factors" [2] 68:24, 69:1
facts [7] - 86:18,
114:28, 124:11,
169:6, 169:25,
178:10, 178:23
factual [5] 81:13, 100:28,
194:26, 201:29,
210:14
factually [4] 81:21, 82:1, 82:2,
82:11
faecal [1] - 18:17
faeces [4] 15:21, 16:17,
16:25
failed [6] - 83:4,
86:2, 86:3, 86:5,
106:18, 106:20
fails [1] - 165:24
failsafe [1] 69:29
failure [15] 86:11, 106:14,
109:26, 109:28,
110:3, 110:10,
110:11, 115:7,
116:3, 116:9,
124:11, 124:20,
212:19, 212:20
failures [3] 86:10, 109:25
fair [6] - 16:5,
58:6, 88:14,
182:15, 195:12,
195:27
fairly [1] - 173:9
fairness [3] 36:5, 143:25,
155:15
fait [1] - 211:11
fallible [1] 29:12
falling [5] 124:13, 124:21,
213:29, 214:1,
214:2
familiar [3] 158:25, 210:11,
210:14
familiarising [2]
- 52:26, 198:8
families [2] 76:2, 78:15
family [9] - 86:2,
86:4, 86:5, 94:3,
94:5, 191:27,
204:25, 204:28,
205:2
fantastic [1] 16:28
far [5] - 23:18,
112:21, 113:19,
124:28, 148:2
Farhan [7] -
29:1, 73:2, 90:9,
90:10, 90:16,
90:29, 91:2
farhan [3] 30:17, 38:11,
90:13
fatal [1] - 165:26
fatally [1] 213:27
fateful [1] 174:6
father [2] 134:16, 163:24
February [13] 8:13, 11:23,
12:13, 13:5,
14:13, 40:16,
69:4, 69:17,
84:27, 86:14,
120:5, 120:7,
124:24
February/
March [1] - 206:4
feelings [1] 38:15
feet [1] - 59:18
Feilim [1] 194:4
fell [4] - 83:13,
85:29, 86:20,
86:24
fellow [5] 58:23, 100:3,
188:2, 188:22,
188:26
fellowship [7] 6:14, 6:16, 6:17,
39:11, 39:19,
159:5, 173:28
fellowships [1] 6:29
felt [24] - 19:1,
40:20, 46:14,
68:5, 68:11,
70:18, 74:11,
75:24, 75:25,
75:26, 76:28,
84:20, 105:28,
118:23, 122:18,
157:28, 167:22,
167:23, 168:3,
168:12, 169:4,
169:8, 178:4,
178:8
fever [1] - 18:13
few [14] - 53:1,
67:25, 88:19,
94:17, 117:5,
143:11, 153:19,
159:24, 159:25,
12
Gwen Malone Stenography Services Ltd.
170:25, 172:24,
172:26, 175:7,
194:24
fifteen [4] 122:5, 122:11,
125:21, 141:9
fifth [2] - 71:10,
183:8
file [3] - 69:21,
69:25, 86:11
filed [1] - 86:13
filing [4] - 69:9,
69:20, 75:17,
110:11
fill [2] - 10:2,
143:4
films [7] - 89:9,
92:3, 104:2,
105:3, 105:10,
106:15, 106:19
final [4] - 41:17,
173:24, 173:25,
196:21
finalised [1] 205:25
findings [2] 18:5, 69:15
fine [4] - 80:6,
128:7, 133:16,
161:24
finish [4] 23:26, 80:12,
143:20, 196:21
finished [15] 23:13, 23:20,
42:10, 45:12,
45:13, 49:28,
60:9, 90:27,
90:28, 131:22,
134:25, 137:15,
143:17, 153:16,
206:27
finished...(
INTERJECTION)
[1] - 131:21
finishes [2] 37:3, 42:7
Finn [1] - 189:29
FINN [1] - 190:2
firm [2] - 126:10,
130:5
First [1] - 210:11
first [53] - 8:2,
13:3, 13:16,
14:26, 15:4,
16:12, 17:14,
17:16, 17:28,
22:16, 31:13,
33:27, 42:19,
43:11, 47:13,
47:26, 52:25,
56:8, 60:1, 81:2,
81:6, 81:11,
83:29, 86:27,
94:17, 101:15,
102:6, 115:9,
117:5, 123:8,
126:11, 129:9,
143:23, 146:12,
155:1, 155:3,
156:22, 157:27,
171:10, 171:17,
172:21, 172:26,
173:28, 183:15,
184:8, 186:11,
186:12, 186:26,
202:24, 202:25,
205:26, 209:22
firstly [6] - 8:19,
30:29, 115:6,
116:18, 133:29,
155:27
fistula [16] 23:16, 44:6, 44:9,
98:23, 130:26,
131:10, 131:18,
131:23, 131:25,
132:18, 132:22,
133:21, 133:22,
133:27, 134:8,
135:2
fit [2] - 139:15,
164:19
FITNESS [1] 1:3
fitted [1] 166:12
Fitzgerald [4] 13:10, 13:15,
15:13, 191:17
five [71] - 22:7,
23:5, 26:18,
47:28, 47:29,
48:3, 49:17,
49:21, 80:3,
80:11, 87:13,
94:2, 94:3, 96:16,
96:26, 97:4,
97:12, 97:14,
101:5, 101:12,
101:16, 102:8,
102:16, 102:20,
102:22, 103:19,
103:27, 113:8,
113:13, 113:18,
114:25, 115:1,
122:5, 122:6,
122:24, 126:7,
126:8, 126:15,
126:21, 126:26,
127:5, 129:5,
129:14, 129:19,
129:22, 130:7,
130:8, 133:13,
140:21, 140:22,
140:29, 141:10,
146:18, 150:28,
150:29, 151:2,
166:26, 208:20,
209:10, 209:11,
209:15, 209:25,
210:2, 210:9,
210:18, 210:20,
210:22, 211:2,
211:5
Five [1] - 96:28
fix [1] - 141:13
flag [5] - 29:15,
158:10, 194:7,
213:20
flagged [1] 54:15
flagging [1] 102:28
flags [1] 158:13
flexible [1] 132:7
floppy [1] 164:10
flown [1] 195:19
fluid [5] - 16:22,
36:26, 37:5,
125:4, 135:7
fluidity [2] 131:6, 134:5
focus [1] - 36:27
focused [1] 192:8
folder [5] 19:19, 20:28,
21:12, 35:9, 97:6
folders [1] - 20:6
follow [4] - 21:1,
112:28, 161:11,
170:4
following [6] 1:28, 32:6, 42:29,
72:14, 111:25,
183:11
FOLLOWS [17] 4:1, 4:25, 80:18,
80:24, 108:1,
108:13, 171:7,
171:14, 177:13,
179:2, 187:9,
190:3, 193:4,
196:2, 205:12,
207:17, 211:25
follows [1] 111:11
FOR [3] - 2:11,
2:18, 2:21
force [1] - 104:5
forget [1] - 33:29
form [7] - 25:16,
27:5, 28:3, 54:12,
63:9, 70:4,
172:19
formal [2] 84:24, 98:2
formally [2] 58:19, 98:11
format [2] 173:22, 183:14
formed [2] 15:13, 23:17
formulated [1] 181:21
forth [1] - 173:3
forthcoming [1]
- 157:9
fortunate [2] 6:13, 38:25
forty [4] 114:25, 115:1,
122:5, 142:11
forum [2] - 9:28,
84:24
forward [3] 29:27, 87:24,
141:25
forwarding [1] 179:25
forwardly [1] 181:11
Foundation [1] 7:25
four [17] - 9:25,
15:11, 15:20,
15:25, 89:23,
103:15, 138:9,
138:14, 139:14,
139:26, 142:29,
143:5, 144:6,
144:8, 144:12,
144:13, 196:26
fourth [3] 33:15, 71:9,
143:25
frame [3] - 48:5,
86:12, 89:7
free [7] - 18:10,
19:1, 66:29,
131:26, 131:27,
132:5, 136:13
freely [1] 111:21
frequent [1] -
135:15
Friday [5] - 8:26,
8:29, 37:24,
38:18, 73:23
FRIDAY [1] 215:20
Friend [1] 34:26
friend [6] 48:26, 53:22,
55:23, 158:3,
182:26, 184:7
fro [1] - 204:25
front [2] - 65:27,
102:4
fuel [3] - 166:2,
166:3
fulfilling [1] 212:28
full [12] - 9:14,
9:26, 10:4, 10:6,
30:8, 61:18,
74:17, 123:23,
123:27, 184:25,
196:9, 209:5
full-time [6] 9:14, 9:26, 10:4,
10:6, 74:17,
196:9
fully [5] - 65:17,
162:18, 178:13,
208:14, 211:10
function [14] 18:22, 18:27,
25:8, 25:14,
25:17, 58:28,
65:3, 67:24,
70:12, 70:17,
70:18, 81:20,
164:1
functioning [3] 67:24, 71:4,
164:13
fundamental [2]
- 201:15, 203:13
fundamentally
[2] - 54:5, 83:3
furnished [1] 120:10
FURTHER [3] 3:8, 177:12,
178:26
furthermore [2]
- 124:8, 124:18
future [3] 177:5, 185:5,
192:1
G
gain [3] - 7:16,
60:17, 61:14
gained [2] 6:14, 176:1
gains [1] 172:17
Galway [3] 5:21, 40:1, 40:2
gather [3] 35:14, 147:2,
164:2
general [7] 17:11, 18:7,
72:12, 73:20,
143:29, 175:19,
180:29
generality [2] 7:10, 9:19
generally [9] 26:12, 30:6, 30:9,
58:1, 71:25,
72:18, 72:28,
98:10, 188:11
generated [1] 21:10
generation [1] 202:11
generous [4] 38:9, 140:17,
188:1, 188:20
George [1] 8:15
George's [1] 196:10
Ghallab [9] 30:2, 30:23,
30:26, 31:2,
31:15, 31:24,
72:2, 72:8, 84:28
Gillick [1] 99:12
given [32] - 9:4,
41:21, 42:2,
42:11, 42:15,
44:3, 45:6, 46:18,
51:13, 62:21,
69:25, 73:20,
96:9, 97:12,
115:10, 117:26,
121:18, 124:29,
155:9, 191:28,
192:4, 192:21,
194:13, 195:5,
195:16, 195:18,
206:20, 206:22,
206:28, 207:1,
207:7, 210:15
13
Gwen Malone Stenography Services Ltd.
glad [1] - 190:29
globally [3] 6:9, 176:2, 176:4
GOS [5] - 92:15,
94:28, 96:18,
97:22, 97:26
GP [2] - 18:2,
163:16
grade [2] 13:17, 98:19
Grade [1] 11:26
graded [1] 77:22
Graduate [2] 7:15, 8:7
graduate [1] 196:16
graduated [1] 5:20
grateful [2] 49:10, 49:18
great [8] - 29:16,
37:12, 43:17,
43:25, 87:11,
87:14, 173:18,
182:28
Great [16] - 6:26,
27:11, 92:16,
94:12, 95:5,
116:20, 116:22,
117:15, 119:8,
179:26, 180:7,
180:10, 184:6,
196:22, 197:2,
197:4
grieving [1] 169:3
grossly [1] 188:11
group [21] 56:10, 56:11,
56:15, 56:16,
56:20, 57:7, 57:8,
57:15, 57:18,
57:20, 57:24,
58:3, 58:7, 58:8,
151:11, 151:15,
151:17, 151:23,
151:26, 152:13,
191:1
grow [2] 191:19
guarantee [1] 89:20
Guardia [1] 165:29
guess [2] 109:5, 123:2
guidance [1] -
35:6
guide [1] 197:26
guidelines [2] 173:6, 203:23
guilt [1] - 203:5
H
half [12] - 13:15,
39:21, 73:24,
122:25, 125:5,
125:20, 126:14,
130:8, 136:27,
137:1, 159:8,
206:23
hand [31] - 4:28,
11:6, 16:4, 25:9,
27:2, 30:8, 40:26,
65:16, 92:13,
92:18, 101:5,
102:16, 144:16,
144:27, 144:28,
147:22, 147:26,
147:28, 148:4,
148:6, 148:10,
148:11, 148:13,
148:22, 148:23,
148:24, 149:24,
163:14, 163:21,
176:14, 186:27
handed [9] 25:17, 94:22,
95:10, 98:17,
103:18, 106:17,
117:11, 120:12,
187:13
HANDED [3] 5:4, 11:8, 40:28
Handed [3] 87:16, 98:18,
196:6
Handed) [1] 81:25
HANDED) [1] 5:1
handing [3] 103:13, 196:5,
202:24
handle [1] - 63:6
hands [2] 104:23, 122:10
handwritten [2]
- 27:20, 81:18
happening...(
INTERJECTION
[1] - 114:9
happily [1] 69:26
happy [25] 4:14, 6:20, 39:5,
45:15, 46:10,
46:26, 46:28,
47:15, 60:1,
61:24, 79:22,
95:29, 106:8,
121:8, 131:12,
145:21, 145:26,
146:15, 161:24,
162:29, 184:4,
186:13, 186:15,
202:21
hard [3] - 69:10,
69:19, 159:5
harsh [1] 204:24
Hart [3] - 31:17,
31:20
has...(
INTERJECTION)
[1] - 42:17
HAVING [4] 4:24, 187:8,
190:2, 196:1
he...(
INTERJECTION
[1] - 206:29
head [2] - 74:6,
74:11
headache [1] 18:13
headed [2] 55:5, 183:17
heading [4] 68:24, 69:1, 92:9,
92:19
headings [1] 77:22
Health [1] - 8:9
health [2] 173:26, 191:27
heaped [1] 159:20
hear [4] - 86:22,
100:18, 145:23,
159:19
HEARD [1] 1:14
heard [24] - 5:5,
24:24, 27:24,
30:2, 30:21,
33:19, 33:20,
36:13, 37:9,
44:29, 52:3,
58:12, 59:8, 76:8,
96:25, 156:17,
160:21, 160:24,
160:27, 161:1,
171:22, 171:23,
171:28
hearing [4] 5:14, 146:11,
155:1, 155:3
HEARING [6] 1:14, 4:1, 80:18,
108:1, 171:6,
215:20
heart [1] - 8:1
heights [1] 159:25
held [1] - 151:17
help [8] - 76:1,
76:26, 78:1,
91:11, 156:4,
177:20, 182:28,
199:15
helped [3] 94:19, 117:7,
134:13
helpful [9] 26:12, 38:9, 52:8,
65:16, 132:6,
138:20, 156:9,
156:15, 211:29
helping [6] 30:16, 30:20,
38:20, 38:25,
43:24, 73:5
hepatectomy [1]
- 176:17
hepatobiliary [2]
- 7:12, 9:18
hernia [6] - 43:3,
98:22, 99:2, 99:3,
172:23, 172:24
hernias [1] 173:2
herself [2] 103:5, 199:14
hiatus [2] 41:28, 143:2
Hickman [1] 98:22
Hickman/
Broviac [2] 132:21, 132:28
hide [1] - 169:25
hiding [2] 177:28, 178:1
hierarchal [1] 158:23
hierarchical [1] 31:23
high [3] - 15:12,
16:19, 19:27
highlight [1] 56:1
highlighted [3] 57:29, 62:13,
86:10
highlighting [1]
- 102:27
highlights [1] 51:3
highly [4] - 6:22,
32:9, 137:19,
159:29
himself [15] 14:3, 52:26,
58:13, 63:6,
99:27, 103:5,
104:9, 106:19,
120:29, 159:15,
162:29, 187:28,
191:25, 202:16,
210:10
hold [18] - 52:24,
56:10, 56:12,
56:16, 57:7, 57:8,
57:15, 57:18,
57:20, 57:24,
58:3, 58:7, 58:8,
103:21, 115:13,
151:12, 151:16,
151:26
holes [1] - 214:1
holidays [1] 91:18
holistic [2] 104:3, 105:13
home [2] 23:14, 23:22
honest [1] 198:3
hoof [1] - 172:3
hope [3] - 11:21,
37:29, 55:4
hopefully [1] 9:25
hoping [1] 74:16
horrified [1] 76:4
horror [2] 168:16, 168:20
Hospital [33] 5:7, 5:10, 5:13,
5:24, 5:29, 6:26,
8:8, 13:26, 20:19,
30:4, 35:27,
36:10, 69:14,
83:10, 85:24,
86:5, 86:14,
97:17, 110:10,
140:20, 142:28,
189:18, 191:1,
191:5, 192:15,
194:20, 194:22,
196:10, 196:25,
196:26, 197:3,
206:18
hospital [63] 7:16, 8:1, 20:1,
20:8, 20:13,
20:14, 21:2, 22:5,
28:14, 29:11,
29:26, 67:23,
69:12, 69:13,
69:18, 69:20,
71:13, 73:6, 75:5,
75:26, 83:20,
84:29, 85:6,
86:11, 89:15,
89:23, 93:23,
93:27, 94:1,
96:24, 100:12,
106:21, 106:26,
110:12, 111:22,
128:2, 128:3,
151:14, 151:27,
154:23, 157:14,
168:1, 168:5,
170:8, 171:24,
172:18, 174:7,
175:14, 175:24,
179:21, 179:27,
187:22, 188:10,
188:16, 188:23,
188:29, 189:5,
189:8, 189:9,
189:10, 192:19,
205:1, 213:5
hospitals [4] 22:5, 24:17,
36:11, 201:6
hour [13] 10:29, 22:15,
23:2, 23:9, 24:8,
122:25, 125:6,
125:20, 136:27,
137:1, 206:23
hours [14] 10:23, 11:1,
57:14, 57:28,
71:10, 72:11,
72:22, 125:6,
154:12, 154:13,
168:21, 173:17,
180:8, 189:16
HOUSE [1] 1:16
however...(
INTERJECTION
[1] - 151:27
huge [1] 143:18
human [15] 28:4, 69:7, 83:8,
83:17, 86:28,
14
Gwen Malone Stenography Services Ltd.
86:29, 106:14,
165:18, 165:23,
176:5, 176:10,
212:2, 212:20,
213:7, 213:27
humanitarian
[1] - 7:22
hydronephrosi
s [2] - 164:9,
164:12
hydronephroti
c [2] - 164:12,
164:19
hypospadias
[10] - 43:16, 44:9,
45:12, 45:28,
53:12, 130:26,
131:23, 133:21,
133:22, 133:27
hypothetical [1]
- 97:9
I
ICU [6] - 30:10,
30:11, 139:14,
142:29, 154:4,
154:22
ID [3] - 82:9,
105:8, 145:16
idea [4] - 26:23,
30:18, 199:27,
212:17
ideal [3] - 96:19,
102:20, 102:23
ideally [1] - 53:1
identified [14] 26:8, 26:16,
36:20, 56:17,
68:18, 68:29,
69:3, 69:28,
72:20, 72:23,
74:29, 75:1, 87:5,
183:10
identify [2] 87:12, 182:26
identifying [2] 87:21, 87:25
identity [1] 50:9
ignore [1] 120:23
ill [2] - 35:23,
189:8
illuminated [1] 51:2
illustrated [1] 56:5
image [6] -
20:27, 50:16,
65:17, 97:6,
115:15, 115:16
images [47] 12:24, 20:21,
20:22, 20:23,
20:28, 21:4,
21:17, 21:20,
22:6, 25:22, 33:9,
34:22, 50:15,
50:20, 51:6, 52:5,
52:7, 52:9, 52:12,
52:16, 63:15,
63:16, 63:17,
63:18, 64:22,
70:16, 70:29,
89:13, 102:25,
109:1, 109:5,
109:7, 109:8,
109:9, 124:20,
177:1, 194:23,
194:24, 195:3,
197:13, 197:17,
197:19, 197:25,
198:1, 198:8
imagine [1] 136:1
imaging [70] 19:11, 19:12,
19:23, 21:11,
28:23, 28:25,
29:7, 29:9, 29:20,
35:10, 50:9,
50:11, 51:4,
51:11, 52:28,
53:15, 65:1, 66:7,
69:2, 70:23,
72:22, 82:12,
89:17, 89:18,
92:11, 92:22,
93:21, 93:27,
94:7, 94:10,
95:17, 95:27,
101:15, 101:18,
104:9, 104:12,
111:3, 115:4,
115:28, 122:12,
122:16, 122:20,
123:7, 123:20,
124:12, 125:7,
125:10, 146:26,
147:4, 149:1,
149:3, 149:7,
149:8, 149:12,
149:14, 149:27,
149:29, 150:3,
161:21, 161:22,
161:23, 161:29,
162:2, 162:7,
162:13, 176:28,
177:4, 180:4
immediate [1] 115:22
immediately [7]
- 44:23, 63:7,
64:25, 65:2, 65:5,
108:23, 109:9
immensely [1] 204:28
impact [1] - 66:9
implant [1] 66:17
implausible [1] 137:19
implement [2] 69:15, 74:25
implication [2] 75:4, 198:4
implications [1]
- 54:19
implicit [1] 61:20
Implicit [1] 103:4
implies [1] 210:18
importance [2] 51:15, 136:3
important [28] 33:2, 52:9, 55:7,
65:24, 96:14,
96:17, 118:18,
119:4, 119:6,
119:7, 119:10,
119:18, 119:19,
119:21, 121:15,
123:26, 125:2,
154:29, 176:11,
176:19, 176:29,
178:16, 181:10,
184:9, 188:9,
188:25, 200:1,
202:3
important...(
INTERJECTION)
[1] - 154:24
impossible [4] 60:15, 134:6,
137:16, 137:17
impression [5] 46:22, 46:23,
46:24, 147:2,
166:6
improve [4] 9:21, 28:19, 76:2,
192:23
improved [1] 17:7
improving [1] 78:5
inadequacy [1] -
181:24
inadequate [1] 210:10
inappropriate
[3] - 180:24,
200:17, 202:5
inaudible [1] 15:22
incident [6] 8:13, 12:15,
75:14, 175:18,
175:22, 175:27
incidents [1] 165:17
incision [24] 59:6, 59:10,
60:13, 60:14,
60:16, 60:25,
60:26, 61:14,
82:29, 92:29,
103:29, 104:13,
104:16, 147:11,
147:12, 147:18,
147:20, 147:26,
147:28, 147:29,
148:1, 149:15,
149:22, 209:25
include [1] 24:8
included [1] 179:14
including [6] 8:5, 23:4, 52:28,
96:11, 113:27,
156:1
incompetent [1]
- 204:8
inconsistency
[1] - 139:23
inconsistent [4]
- 138:12, 138:15,
150:11, 164:27
incontinence [1]
- 16:6
incontinent [1] 16:16
inconvenience
[1] - 36:28
incorporate [1] 24:13
incorrect [9] 12:2, 27:12,
48:26, 69:2, 69:6,
88:14, 88:27,
150:8, 151:13
incorrectly [1] 212:26
increase [1] 24:21
increased [2] -
24:22, 74:14
increasingly [1]
- 24:17
incredible [1] 191:25
indeed [16] 30:19, 58:27,
87:28, 100:26,
101:18, 108:8,
114:26, 132:8,
135:13, 156:20,
180:22, 188:15,
188:23, 193:18,
200:17, 209:21
Independent [2]
- 92:7, 96:2
independent [2]
- 68:18, 69:16
independently
[1] - 117:18
INDEX [1] - 3:2
indicate [5] 27:11, 31:18,
62:8, 63:29,
120:26
indicated [14] 6:28, 26:29,
30:26, 31:18,
38:11, 47:14,
60:12, 60:18,
71:12, 82:21,
146:19, 179:8,
187:28, 201:16
indication [1] 180:1
indicative [1] 58:8
individual [5] 85:8, 118:9,
203:19, 208:10,
212:2
individually [1] 117:24
individuals [1] 85:23
induced [4] 47:18, 48:2,
48:16, 48:21
industrial [1] 69:26
industry [2] 165:15, 202:23
inexperienced
[2] - 91:23, 91:27
infection [3] 18:10, 19:2, 19:5
infections [7] 17:27, 18:9,
18:18, 28:17,
28:19, 70:10,
70:11
inferior [1] 56:28
influenced [2] 66:11, 88:28
inform [4] 33:28, 72:8,
161:12, 162:27
information [19]
- 25:10, 25:14,
26:10, 68:11,
85:18, 102:17,
110:5, 110:9,
119:1, 119:4,
119:7, 119:11,
121:2, 121:4,
136:11, 144:28,
148:28, 177:25,
207:5
informative [1] 165:12
informed [5] 18:6, 34:4, 94:6,
166:1, 166:4
inherently [1] 93:20
initial [7] - 5:23,
14:23, 106:14,
179:7, 199:27,
207:3, 212:25
input [3] - 94:26,
122:29, 191:3
inputs [1] 96:11
inquiry [6] - 4:6,
4:12, 153:13,
170:7, 170:10,
185:5
Inquiry [11] 80:29, 81:24,
117:14, 117:15,
119:9, 181:14,
181:21, 181:23,
206:5, 206:7,
206:11
inserted [1] 41:26
insignificant [1]
- 70:19
insist [3] 157:17, 157:18,
158:16
insofar [7] 53:20, 74:24,
101:4, 110:24,
179:17, 186:6,
204:13
inspection [2] 164:18, 164:29
instances [1] -
15
Gwen Malone Stenography Services Ltd.
13:4
instinctive [1] 52:9
instituted [1] 17:4
institution [2] 6:11, 6:23
institutionally
[1] - 10:1
instructed [3] 206:1, 206:2,
206:14
INSTRUCTED
[3] - 2:12, 2:19,
2:24
instructions [2]
- 206:10, 206:13
instrumental [1]
- 189:17
insufficient [2] 180:24, 202:16
insurance [1] 174:25
intact [1] - 67:4
intend [2] - 70:5,
89:11
intended [8] 27:28, 27:29,
28:24, 28:25,
70:3, 89:16,
130:12, 130:13
intending [1] 146:13
intensive [11] 59:14, 138:10,
138:14, 139:17,
139:25, 144:6,
144:7, 144:8,
144:11, 145:2,
155:29
intention [11] 29:19, 62:1,
70:28, 89:8,
89:18, 148:10,
149:2, 149:6,
149:9, 149:17,
152:14
inter [2] 189:17, 201:11
interdisciplinary [1] 189:17
interacted [1] 190:25
interacting [1] 172:17
interaction [4] 22:11, 36:22,
173:13, 188:5
interfered [1] -
66:11
internal [5] 92:12, 116:20,
116:25, 179:26,
206:19
interrupt [3] 132:25, 139:2,
155:14
interrupted [1] 122:17
interrupting [1] 76:19
intervene [3] 46:27, 48:9,
53:19
interview [2] 118:14, 118:19
interviewed [2] 94:28, 118:12
interwoven [1] 144:2
into...(
INTERJECTION)
[1] - 121:11
intra [1] - 58:1
intraoperatively [1] 58:1
introduce [1] 16:20
introduced [3] 48:13, 71:13,
143:24
invariable [3] 148:16, 160:10,
160:16
invasion [1] 56:29
investigated [2]
- 116:16, 116:18
investigating [1]
- 191:5
invited [1] 117:21
involve [1] 7:23
involved [29] 13:23, 15:5,
17:14, 23:8,
61:29, 79:9, 93:2,
93:4, 93:5, 93:6,
93:8, 94:2, 94:9,
102:26, 117:16,
118:9, 119:20,
119:22, 121:13,
132:20, 133:21,
133:27, 134:10,
135:8, 160:21,
162:19, 178:4,
191:16, 212:16
involvement [7]
- 11:2, 14:23,
66:18, 144:28,
178:5, 178:13,
190:28
involves [2] 8:20, 101:10
involving [1] 124:1
Iraq [1] - 6:5
Ireland [8] 6:25, 7:24, 76:28,
106:11, 159:4,
196:15, 196:17,
208:25
Irish [1] - 39:8
irregular [1] 58:17
irrespective [3] 110:26, 111:6,
160:5
irreversible [1] 109:13
isolation [1] 213:15
issue [50] 15:19, 15:23,
15:24, 17:12,
30:26, 31:1,
31:17, 31:19,
32:4, 33:14,
33:17, 34:9,
34:10, 56:1,
69:12, 69:13,
72:2, 72:7, 75:9,
75:13, 75:19,
83:23, 85:4,
85:10, 96:14,
96:17, 102:22,
102:28, 119:12,
121:10, 121:14,
121:15, 121:16,
121:26, 122:24,
122:25, 122:27,
123:15, 123:16,
152:13, 155:6,
160:19, 172:11,
176:28, 181:24,
182:15, 195:25,
201:7, 204:9,
212:25
issued [1] 25:24
issues [17] 14:24, 15:10,
15:18, 15:24,
16:7, 17:15,
69:24, 82:4,
178:2, 194:22,
194:25, 198:13,
199:19, 202:28,
205:2, 205:3,
205:28
it.. [1] - 102:18
itself [6] - 67:5,
108:26, 175:22,
190:24, 197:27,
203:13
IV [1] - 41:26
J
January [10] 13:8, 19:8, 19:15,
24:24, 83:17,
88:15, 88:24,
90:23, 92:2,
105:3
job [1] - 204:18
joined [1] 191:15
joint [1] - 13:28
journey [2] 20:1, 71:14
JP [1] - 2:12
judgment [4] 83:5, 83:13,
173:12, 212:20
juggling [1] 24:12
July [7] - 40:8,
90:2, 90:24,
90:29, 179:8,
205:24, 205:25
junctures [2] 94:5, 94:9
June [5] - 14:6,
14:9, 15:29, 16:3,
179:10
junior [27] 53:17, 55:2, 55:3,
55:4, 55:6, 77:7,
78:9, 90:26,
98:10, 103:26,
119:3, 120:27,
137:18, 160:14,
172:17, 174:20,
178:17, 188:6,
188:23, 189:9,
190:26, 192:9,
192:14, 193:21,
202:8, 211:4,
211:8
K
keep [4] - 5:16,
19:1, 74:12,
186:17
keeping [3] 140:1, 159:28,
177:28
keeps [1] - 78:6
Kenny [2] 17:11, 17:28
kept [3] - 19:19,
19:20, 20:28
Kettering [13] 6:7, 6:10, 6:18,
6:20, 6:21, 6:24,
39:11, 39:15,
40:7, 100:1,
100:2, 159:5
kidney [78] 12:9, 18:27,
25:15, 34:1, 34:2,
59:7, 60:17,
61:15, 63:2, 64:9,
64:11, 64:12,
64:17, 64:18,
64:24, 65:2, 65:3,
65:4, 65:7, 65:10,
65:12, 65:13,
65:14, 65:17,
65:25, 65:27,
65:28, 66:5,
66:10, 66:17,
66:28, 67:1, 67:2,
67:5, 67:8, 67:10,
67:13, 67:14,
67:23, 67:26,
70:13, 70:14,
81:20, 87:21,
87:26, 88:3, 88:6,
88:23, 102:26,
104:21, 108:19,
108:25, 109:18,
109:21, 112:14,
147:21, 163:4,
163:8, 163:29,
164:7, 164:10,
164:11, 164:13,
164:15, 164:16,
164:18, 164:22,
164:24, 164:25,
164:26, 164:27,
166:11, 168:21,
174:10, 174:11,
212:10
kidney" [1] 174:13
kidneys [1] 18:23
kind [5] - 40:11,
178:9, 204:23,
209:12, 212:27
kindly [1] 190:23
Kingdom [3] -
196:23, 203:25,
208:22
KINGRAM [2] 1:16, 1:17
Kings [1] - 5:12
knife [12] 47:22, 48:1, 48:5,
49:21, 51:23,
52:1, 52:21, 53:6,
53:9, 113:24,
113:25, 114:20
knowing [1] 115:6
knowledge [9] 30:16, 33:27,
78:7, 90:10, 98:1,
105:28, 122:19,
172:8, 174:24
known [10] 51:15, 82:24,
87:28, 90:23,
111:16, 121:28,
169:20, 169:22,
192:5, 193:22
knows [1] 176:12
L
lab [1] - 56:15
lack [3] - 58:9,
69:11, 72:22
Lady's [1] 189:18
large [4] - 7:10,
20:28, 87:18,
153:25
largest [1] - 6:11
last [19] - 6:16,
7:6, 22:16, 40:11,
69:26, 74:9, 77:5,
84:12, 86:14,
88:1, 88:2, 92:17,
159:25, 165:3,
174:16, 175:7,
183:11, 183:21,
205:25
lastly [1] - 76:15
late [4] - 63:14,
143:11, 185:10,
214:23
laterality [14] 26:6, 30:25, 31:5,
31:14, 32:5, 33:1,
33:9, 34:5, 34:9,
62:10, 94:11,
158:11, 158:14,
212:25
laterally [1] -
16
Gwen Malone Stenography Services Ltd.
16:13
laxative [1] 16:23
lay [1] - 171:20
layman's [1] 134:9
leadership [1] 78:23
leading [5] 34:25, 62:26,
95:28, 181:2,
181:6
learned [1] - 8:3
least [51] 10:21, 16:15,
20:17, 41:29,
53:8, 53:14,
53:23, 55:15,
72:4, 94:2,
112:19, 112:21,
112:25, 112:26,
113:10, 113:13,
113:15, 113:17,
114:3, 115:19,
115:20, 115:24,
116:2, 116:5,
116:11, 118:16,
119:3, 120:27,
121:18, 122:1,
123:9, 125:1,
126:6, 129:1,
129:2, 129:3,
136:17, 136:27,
139:8, 141:26,
141:27, 142:16,
142:23, 143:12,
155:18, 159:6,
159:7, 179:15,
184:14, 191:3,
206:23
leave [8] - 30:17,
30:19, 48:18,
67:8, 90:11,
103:10, 141:20,
184:19
leaving [6] 12:6, 82:3, 99:24,
134:23, 145:20,
196:21
lecture [3] 165:2, 165:6,
166:6
lectures [1] 173:22
led [4] - 35:27,
36:1, 36:6, 175:5
left [81] - 11:26,
12:1, 12:20,
12:25, 13:3,
13:11, 13:18,
14:1, 14:4, 14:8,
14:10, 14:19,
25:2, 25:9, 25:15,
27:29, 33:4, 35:4,
50:13, 50:26,
60:12, 60:16,
60:17, 60:28,
61:9, 65:2, 81:19,
81:20, 82:23,
82:27, 82:28,
86:29, 87:8, 88:6,
89:3, 89:6, 90:8,
104:19, 105:7,
105:9, 121:5,
133:9, 134:21,
135:20, 136:5,
142:26, 145:17,
145:25, 145:28,
147:19, 147:22,
147:26, 147:28,
148:4, 148:6,
148:8, 148:11,
148:12, 148:13,
148:22, 148:23,
148:24, 148:25,
148:27, 149:24,
163:14, 163:17,
163:18, 163:21,
163:25, 174:10,
174:11, 174:15,
175:9, 175:10,
184:3, 199:2
left-hand [2] 163:14, 163:21
left-sided [6] 12:1, 14:8, 14:10,
14:19, 89:3, 89:6
LEGAL [1] - 2:8
legal [6] - 123:1,
123:2, 123:8,
125:28, 185:6,
207:11
length...(
INTERJECTION
[1] - 87:14
lengths [1] 87:11
lengthy [1] 143:19
LEONARD [36] 2:11, 3:7, 3:8,
3:17, 48:22,
62:20, 65:8, 80:3,
80:10, 80:25,
80:27, 84:7,
106:27, 107:3,
120:12, 120:19,
177:13, 177:15,
178:24, 180:14,
181:28, 184:23,
194:5, 195:6,
195:13, 195:18,
199:5, 200:24,
201:2, 201:19,
205:13, 205:15,
207:12, 207:15,
215:6, 215:13
Leonard [19] 79:27, 80:22,
84:6, 107:5,
116:23, 170:22,
194:15, 195:9,
195:12, 195:23,
199:8, 199:26,
200:15, 201:9,
201:22, 201:24,
202:28, 204:11,
215:5
less [30] - 9:4,
49:16, 56:22,
70:12, 102:8,
113:8, 113:18,
126:7, 126:8,
126:21, 126:26,
129:14, 129:22,
130:8, 133:13,
140:29, 146:18,
150:28, 150:29,
159:21, 166:23,
167:2, 200:23,
201:27, 202:7,
208:19, 209:9,
209:25, 210:9,
211:4
lest [1] - 20:23
letter [47] 11:12, 11:13,
12:28, 13:1, 13:7,
13:8, 13:11,
13:14, 13:21,
14:3, 14:6, 14:8,
17:12, 17:18,
18:2, 87:29,
88:10, 88:11,
119:23, 119:25,
120:5, 120:6,
120:7, 120:16,
120:18, 120:24,
120:25, 120:26,
121:1, 121:3,
121:20, 122:14,
122:26, 122:28,
122:29, 123:14,
124:25, 174:28,
179:12, 179:17,
179:20, 179:24,
180:12, 180:27,
182:6, 182:10
letters [5] 69:18, 69:23,
71:8, 86:13,
212:28
level [16] - 5:23,
35:6, 35:22,
42:13, 51:13,
52:23, 55:5, 56:2,
72:5, 89:27, 91:2,
100:24, 104:11,
106:9, 115:2,
147:3
levels [2] 103:8, 173:8
liability [1] 204:2
lies [1] - 65:27
life [5] - 23:20,
28:19, 73:18,
76:2, 100:15
life-threatening
[1] - 23:20
lift [1] - 33:15
light [5] - 26:4,
37:19, 50:21,
51:2, 134:2
likelihood [1] 91:26
likely [13] 18:19, 27:13,
54:16, 67:24,
87:4, 89:4, 110:9,
132:11, 132:13,
132:14, 137:14,
166:15, 174:25
limit [1] - 62:26
limited [1] 83:10
line [11] - 34:5,
42:29, 53:10,
60:26, 62:7,
97:22, 97:23,
133:3, 133:4,
182:20, 183:2
lines [2] - 41:26,
184:1
list [74] - 8:25,
24:14, 30:16,
35:15, 35:16,
35:20, 35:24,
36:8, 36:13,
36:15, 36:17,
36:18, 36:24,
36:25, 36:26,
38:20, 40:24,
41:9, 41:11,
42:12, 43:18,
44:19, 51:27,
51:29, 58:9,
72:27, 72:29,
73:4, 73:15,
73:19, 73:21,
73:26, 74:19,
90:5, 90:8, 91:11,
93:12, 94:15,
95:19, 95:21,
97:27, 98:3, 98:8,
98:9, 98:13,
98:17, 99:5, 99:7,
99:11, 99:14,
99:17, 99:23,
101:21, 105:21,
117:4, 132:1,
132:6, 135:8,
136:24, 137:15,
140:2, 140:7,
152:4, 156:5,
200:16, 200:19,
201:27, 203:2,
203:4, 204:2
listed [17] - 8:3,
41:18, 42:18,
42:20, 42:22,
43:6, 43:14,
44:13, 44:18,
44:20, 44:21,
69:2, 105:6,
148:8, 148:25,
197:12, 200:23
listen [1] - 79:3
listened [4] 29:18, 35:7, 76:8,
210:16
listening [1] 125:16
listing [3] 40:26, 92:23,
93:6
lists [8] - 36:23,
37:11, 37:13,
73:17, 73:20,
73:22, 74:12,
74:21
lists" [1] - 36:14
live [2] - 67:17,
199:2
liver [2] - 5:12,
56:29
load [1] - 208:24
loaned [1] - 2:26
Locum [1] - 6:1
logic [2] 136:21, 209:13
logical [1] 168:18
logistical [1] 98:12
London [4] 5:13, 6:26, 8:12,
196:10
longest [1] - 7:3
look [41] - 12:26,
24:21, 34:14,
35:9, 35:12,
41:16, 52:5, 52:7,
53:3, 53:15,
55:29, 57:9, 62:3,
63:9, 68:20, 72:9,
72:28, 77:11,
81:26, 83:28,
86:27, 88:18,
97:7, 100:6,
102:3, 102:6,
103:1, 103:8,
106:15, 116:22,
119:25, 120:25,
142:21, 146:25,
149:3, 149:14,
163:9, 164:18,
166:29, 182:25,
198:10
looked [27] 4:12, 26:7, 50:20,
59:8, 63:11,
64:11, 64:12,
64:22, 89:2,
89:17, 93:25,
97:23, 111:8,
111:23, 112:5,
145:16, 147:4,
148:21, 149:1,
149:8, 149:11,
150:3, 163:29,
164:2, 164:19,
180:4
looking [35] 5:19, 9:23, 25:3,
27:27, 51:15,
65:1, 66:7, 68:23,
77:12, 81:22,
81:24, 88:17,
102:24, 102:25,
106:19, 111:2,
120:6, 120:7,
141:13, 145:11,
145:14, 145:29,
149:2, 149:6,
149:17, 151:6,
159:26, 162:12,
180:9, 198:8,
198:9, 213:9
looks [4] 42:18, 87:29,
92:7, 110:22
loose [1] - 120:1
loosely [1] 203:10
loss [5] - 56:24,
108:29, 152:10,
152:11, 176:17
lost [3] - 19:28,
20:24, 114:29
17
Gwen Malone Stenography Services Ltd.
low [3] - 56:22,
61:14, 166:3
lower [5] 60:13, 61:4, 61:9,
104:17, 147:15
luck [1] - 204:9
LUNCHEON [2]
- 107:14, 108:1
lunchtime [2] 80:5, 80:12
lying [1] - 66:5
M
main [2] - 14:28,
17:13
maintain [2] 7:9, 125:5
major [2] - 70:1,
72:17
majority [1] 165:17
Malaysian [1] 32:10
male [1] - 15:25
Malone [3] 1:27, 2:25, 2:27
man [2] 100:17, 188:14
manage [3] 79:21, 183:6,
191:11
Management [1]
- 8:9
management
[14] - 13:24, 16:6,
27:26, 28:15,
28:18, 49:29,
75:14, 76:10,
77:26, 78:3, 78:4,
110:12, 172:11,
175:14
managing [1] 18:15
manner [1] 2:26
mannion [1] 64:27
Mannion [6] 46:24, 46:28,
47:24, 63:24,
66:16, 151:21
Mannion's [3] 53:10, 128:22,
151:16
March [10] 13:1, 40:27,
57:14, 82:6, 90:3,
181:16, 183:7,
183:11, 183:16,
183:17
marked [3] 65:23, 65:24,
103:22
marking [3] 73:7, 73:9, 73:13
martin [1] 188:27
MARTIN [2] 4:24, 108:12
Mary [1] - 13:22
MARY'S [1] 2:15
massive [1] 133:3
Master [21] 11:3, 13:24,
14:23, 14:26,
16:5, 17:14,
17:19, 19:7,
22:11, 24:24,
24:27, 29:25,
29:29, 32:19,
45:4, 66:25,
81:18, 85:3,
106:19, 179:7,
197:13
match [8] 56:20, 56:26,
57:2, 57:25,
151:23, 152:8,
152:14, 176:16
matched [2] 105:8, 152:7
matching [3] 56:18, 57:22,
151:11
mate [2] 202:24, 202:25
mATHESON [1]
- 2:19
matter [31] 4:12, 17:19,
48:10, 50:23,
53:27, 54:22,
71:19, 81:11,
81:17, 82:4,
106:11, 106:17,
109:25, 111:18,
112:4, 116:15,
122:10, 152:17,
169:25, 181:3,
182:11, 199:9,
199:14, 201:23,
207:22, 207:24,
207:28, 208:6,
208:9, 211:9,
214:26
matters [11] -
54:22, 54:25,
54:26, 56:3,
155:10, 155:26,
166:24, 179:5,
199:11, 199:23,
201:14
McDOWELL [2]
- 2:12, 2:14
MCUG [2] - 13:2,
13:17
mean [24] 27:23, 38:5,
47:21, 51:7, 54:7,
61:7, 93:13,
97:11, 109:16,
111:20, 113:19,
114:6, 126:20,
139:2, 142:14,
147:2, 149:5,
149:7, 155:21,
158:23, 162:15,
168:28, 176:25,
186:16
means [12] 17:5, 47:29,
56:16, 70:13,
74:20, 74:27,
98:1, 99:19,
134:9, 165:22,
202:18, 210:7
meant [4] - 36:6,
59:23, 76:26,
128:10
measure [3] 27:25, 27:26,
46:17
measures [3] 16:11, 176:25,
178:7
meat [1] 164:14
med [1] - 153:14
Medical [16] 39:8, 76:23,
76:26, 77:3,
84:11, 85:16,
119:19, 119:22,
121:12, 159:3,
172:13, 175:18,
175:22, 179:13,
179:21, 179:25
MEDICAL [2] 1:2, 1:4
medical [17] 11:4, 39:28,
69:10, 75:15,
76:22, 81:19,
82:5, 82:7, 82:10,
87:13, 94:2,
111:28, 158:24,
171:25, 172:14,
174:24, 175:11
medications [1]
- 42:14
medicine [3] 40:1, 173:24,
173:25
MEENAN [55] 2:21, 3:7, 3:14,
3:18, 34:24, 48:7,
48:9, 48:24, 49:2,
49:6, 53:18,
53:29, 54:11,
54:20, 54:24,
62:25, 107:8,
108:8, 108:13,
108:15, 119:28,
120:10, 120:15,
120:21, 133:1,
133:7, 133:17,
153:7, 155:19,
155:23, 157:1,
170:14, 181:2,
181:8, 182:1,
182:4, 182:26,
183:23, 184:7,
186:16, 193:5,
193:7, 193:24,
193:27, 198:17,
198:24, 199:3,
199:21, 200:6,
207:18, 207:20,
211:15, 211:19,
214:24, 215:4
meenan [6] 34:18, 107:7,
108:6, 110:1,
120:9, 132:26
Meenan [21] 49:10, 54:13,
56:3, 58:15, 63:8,
64:14, 102:7,
103:2, 155:14,
156:28, 161:14,
166:15, 166:27,
170:13, 177:16,
177:17, 179:12,
182:2, 186:15,
204:11, 214:20
Meenan's [1] 59:8
meet [1] - 66:25
meeting [7] 12:23, 19:14,
22:12, 23:24,
33:29, 70:26
meetings [1] 71:16
member [3] 30:5, 32:4,
171:11
members [4] 78:22, 96:12,
171:18
membership [2]
- 173:27, 173:29
Memorial [2] 6:10, 39:11
memory [3] 48:22, 67:16,
201:13
mention [1] 97:16
mentioned [2] 159:1, 173:14
mentioned...(
INTERJECTION
[1] - 97:21
mentor [1] 158:3
merely [8] 85:13, 86:18,
104:14, 121:21,
146:14, 151:9,
178:23, 212:28
met [5] - 24:26,
55:12, 75:13,
191:13
Michael [1] 39:14
Michelle [1] 136:7
middle [1] 131:4
might [29] 5:15, 24:2, 30:3,
37:19, 57:9,
61:28, 69:6, 80:7,
81:26, 96:18,
96:19, 98:18,
99:10, 120:26,
132:27, 137:5,
137:6, 137:15,
146:9, 157:26,
157:29, 164:14,
164:18, 170:20,
172:23, 179:8,
183:21, 195:20
mild [1] - 13:17
mildly [1] 96:26
million [1] 176:3
mind [10] 51:22, 62:14,
130:5, 146:15,
158:11, 165:23,
167:25, 169:28,
170:2, 193:12
mine [2] -
174:16, 191:22
minimal [4] 11:26, 13:2,
152:10, 152:12
minimise [2] 36:28, 176:9
minimised [1] 20:18
minimum [1] 53:4
minor [3] 137:2, 143:5,
202:12
minute [14] 52:25, 96:27,
97:7, 101:5,
102:22, 102:24,
115:16, 135:2,
141:18, 149:10,
160:5, 186:4,
187:14, 209:15
minute...(
INTERJECTION
[1] - 207:8
minutes [183] 35:8, 41:24,
41:29, 42:16,
44:8, 47:28,
47:29, 48:1, 48:3,
49:17, 49:21,
53:2, 53:8, 53:15,
53:23, 63:27,
80:4, 80:11,
96:15, 96:28,
97:3, 97:4, 97:15,
101:13, 101:16,
102:9, 102:16,
102:20, 102:22,
102:27, 103:19,
103:27, 104:24,
112:16, 112:20,
112:21, 112:23,
112:25, 112:26,
112:29, 113:8,
113:10, 113:13,
113:14, 113:15,
113:18, 114:3,
114:14, 114:17,
114:22, 114:25,
115:1, 115:11,
115:14, 115:17,
115:19, 115:20,
115:24, 116:2,
116:6, 116:12,
117:24, 117:27,
118:17, 119:3,
120:28, 121:19,
122:1, 122:5,
122:6, 122:10,
122:11, 122:24,
18
Gwen Malone Stenography Services Ltd.
122:25, 122:27,
123:3, 123:5,
123:9, 125:1,
125:21, 125:27,
126:6, 126:7,
126:8, 126:21,
126:25, 126:26,
127:5, 127:6,
128:27, 129:2,
129:5, 129:14,
129:19, 129:20,
129:22, 130:5,
130:8, 130:24,
133:13, 136:18,
137:10, 137:29,
138:13, 139:8,
139:12, 140:21,
140:22, 141:1,
141:2, 141:8,
141:9, 141:10,
141:15, 141:19,
141:20, 141:23,
141:26, 141:27,
142:7, 142:11,
142:12, 142:13,
142:23, 142:24,
142:25, 142:26,
142:28, 143:11,
144:1, 144:5,
144:20, 145:4,
145:7, 146:18,
147:5, 150:6,
150:28, 150:29,
151:3, 151:5,
153:19, 155:5,
155:10, 155:16,
155:18, 155:25,
159:22, 160:4,
166:23, 166:26,
166:27, 166:28,
167:2, 167:13,
167:16, 167:17,
170:28, 179:15,
208:20, 209:10,
209:11, 209:12,
209:25, 210:3,
210:9, 210:18,
210:23, 211:2,
211:5, 214:27
minutes' [4] 96:15, 96:16,
97:12, 210:20
minutes...(
INTERJECTION)
[1] - 142:16
misapprehensi
on [2] - 88:6,
88:12
misconduct [4] 54:4, 81:14,
203:5, 204:3
mishap [1] 68:13
mislaid [1] 21:9
mislaying [1] 20:18
misplaced [1] 19:28
missing [3] 20:13, 183:22,
184:22
mistake [4] 84:27, 86:16,
87:12, 88:15
mistakes [4] 29:13, 111:17,
203:6, 213:23
mistreat [1] 192:9
mistreatment
[1] - 192:11
misunderstood
[1] - 131:15
mls [1] - 56:26
Mohamed [3] 58:12, 59:4, 63:9
moment [5] 137:4, 149:16,
190:10, 210:1,
213:26
moments [3] 84:29, 159:24,
159:25
MONAGHAN [1]
- 2:4
Monday [4] 8:25, 8:29, 37:23,
73:23
month [7] - 9:8,
24:11, 40:9,
90:20, 154:14
months [17] 6:6, 39:10, 39:24,
40:10, 40:12,
71:20, 75:14,
75:20, 77:5,
90:21, 90:22,
90:27, 91:25,
99:29, 123:11,
123:12, 133:9
morning [48] 4:4, 4:13, 10:14,
10:15, 10:23,
23:4, 23:21,
23:23, 29:22,
30:6, 30:11,
30:13, 32:6,
32:16, 32:17,
33:8, 35:15,
38:18, 38:22,
38:29, 43:10,
51:19, 70:25,
72:14, 72:25,
91:14, 92:25,
93:6, 94:15,
105:2, 106:16,
111:25, 112:9,
112:15, 117:3,
121:17, 127:18,
130:14, 130:22,
154:8, 177:21,
184:21, 184:27,
191:22, 206:25,
210:16, 214:28,
215:18
Mortell [5] 15:6, 52:4,
144:17, 144:26,
162:6
mortell's [1] 144:28
Mortell's [1] 52:10
most [15] - 7:4,
18:18, 26:12,
32:2, 39:7, 53:22,
78:3, 99:12,
105:21, 110:9,
115:26, 165:11,
200:20, 202:13,
212:1
mostly [2] 7:27, 205:27
mother [2] 163:21, 163:23
motivation [1] 177:28
motivational [1]
- 178:2
move [7] - 11:2,
29:24, 37:4,
66:19, 94:12,
135:10, 163:3
movement [3] 130:14, 134:5,
135:14
movements [2] 135:7, 150:12
moving [1] 131:7
MR [139] - 2:5,
2:8, 2:11, 2:22,
3:7, 3:7, 3:8,
3:10, 3:13, 3:14,
3:16, 3:17, 3:18,
34:24, 48:7, 48:9,
48:22, 48:24,
48:29, 49:2, 49:5,
49:6, 53:18,
53:25, 53:29,
54:7, 54:11,
54:13, 54:20,
54:21, 54:24,
54:26, 62:20,
62:25, 65:8, 80:3,
80:10, 80:25,
80:27, 84:7,
106:27, 107:3,
107:8, 108:8,
108:13, 108:15,
119:27, 119:28,
120:8, 120:10,
120:12, 120:15,
120:19, 120:21,
133:1, 133:7,
133:9, 133:17,
153:7, 155:19,
155:23, 156:26,
157:1, 170:14,
171:20, 174:2,
177:13, 177:15,
178:24, 180:11,
180:14, 180:15,
180:17, 181:2,
181:6, 181:8,
181:12, 181:28,
182:1, 182:8,
182:17, 182:26,
183:23, 184:7,
184:10, 184:14,
184:23, 185:13,
186:16, 189:23,
190:2, 193:1,
193:4, 193:5,
193:7, 193:24,
193:27, 194:5,
194:26, 195:6,
195:12, 195:13,
195:14, 195:18,
195:27, 196:1,
198:17, 198:22,
198:24, 199:3,
199:5, 199:8,
199:21, 200:2,
200:6, 200:11,
200:24, 200:27,
201:2, 201:9,
201:19, 205:9,
205:12, 205:13,
205:15, 207:12,
207:15, 207:17,
207:18, 207:20,
211:15, 211:19,
211:25, 214:24,
215:4, 215:6,
215:13
MS [79] - 2:5,
2:13, 2:18, 3:6,
3:9, 3:11, 3:14,
3:17, 4:9, 4:16,
4:20, 4:25, 4:27,
11:11, 11:16,
11:21, 34:27,
41:2, 48:8, 48:28,
49:10, 54:28,
62:23, 62:28,
65:11, 65:21,
76:20, 79:25,
155:13, 155:22,
170:25, 171:1,
179:2, 179:4,
180:16, 180:18,
181:3, 181:14,
182:2, 182:5,
182:13, 182:29,
183:28, 184:17,
184:25, 185:18,
185:28, 186:1,
186:13, 186:23,
187:2, 187:9,
187:11, 187:18,
189:19, 189:23,
189:29, 190:3,
190:5, 190:14,
192:25, 193:2,
194:4, 194:15,
194:29, 195:7,
195:23, 196:2,
196:12, 198:12,
198:20, 198:27,
199:17, 200:12,
201:20, 205:5,
205:10, 211:21,
214:19
multi [6] - 12:23,
70:2, 70:6, 70:26,
78:22, 191:12
multidisciplinary [6] 12:23, 70:2, 70:6,
70:26, 78:22,
191:12
multiple [1] 39:12
MURPHY [9] 3:16, 196:1,
205:9, 205:12,
207:15, 207:17,
211:19, 211:25,
214:12
murphy [1] 214:10
Murphy [19] 185:19, 186:12,
194:4, 194:20,
195:3, 195:10,
195:28, 196:4,
197:7, 199:17,
199:22, 200:13,
202:15, 205:6,
205:15, 209:9,
211:3, 211:17,
211:21
Murphy's [3] 186:6, 199:27,
201:28
Murphy...(
INTERJECTION
[1] - 185:28
muscle [2] 17:1, 17:2
must [10] - 2:26,
75:24, 76:6,
87:28, 113:19,
121:28, 123:2,
157:13, 206:24,
210:5
mutually [2] 136:25, 137:3
myself' [1] - 96:1
N
name [2] - 41:3,
136:7
named [1] - 1:30
namely [1] 48:14
nappies [1] 16:16
narrative [1] 145:1
national [2] 9:16, 24:15
nature [1] - 6:9
near [1] - 193:13
nearly [2] 170:14, 197:4
necessarily [9] 36:2, 36:7,
101:10, 102:16,
123:4, 136:25,
137:16, 137:17,
151:8
necessary [10] 20:25, 51:10,
57:25, 102:18,
129:23, 129:26,
130:7, 178:5,
202:26, 210:23
necessity [3] 70:7, 70:8,
106:15
neck [1] - 133:5
need [20] 20:16, 33:7,
34:19, 51:20,
56:19, 57:1,
58:22, 59:2,
19
Gwen Malone Stenography Services Ltd.
70:28, 101:15,
102:23, 146:21,
176:17, 208:13,
208:15, 209:5,
209:16, 209:18,
209:28
needed [4] 9:29, 19:1, 78:2,
167:23
needs [2] - 92:3,
103:23
negligence [1] 204:9
neonatal [2] 7:11, 9:17
neonate [1] 23:15
Neonatologist
[1] - 13:25
nephrectomies
[9] - 40:21, 40:23,
56:22, 56:23,
100:5, 100:6,
152:8, 152:11
nephrectomy
[95] - 24:29, 25:1,
25:2, 27:1, 27:27,
27:29, 28:1, 29:3,
38:13, 46:5, 46:7,
47:2, 47:14,
49:16, 49:21,
49:26, 51:5, 53:6,
55:18, 56:24,
56:25, 58:18,
59:20, 64:6,
65:25, 70:7, 70:9,
82:16, 82:22,
82:27, 89:25,
90:9, 94:21, 95:2,
98:26, 98:28,
99:15, 99:24,
99:26, 99:28,
100:6, 100:7,
100:10, 100:19,
100:25, 100:26,
100:27, 104:18,
105:7, 105:9,
109:17, 109:19,
117:9, 124:12,
127:10, 127:11,
129:11, 129:12,
129:16, 129:17,
130:25, 131:19,
134:28, 136:14,
136:18, 136:19,
136:26, 137:10,
137:11, 137:20,
138:6, 138:13,
138:23, 138:26,
139:5, 139:7,
139:27, 141:21,
141:28, 144:15,
148:8, 148:12,
148:25, 156:12,
167:2, 174:8,
178:19, 179:15,
200:18, 200:22,
201:24, 201:28,
202:2, 211:4,
211:9
nephrectomy"
[1] - 27:22
Nephrologist [1]
- 13:23
nephropathy [1]
- 12:11
neurosurgical
[1] - 10:17
never [27] 33:29, 51:25,
94:21, 95:1,
97:18, 102:28,
106:19, 110:12,
117:10, 118:18,
130:3, 136:1,
136:19, 137:11,
138:5, 153:11,
155:6, 155:27,
155:28, 158:4,
159:12, 159:16,
167:16, 172:10,
192:9, 192:11,
193:19
nevertheless [2]
- 69:17, 188:14
new [7] - 15:15,
37:20, 37:21,
61:8, 74:1, 74:2,
191:14
New [1] - 159:5
newborn [1] 23:15
news [1] - 67:19
next [23] - 14:3,
14:8, 14:10,
16:19, 40:9,
42:29, 43:4,
43:13, 44:11,
44:18, 45:2,
67:25, 72:20,
73:6, 75:9, 82:3,
82:15, 98:15,
136:8, 137:12,
138:4, 139:24,
194:5
NHS [3] 208:22, 211:6,
211:7
night [3] 174:16, 188:17,
213:7
nights [4] - 9:8,
154:13, 154:14,
173:17
nine [1] - 87:24
NO'S [1] - 3:4
no-one [1] - 34:6
Noble [1] - 7:25
nobody [1] 111:18
non [1] - 123:24
non-delegation
[1] - 123:24
none [2] - 16:14,
53:21
nonetheless [1]
- 182:14
norm [2] - 24:1,
39:2
normal [29] 31:23, 38:12,
39:3, 56:11,
56:24, 59:8, 63:2,
63:26, 64:11,
64:12, 64:24,
70:21, 71:10,
97:27, 108:25,
150:19, 151:22,
151:25, 152:3,
152:15, 154:12,
157:17, 161:15,
163:29, 164:24,
168:21, 197:18,
198:10, 202:13
normally [13] 19:18, 21:18,
21:22, 26:23,
50:26, 64:6,
70:21, 71:11,
72:21, 89:12,
92:10, 160:6,
201:14
not...(
INTERJECTION
[1] - 182:7
note [20] - 11:3,
14:11, 14:29,
25:3, 25:8, 25:11,
27:22, 27:28,
28:24, 41:16,
47:25, 62:3, 62:6,
81:18, 92:2,
160:29, 161:6,
163:15, 184:3,
201:20
noted [8] 12:19, 12:20,
18:6, 25:7, 25:9,
64:4, 162:24,
187:29
notes [22] - 1:29,
14:18, 14:20,
15:29, 26:23,
44:28, 62:7,
62:11, 62:16,
66:23, 87:20,
124:12, 145:11,
145:14, 145:15,
146:1, 174:7,
174:10, 198:9,
212:11, 212:26
nothing [8] 18:13, 130:11,
130:13, 131:27,
132:1, 135:26,
150:26, 180:22
Notice [7] 80:28, 81:24,
181:14, 181:20,
181:23, 206:5,
206:7
notice [15] 94:23, 95:11,
95:18, 95:24,
96:15, 96:16,
96:22, 96:25,
96:27, 97:2,
97:12, 103:14,
103:27, 117:11
noting [1] - 27:8
November [4] 17:21, 17:25,
18:1, 18:2
nozzle [1] 16:24
number [39] 10:23, 12:16,
14:18, 19:27,
28:9, 36:19,
36:21, 41:4,
42:21, 43:1, 43:5,
68:19, 74:22,
76:18, 81:5,
86:28, 87:18,
92:18, 98:16,
100:4, 132:24,
153:14, 153:25,
173:1, 186:29,
188:29, 190:18,
190:21, 194:18,
196:19, 197:10,
198:29, 199:18,
203:24, 205:28,
210:14, 213:7,
214:5
numbered [1] 92:19
numbers [3] 9:21, 10:21,
140:6
Nurse [19] 31:17, 31:18,
31:20, 33:15,
33:16, 33:18,
33:20, 33:22,
43:9, 43:19,
45:17, 45:23,
52:4, 52:12,
151:18, 160:24,
162:5
nurse [12] 26:18, 26:25,
31:17, 31:29,
32:3, 33:18,
44:29, 58:24,
133:24, 151:9,
151:18, 162:24
nurses [6] 22:28, 57:12,
58:25, 77:7,
150:22, 189:10
nurses' [2] 22:8, 30:7
Nursing [1] 32:1
nursing [11] 26:12, 31:22,
31:27, 44:25,
57:6, 66:23, 94:4,
96:12, 111:26,
111:28, 151:13
O
o'clock [18] 23:14, 23:21,
23:23, 23:24,
30:7, 45:29,
53:13, 66:20,
107:6, 126:12,
128:13, 128:15,
131:12, 134:27,
142:9, 142:18,
185:17, 191:22
O'CONNOR [1] 2:24
O'Neill [1] 156:21
O'NEILL [3] 2:5, 171:20,
174:2
object [2] 195:20, 195:23
objection [4] 186:15, 195:9,
201:19, 201:20
objectively [1] 110:23
obligation [1] 9:6
obligations [3] 8:18, 24:3,
100:23
oblige [1] - 75:5
obliged [1] 200:4
observation [2]
- 190:24, 198:2
observations [9]
- 38:1, 46:20,
60:3, 64:16,
84:10, 101:20,
179:13, 180:28,
181:19
obstructing [1] 181:9
obtained [1] 31:24
obtaining [1] 40:16
obvious [3] 164:23, 165:24
obviously [5] 111:16, 162:18,
166:6, 181:10,
199:14
occasion [2] 31:13, 31:17
occasionally [3]
- 20:13, 57:19,
154:20
occasions [8] 12:17, 37:6,
88:28, 94:28,
118:13, 118:22,
164:8, 194:18
occur [3] 30:13, 71:6,
204:5
occurred [18] 12:5, 60:7, 67:12,
68:6, 68:14,
68:20, 86:19,
109:10, 121:7,
121:22, 129:14,
130:26, 130:29,
149:29, 175:18,
204:19, 204:20,
204:26
occurrence [2] 20:11, 150:10
October [3] 17:20, 87:28,
88:12
odd [3] - 139:28,
140:3, 157:19
odds [1] 158:17
oesophageal [1]
- 23:16
20
Gwen Malone Stenography Services Ltd.
oesophagus [2]
- 23:17, 23:19
OF [23] - 1:3,
1:14, 80:1, 107:2,
170:16, 177:10,
178:26, 185:1,
189:23, 193:1,
193:26, 205:9,
207:15, 211:19,
214:12
of...(
INTERJECTION
[1] - 201:1
offer [1] - 176:26
office [3] 70:24, 117:22,
117:23
Officer [1] - 81:8
official [13] 19:21, 21:29,
25:12, 25:20,
25:21, 25:29,
26:4, 26:15,
27:14, 27:16,
27:18, 64:29,
128:2
often [7] - 15:17,
25:23, 37:6,
46:24, 57:22,
95:20, 105:29
old [3] - 60:19,
61:1, 61:2
olive [1] - 38:2
Olive [2] - 46:1,
101:27
omission [1] 124:13
ON [2] - 1:14,
4:1
on-call [14] - 9:6,
9:7, 9:8, 9:11,
9:13, 10:9, 23:5,
23:7, 24:10,
152:20, 154:13,
154:14, 173:17,
188:18
on-going [1] 106:12
on.. [1] - 103:5
once [5] - 52:27,
145:22, 203:10,
209:3, 209:4
oncological [3] 7:11, 9:9, 9:18
Oncologist [2] 5:7, 190:16
oncologist [1] 191:9
Oncology [2] 23:27, 39:15
oncology [7] 6:15, 40:19,
100:3, 154:15,
173:17, 191:7,
191:17
one [134] - 6:11,
6:22, 8:12, 12:22,
12:26, 13:3, 14:3,
15:25, 21:11,
22:7, 22:20,
22:21, 24:11,
26:18, 27:19,
28:9, 28:11,
32:27, 33:1, 34:6,
35:8, 37:23,
37:24, 40:6,
41:15, 42:18,
49:12, 53:1, 53:2,
57:5, 58:24, 59:3,
64:28, 65:28,
69:2, 70:21, 72:4,
73:21, 73:25,
73:28, 74:15,
75:6, 78:13,
79:11, 79:13,
82:3, 85:16,
85:20, 87:29,
88:18, 89:24,
90:29, 91:26,
92:7, 93:24,
94:22, 95:23,
97:6, 98:3, 98:11,
98:19, 100:2,
100:6, 100:14,
102:16, 102:27,
103:8, 103:11,
104:14, 104:17,
105:21, 105:25,
106:13, 110:22,
111:17, 111:26,
112:3, 115:15,
116:26, 117:10,
119:12, 122:25,
126:6, 126:25,
133:23, 135:8,
136:15, 138:25,
143:25, 144:11,
149:21, 149:23,
149:25, 150:21,
152:24, 152:28,
152:29, 159:7,
161:16, 161:20,
164:13, 164:22,
166:18, 166:28,
168:17, 171:20,
172:17, 173:12,
176:29, 177:7,
179:4, 185:9,
185:18, 185:29,
189:6, 190:10,
195:14, 197:9,
198:5, 198:12,
198:23, 201:6,
202:18, 202:28,
203:28, 203:29,
211:27, 212:3
onerous [3] 9:20, 23:6, 191:2
ones [1] - 4:15
ongoing [5] 12:10, 24:4,
24:13, 59:13,
76:27
onwards [1] 190:16
open [1] - 7:29
operate [6] 8:27, 9:2, 24:19,
35:19, 82:28,
202:11
operated [4] 34:15, 35:16,
36:20, 36:21
operates [2] 22:14, 36:13
operating [34] 8:25, 10:9, 41:12,
43:2, 43:6, 44:13,
44:20, 44:22,
44:27, 44:28,
51:28, 58:21,
59:1, 96:22, 98:2,
98:9, 98:17,
105:13, 122:9,
126:16, 130:15,
142:25, 149:23,
150:23, 154:27,
162:3, 163:13,
197:16, 197:21,
197:22, 197:24,
198:6, 208:11,
208:24
operation [189] 15:15, 28:26,
37:25, 41:18,
41:19, 41:21,
42:20, 42:21,
44:4, 46:21,
47:21, 47:23,
47:28, 49:17,
52:22, 53:24,
54:17, 54:18,
62:2, 62:3, 62:6,
73:14, 73:17,
82:6, 84:19, 91:5,
91:6, 91:22,
92:27, 93:9,
94:20, 95:26,
95:28, 95:29,
96:3, 98:26,
98:28, 99:4,
99:20, 100:17,
100:22, 101:8,
101:9, 103:28,
105:2, 105:19,
106:16, 108:18,
108:22, 109:12,
109:14, 109:16,
109:27, 110:25,
111:8, 111:13,
111:19, 112:2,
112:6, 112:10,
112:12, 112:17,
112:22, 112:23,
113:5, 113:9,
113:21, 113:26,
114:4, 114:24,
115:6, 115:8,
115:11, 115:23,
115:25, 116:5,
116:11, 117:8,
118:16, 118:17,
119:2, 120:28,
121:19, 121:29,
123:10, 123:19,
124:4, 124:19,
125:1, 126:3,
127:8, 129:15,
129:25, 130:6,
130:8, 131:1,
131:2, 131:4,
131:18, 131:25,
132:18, 132:20,
132:21, 132:24,
132:29, 133:6,
134:10, 134:20,
134:22, 135:5,
135:17, 135:20,
136:5, 136:6,
136:8, 137:20,
137:21, 139:22,
140:22, 140:29,
141:27, 142:2,
142:3, 142:8,
142:10, 142:24,
142:25, 142:29,
143:16, 143:18,
143:19, 144:21,
146:18, 146:21,
147:17, 148:3,
150:7, 150:16,
155:5, 157:16,
157:17, 158:28,
159:16, 159:21,
159:27, 160:4,
166:23, 167:1,
167:6, 167:18,
167:28, 168:26,
169:20, 174:21,
177:19, 197:26,
201:4, 202:6,
202:14, 202:18,
203:20, 204:13,
206:24, 208:10,
208:11, 208:13,
208:19, 209:5,
209:6, 209:7,
209:17, 209:18,
209:19, 209:23,
209:28, 209:29,
210:2, 210:3,
210:11, 210:13,
210:19, 211:5,
211:8, 211:9,
211:11, 211:12,
213:10
operational [3] 41:16, 56:13,
151:25
operations [18] 98:24, 99:1, 99:5,
99:14, 100:13,
105:21, 105:22,
148:17, 157:15,
160:11, 193:20,
200:18, 200:20,
202:4, 202:7,
202:8, 202:10,
202:12
operative [6] 56:29, 57:6,
92:25, 124:5,
148:9, 191:6
Operative [2] 8:11, 8:14
operatively [1] 58:1
opinion [7] 172:19, 188:16,
188:20, 188:21,
189:11, 206:19,
212:18
opinions [3] 22:27, 54:9,
118:9
opportunities
[1] - 93:27
opportunity [16]
- 29:21, 29:23,
52:24, 72:9, 73:4,
79:5, 101:12,
101:14, 104:9,
114:21, 115:3,
115:4, 123:17,
151:4, 155:11,
188:7
opposed [2] 87:1, 133:13
option [12] 28:13, 28:20,
28:21, 55:27,
95:25, 146:24,
146:25, 177:3,
177:5, 178:15
options [3] 28:9, 28:11,
177:2
or...(
INTERJECTION
[1] - 26:26
orally [1] 198:19
orchestra [1] 191:10
order [4] - 26:19,
42:19, 98:13,
140:20
organ [3] - 70:1,
160:13, 161:20
organise [2] 6:20, 58:28
organised [1] 18:20
original [3] 13:17, 29:27,
206:7
Ormond [19] 6:26, 27:11,
92:16, 94:13,
95:5, 97:17,
116:18, 116:21,
116:22, 117:14,
117:15, 119:8,
179:27, 180:7,
180:10, 184:6,
196:22, 197:2,
197:4
ORMSBY [1] 2:19
orthopaedic [1]
- 23:12
Oslizlok [4] 187:5, 187:6,
187:18, 189:20
OSLIZLOK [3] 3:10, 187:8,
189:23
oslizlok [1] 187:11
otherwise [6] 55:19, 57:2,
110:5, 131:29,
148:22, 202:11
ought [5] 82:22, 82:24,
82:25, 84:28,
92:1
out-of-hours [1]
- 72:11
out-patient [1] 10:14
out-patients [7]
21
Gwen Malone Stenography Services Ltd.
- 8:21, 10:19,
16:8, 88:9,
105:20, 154:26,
173:23
Out-Patients
[14] - 10:10, 15:2,
15:29, 19:7,
19:18, 21:15,
21:18, 21:23,
22:3, 22:14,
22:18, 24:25,
26:13, 111:21
outcome [4] 79:23, 106:23,
158:8, 165:26
outline [12] 6:8, 7:7, 8:4,
8:17, 15:9, 18:5,
22:12, 24:26,
60:5, 66:26,
175:20, 185:16
outs [1] - 24:9
outset [7] 14:24, 62:16,
98:3, 148:26,
149:12, 188:10,
197:8
outside [4] 31:23, 58:13,
59:17, 71:10
outstanding [19]
- 75:1, 77:25,
77:26, 77:27,
77:28, 78:1, 78:3,
78:5, 78:6, 78:9,
78:13, 78:14,
78:16, 78:17,
78:19, 78:21,
78:23, 78:25,
78:26
overall [4] 41:8, 85:5,
169:16
overload [1] 177:24
overseas [1] 5:26
overstating [1] 58:16
own [25] - 30:11,
54:10, 72:29,
85:25, 87:29,
91:15, 101:20,
106:17, 118:9,
128:19, 130:5,
135:29, 143:28,
145:15, 146:15,
167:15, 167:25,
169:18, 172:6,
172:7, 174:14,
174:28, 189:12,
191:26, 195:8
P
pace [3] - 74:13,
95:16, 153:22
packet [10] 20:6, 20:27,
20:29, 21:13,
21:17, 27:17,
27:19, 50:20,
64:25, 109:7
packets [2] 21:1, 21:4
PACS [7] 20:15, 20:18,
20:20, 22:5, 22:9,
71:19, 75:9
Paediatric [13] 5:6, 5:7, 5:8, 7:1,
7:4, 10:5, 13:22,
32:12, 39:9,
39:14, 39:20,
190:15, 196:7
paediatric [34] 6:12, 6:15, 7:11,
7:12, 7:17, 7:27,
7:28, 9:14, 9:16,
9:19, 9:23, 24:5,
24:15, 24:16,
39:22, 40:18,
72:4, 75:29,
83:25, 100:3,
159:7, 159:8,
159:9, 172:22,
173:5, 173:21,
187:19, 187:24,
188:13, 191:9,
191:17, 194:21,
196:9, 196:18
paediatrician [1]
- 32:10
Paediatrician [2]
- 13:25, 40:17
page [71] - 5:20,
7:18, 7:21, 8:4,
11:19, 13:7,
13:14, 13:21,
14:29, 16:3,
17:13, 17:22,
18:3, 18:25,
19:14, 25:3,
43:14, 49:18,
57:9, 57:12,
57:13, 62:4,
66:23, 68:23,
68:29, 74:6,
74:10, 77:11,
78:11, 78:29,
81:26, 84:2, 84:5,
84:7, 87:13,
87:20, 87:24,
87:29, 92:8, 92:9,
92:12, 92:13,
92:18, 94:13,
97:29, 102:6,
102:14, 103:1,
116:25, 116:28,
116:29, 124:1,
143:23, 156:22,
156:24, 156:25,
157:5, 157:6,
174:7, 180:9,
180:19, 182:27,
183:2, 183:8,
183:11, 183:15,
184:16, 190:8,
196:14
PAGE [1] - 3:4
pages [1] 87:24
pagination [3] 16:3, 92:12,
119:26
palpate [2] 164:11, 164:16
palpates [1] 164:22
palpation [1] 165:1
paper [1] 173:24
papers [1] 173:25
paperwork [7] 153:29, 154:1,
154:2, 154:7,
154:10, 154:17,
154:22
paragraph [6] 13:2, 13:16, 74:9,
88:1, 92:17,
92:19
parallel [11] 36:14, 36:15,
36:17, 36:18,
37:11, 37:13,
60:26, 73:14,
73:17, 74:12,
117:3
Paran [314] 6:17, 6:21, 13:9,
30:14, 30:15,
30:20, 32:6,
32:21, 32:27,
33:21, 33:22,
34:8, 35:11,
35:12, 37:18,
38:8, 38:16,
38:19, 38:25,
39:4, 39:6, 39:19,
39:24, 39:29,
43:7, 43:9, 43:13,
43:20, 44:14,
45:8, 45:10,
45:11, 45:19,
45:21, 45:22,
45:24, 45:26,
46:4, 46:6, 46:12,
46:20, 46:29,
47:1, 47:4, 47:11,
47:26, 48:15,
48:16, 49:15,
49:20, 49:25,
49:26, 49:27,
49:28, 50:7, 51:9,
51:12, 51:14,
51:18, 52:14,
52:20, 52:24,
53:5, 53:13,
53:23, 54:4,
55:17, 55:21,
55:23, 56:6, 56:9,
58:13, 58:14,
58:17, 58:26,
59:7, 59:9, 59:19,
59:25, 59:29,
60:1, 60:9, 60:22,
61:16, 61:21,
62:2, 62:6, 63:1,
63:8, 63:11,
64:12, 64:15,
64:21, 65:9, 66:7,
72:24, 73:2,
74:16, 81:24,
82:19, 83:25,
84:19, 84:26,
86:18, 89:24,
90:26, 90:27,
91:4, 91:10,
91:24, 91:28,
93:11, 95:1,
95:10, 95:12,
96:9, 96:11,
96:16, 97:20,
98:14, 98:15,
99:22, 99:24,
99:27, 100:24,
100:29, 101:11,
101:14, 102:8,
103:9, 103:25,
104:7, 104:8,
104:27, 104:29,
105:12, 105:26,
106:18, 108:27,
109:2, 109:4,
112:11, 112:23,
113:12, 114:26,
114:29, 115:3,
115:11, 115:23,
115:27, 115:28,
116:10, 117:20,
117:24, 118:16,
118:23, 118:28,
120:27, 121:7,
121:18, 121:25,
122:1, 122:15,
122:19, 123:9,
124:4, 124:29,
125:5, 125:6,
125:26, 126:7,
126:13, 126:21,
129:10, 130:15,
130:25, 131:3,
131:8, 131:19,
131:24, 132:6,
132:11, 132:15,
133:7, 133:18,
133:27, 133:29,
134:8, 134:13,
134:20, 134:23,
134:25, 135:17,
135:28, 136:1,
136:11, 136:16,
137:9, 137:13,
137:20, 137:24,
138:3, 138:16,
139:7, 139:11,
139:24, 140:9,
140:17, 143:1,
143:3, 143:10,
144:4, 144:10,
144:16, 144:22,
144:29, 145:2,
145:8, 145:9,
145:20, 145:22,
145:26, 145:27,
146:2, 146:8,
146:10, 146:14,
146:20, 146:23,
146:28, 147:4,
147:12, 148:1,
148:20, 148:26,
148:27, 148:28,
149:1, 149:11,
149:14, 149:25,
150:2, 150:12,
150:18, 150:27,
151:4, 151:8,
152:12, 152:17,
152:23, 153:11,
153:16, 154:2,
154:29, 155:9,
155:16, 155:17,
155:23, 156:4,
156:23, 158:23,
159:1, 159:2,
159:13, 159:19,
159:28, 160:6,
161:7, 162:8,
162:16, 162:18,
162:21, 162:26,
162:29, 163:9,
163:27, 164:5,
166:17, 166:22,
167:15, 167:21,
167:22, 167:26,
168:6, 168:25,
168:27, 169:1,
169:2, 169:18,
169:20, 172:10,
177:19, 177:21,
178:19, 178:20,
179:14, 180:2,
180:25, 182:24,
193:7, 196:29,
197:1, 197:29,
206:24, 209:21,
209:23, 210:10,
210:12, 210:26,
214:26, 214:28
PARAN [3] - 1:9,
2:21, 133:9
paran [13] 44:17, 64:7, 65:6,
65:10, 96:3,
148:2, 153:9,
153:20, 158:10,
159:17, 159:25,
167:29, 184:19
Paran" [1] 161:1
paran's [1] 62:3
Paran's [28] 38:1, 38:3, 52:14,
86:16, 97:5,
103:16, 104:11,
104:23, 130:14,
134:7, 135:3,
136:4, 138:19,
140:13, 145:11,
146:4, 147:3,
147:10, 152:22,
156:2, 158:3,
158:26, 161:9,
162:11, 166:19,
178:4, 178:13,
204:14
paranoid [1] 33:2
pardon [1] 122:18
parenchyma [1]
- 164:15
parent [2] 22:21, 34:3
parent's [4] 29:17, 34:20,
34:21, 35:1
parental [1] -
22
Gwen Malone Stenography Services Ltd.
51:16
parents [93] 19:2, 22:11,
23:22, 24:25,
26:17, 26:22,
26:24, 26:28,
28:1, 28:10,
28:14, 29:16,
30:25, 31:1,
31:13, 31:25,
32:15, 32:21,
33:13, 33:26,
33:28, 33:29,
35:5, 35:6, 35:11,
36:28, 52:13,
66:19, 66:25,
66:27, 67:11,
67:16, 67:28,
68:6, 68:14,
75:28, 76:6,
83:28, 84:18,
87:6, 87:9, 90:5,
100:11, 100:16,
106:18, 106:20,
110:20, 110:24,
110:27, 110:29,
111:6, 111:13,
111:25, 138:7,
157:9, 160:20,
160:28, 161:8,
161:15, 162:9,
162:17, 162:19,
162:25, 162:28,
164:3, 167:20,
167:21, 167:24,
168:1, 168:6,
168:12, 168:27,
169:3, 169:4,
169:9, 169:13,
169:19, 169:26,
169:27, 169:29,
170:10, 177:18,
177:25, 177:29,
178:1, 178:6,
191:8, 192:3,
204:13, 204:17,
204:18, 213:19,
214:7
parents' [4] 92:27, 93:8,
162:21, 163:1
part [40] - 9:16,
9:26, 10:7, 22:16,
28:4, 37:21,
45:13, 52:10,
52:21, 58:28,
62:9, 70:4, 73:23,
74:15, 74:18,
76:6, 83:21,
83:22, 104:7,
105:13, 109:14,
110:16, 115:26,
123:26, 124:5,
124:9, 124:27,
138:19, 140:14,
152:3, 173:6,
173:28, 173:29,
175:28, 184:9,
188:28, 191:15,
198:7, 198:10,
203:6
PART [1] - 1:3
part-time [7] 9:16, 9:26, 10:7,
37:21, 73:23,
74:15, 74:18
participate [2] 76:24, 77:1
particular [12] 23:29, 38:4, 51:1,
59:19, 85:13,
134:15, 134:24,
188:5, 190:26,
208:19, 213:24
particularly [8] 16:17, 22:18,
22:25, 22:29,
23:6, 160:3,
188:27, 207:5
party [1] - 2:27
pass [2] - 31:18,
111:26
passed [13] 16:23, 33:17,
33:19, 33:21,
39:19, 111:29,
114:1, 144:27,
159:8, 168:17,
168:20, 168:26,
169:12
passes [1] - 12:7
past [3] 126:14, 126:15,
213:1
path [1] - 213:24
pathway [1] 213:3
pathways [1] 20:21
patient [151] 8:20, 10:14, 12:2,
15:6, 15:11,
15:20, 15:27,
20:7, 21:1, 28:16,
28:21, 29:20,
30:18, 32:5,
35:24, 36:27,
37:2, 37:4, 41:3,
41:12, 41:25,
42:6, 43:18, 45:2,
45:26, 47:3, 47:8,
48:15, 48:17,
50:9, 52:5, 52:17,
53:11, 56:13,
56:19, 56:21,
57:24, 59:14,
60:7, 60:9, 60:10,
61:9, 70:1, 70:29,
71:1, 71:14,
71:21, 72:11,
73:12, 74:28,
74:29, 82:8, 82:9,
83:9, 85:5, 85:7,
86:4, 89:12, 90:8,
90:12, 92:22,
93:23, 94:1, 94:3,
94:4, 94:15,
97:24, 98:11,
99:6, 99:10,
103:5, 105:6,
112:2, 117:3,
126:13, 126:16,
127:13, 127:20,
128:3, 128:12,
128:20, 128:25,
134:15, 134:26,
134:28, 135:9,
135:23, 136:8,
136:10, 136:20,
136:26, 136:27,
137:1, 137:12,
137:23, 137:25,
138:4, 138:8,
138:12, 138:23,
139:5, 139:13,
139:19, 139:20,
139:21, 139:24,
139:28, 140:12,
140:24, 140:25,
141:7, 141:16,
141:18, 142:19,
143:9, 143:15,
143:22, 144:8,
144:11, 145:3,
145:6, 145:9,
145:10, 145:16,
148:8, 151:14,
151:19, 151:23,
151:26, 153:3,
153:12, 153:13,
153:19, 154:3,
154:5, 155:28,
157:8, 158:6,
158:8, 164:4,
164:28, 169:17,
177:1, 191:14,
204:2, 209:24,
213:29
Patient [2] 94:19, 117:8
patient's [18] 12:10, 19:17,
19:19, 19:20,
19:29, 20:7,
21:14, 41:5,
56:16, 60:11,
71:14, 84:14,
93:26, 106:26,
134:16, 163:23,
163:24, 167:20
Patients [14] 10:10, 15:2,
15:29, 19:7,
19:18, 21:15,
21:18, 21:23,
22:3, 22:14,
22:18, 24:25,
26:13, 111:21
patients [77] 6:13, 8:21, 9:2,
10:19, 10:20,
10:21, 10:22,
10:24, 10:26,
16:8, 23:2, 24:13,
24:15, 24:21,
30:3, 30:5, 30:10,
35:15, 35:19,
35:23, 36:18,
36:20, 36:21,
36:28, 37:1,
40:23, 40:24,
41:9, 59:16, 71:9,
71:28, 77:7,
78:15, 78:17,
78:20, 78:28,
78:29, 79:1, 86:7,
88:9, 94:17,
94:17, 98:1,
99:17, 105:20,
117:6, 117:6,
138:10, 138:14,
139:14, 139:18,
139:26, 142:29,
143:3, 143:5,
144:6, 144:12,
144:13, 144:17,
153:10, 154:4,
154:19, 154:22,
154:26, 173:23,
176:7, 176:24,
177:4, 188:2,
191:2, 191:5,
191:22, 192:3,
203:2, 203:3
patients' [1] 154:19
pattern [1] 24:20
pause [7] 52:25, 63:8,
74:27, 94:17,
117:6, 122:12,
190:11
paused [1] 63:3
pelvis [1] 164:10
people [29] 22:27, 34:5, 37:9,
46:25, 77:6,
83:20, 84:25,
94:9, 97:22,
117:20, 136:23,
152:27, 185:6,
186:10, 192:15,
201:4, 203:18,
210:7, 212:22,
213:9, 213:13,
213:14, 213:17,
213:22, 213:23,
214:2, 214:5,
214:6
per [5] - 10:20,
16:16, 57:13,
73:21, 176:3
perceived [2] 190:25, 201:26
perception [3] 161:9, 161:10,
163:29
perfectly [1] 204:22
perform [17] 8:23, 17:26,
39:26, 46:21,
47:2, 49:20,
49:25, 52:27,
53:6, 57:6, 58:15,
58:17, 68:1, 70:7,
70:8, 71:25,
144:1
performance [7]
- 39:16, 46:5,
59:20, 77:9,
77:25, 82:16,
166:20
performed [11] 15:15, 18:1,
40:21, 40:23,
43:9, 82:25, 88:8,
94:22, 95:1,
117:10, 176:3
performing [4] 30:23, 51:5,
55:18, 56:11
perhaps [27] 4:10, 24:18,
34:28, 35:3,
49:12, 53:11,
58:16, 90:5,
96:18, 98:29,
103:11, 103:15,
110:9, 147:15,
147:18, 171:9,
171:16, 175:24,
177:23, 178:17,
179:8, 183:5,
184:18, 188:6,
194:7, 200:16,
206:23
period [11] 10:29, 22:15,
23:2, 23:4, 40:9,
93:22, 96:19,
96:27, 97:16,
100:1, 172:8
peripheral [1] 24:17
permission [2] 2:27, 79:17
persists [1] 25:25
person [16] 41:11, 44:26,
72:21, 89:21,
92:10, 93:17,
99:20, 113:23,
113:25, 140:17,
189:13, 201:12,
203:25, 203:28,
203:29, 205:22
person's [1] 203:22
personal [2] 68:27, 204:24
personality [2] 138:19, 138:20
personally [9] 55:16, 74:24,
75:23, 83:8, 85:2,
98:2, 169:6,
204:22, 211:27
personnel [2] 94:2, 117:16
perspective [2] 44:5, 191:19
phenomenon
[1] - 19:22
phlebotomy [1]
- 57:27
phone [1] 22:29
photocopied [1]
- 2:26
photocopying
[1] - 183:22
physically [2] 35:21, 61:29
pick [2] - 56:20,
191:23
picked [3] 12:13, 14:15,
23
Gwen Malone Stenography Services Ltd.
14:21
picture [1] - 51:3
piece [5] 112:29, 115:14,
119:4, 119:6,
119:10
pieces [1] 102:17
pilot [3] - 76:25,
165:22, 166:1
pity [1] - 29:16
place [32] 17:29, 21:9,
22:18, 22:26,
23:1, 23:3, 28:15,
29:11, 48:12,
48:20, 49:7, 49:9,
67:8, 70:24,
84:27, 93:11,
101:11, 110:4,
114:2, 129:6,
138:7, 146:17,
150:7, 150:8,
150:13, 152:27,
160:20, 161:13,
203:16, 212:9
PLACE [1] - 1:17
placed [2] 50:15, 52:12
places [1] 152:28
plan [14] - 19:12,
27:27, 28:15,
28:18, 57:13,
165:7, 165:14,
165:22, 165:23,
165:25, 166:13,
169:28, 170:1,
170:2
plane [3] 165:29, 210:22,
212:1
planned [5] 82:26, 82:27,
164:20, 169:27,
170:6
planning [3] 72:23, 73:14,
180:8
platform [1] 7:26
pleasure [1] 188:8
plenty [1] 122:15
plus [1] - 173:17
point [48] - 4:7,
8:2, 31:2, 31:5,
31:11, 39:22,
40:12, 40:13,
46:12, 51:17,
63:12, 63:14,
64:8, 65:6, 65:15,
67:6, 68:7, 69:27,
83:2, 88:26,
92:23, 92:24,
93:26, 93:29,
104:13, 106:25,
119:6, 119:10,
123:4, 135:6,
158:15, 161:21,
161:23, 161:29,
162:11, 163:3,
167:23, 169:2,
173:11, 181:10,
181:13, 182:9,
188:25, 189:7,
192:13, 200:26,
201:11, 212:5
pointed [6] 9:28, 147:10,
148:1, 148:23,
148:24, 163:18
pointing [4] 147:22, 148:6,
148:13, 163:12
points [8] - 8:20,
19:29, 20:7, 93:2,
94:2, 94:4,
111:27, 199:2
policy [6] 56:13, 71:12,
73:7, 151:25,
175:14, 176:23
polite [3] 78:16, 78:18,
79:2
politically [1] 10:1
poor [2] - 17:1,
204:8
poorly [1] 164:13
porters [1] 77:8
portion [2] 120:22, 180:22
position [18] 6:29, 32:11,
40:17, 58:11,
79:16, 86:1,
94:19, 115:6,
117:8, 140:24,
141:6, 141:18,
157:20, 158:17,
159:23, 168:4,
197:6, 197:25
positioned [1] 145:10
positioning [2] -
60:10, 92:29
positions [1] 10:2
positive [1] 91:5
possibility [1] 19:5
possible [26] 19:3, 30:6, 31:9,
31:10, 35:21,
35:25, 55:24,
60:23, 69:8, 71:3,
88:21, 89:2,
91:28, 96:21,
98:12, 98:13,
100:21, 131:8,
132:27, 138:21,
143:12, 156:5,
156:8, 156:9,
164:18, 179:11
possibly [9] 10:28, 29:4, 48:7,
53:18, 90:14,
121:28, 131:14,
158:27, 184:8
post [5] - 40:13,
40:14, 40:16,
126:19, 144:2
Post [1] - 7:15
posts [1] 103:11
potential [6] 67:9, 72:6,
117:28, 118:8,
139:4, 143:13
practical [1] 77:25
practice [42] 10:24, 25:25,
32:23, 32:25,
38:6, 40:19, 51:4,
51:22, 55:14,
55:27, 58:27,
73:7, 77:7, 85:21,
96:23, 97:27,
98:3, 113:23,
114:23, 124:18,
148:16, 150:19,
150:23, 151:23,
151:25, 152:3,
152:26, 159:6,
160:11, 160:16,
160:17, 174:14,
174:17, 174:25,
194:24, 197:15,
197:18, 197:23,
198:10, 202:13,
204:8, 211:3
Practice [1] 85:16
practices [2] 125:4, 194:19
PRACTISE [1] 1:3
practised [3] 176:20, 176:22
practitioner [2] 17:11, 18:7
practitioners [3]
- 50:24, 76:22,
76:28
PRACTITIONE
RS [1] - 1:4
praise [1] 159:20
praised [1] 159:29
praising [2] 159:25, 168:24
pre [6] - 56:29,
57:6, 75:3, 92:25,
144:2, 153:14
pre-admission
[1] - 75:3
pre-med [1] 153:14
pre-operative
[3] - 56:29, 57:6,
92:25
precise [4] 45:25, 128:28,
129:1, 129:4
precisely [3] 77:2, 128:19,
128:21
predecessor [1]
- 15:14
predicted [1] 106:24
prefer [1] 186:10
premed [1] 139:21
premedical [1] 45:5
PRENTICE [1] 2:19
preoperative [1]
- 93:5
preparation [3] 58:9, 94:26,
139:10
prepare [16] 52:21, 53:23,
82:17, 82:20,
94:19, 95:12,
117:7, 119:14,
123:9, 139:8,
155:5, 180:3,
184:25, 202:16,
205:23, 210:10
prepared [16] 24:18, 117:18,
136:28, 155:21,
182:20, 183:2,
186:27, 187:5,
187:12, 187:26,
189:3, 190:7,
190:23, 192:18,
205:15, 205:24
preparing [2] 144:21, 206:5
prepped [1] 138:27
prerogative [1] 125:9
present [12] 108:5, 108:17,
108:19, 131:3,
131:25, 132:7,
141:2, 145:10,
162:2, 162:13,
163:6, 163:8
presentation [1]
- 214:18
presented [2] 98:8, 177:3
presenting [1] 200:4
preserved [2] 56:17, 56:18
pressure [10] 40:20, 51:26,
68:15, 74:18,
140:5, 146:6,
146:14, 157:28,
159:14, 167:11
pressured [1] 125:4
pressures [2] 83:11, 140:4
presumably [9] 26:7, 42:10,
98:22, 115:20,
117:13, 135:25,
139:6, 141:6,
199:15
Presumably [1]
- 98:19
presume [4] 28:2, 147:5,
193:19, 202:18
prevent [3] 158:7, 208:27,
212:13
prevented [1] 175:26
previous [5] 18:19, 39:23,
61:10, 104:17,
147:13
previously [3] 40:3, 40:21,
40:23
primarily [5] 6:12, 15:22,
15:24, 19:11,
33:4
principally [1] 185:9
principle [1] 198:13
print [1] - 26:19
printed [2] 26:27, 26:28
priorities [1] 110:11
privacy [1] 79:19
private [1] 192:10
problem [34] 9:13, 15:9, 15:20,
16:18, 17:17,
19:25, 31:10,
55:25, 55:26,
55:29, 57:29,
61:11, 69:12,
70:19, 71:5,
75:15, 87:5,
87:22, 88:6, 89:6,
89:7, 102:28,
103:22, 108:24,
110:17, 137:2,
142:1, 151:20,
151:29, 158:6,
181:10, 183:22,
203:13, 203:14
problems [14] 9:9, 12:11, 57:19,
57:21, 59:19,
67:25, 74:3,
74:29, 77:27,
87:25, 136:15,
191:11, 192:16,
212:1
procedural [1] 50:3
procedure [107]
- 28:28, 29:4,
29:5, 39:27,
41:28, 42:1,
42:18, 42:25,
42:27, 42:28,
42:29, 43:4,
43:11, 43:13,
43:16, 43:21,
44:11, 44:14,
44:18, 44:23,
45:2, 46:10,
24
Gwen Malone Stenography Services Ltd.
46:14, 46:18,
46:19, 46:27,
46:29, 52:10,
53:9, 53:14,
53:16, 56:11,
56:14, 61:22,
61:23, 61:24,
61:29, 63:25,
63:28, 68:8,
68:13, 68:17,
71:26, 72:21,
74:27, 74:28,
76:5, 83:24,
89:13, 89:16,
89:28, 89:29,
90:12, 90:15,
90:18, 91:3,
92:10, 92:29,
95:15, 97:2,
97:25, 100:9,
101:14, 103:14,
103:18, 104:4,
104:5, 104:7,
104:8, 104:13,
104:22, 105:12,
105:15, 105:27,
113:22, 118:25,
121:8, 122:7,
123:17, 123:18,
125:12, 131:13,
131:20, 131:22,
133:3, 134:13,
135:11, 135:24,
137:13, 143:6,
147:6, 147:7,
148:18, 148:25,
164:20, 174:21,
175:23, 175:26,
175:28, 176:12,
177:1, 184:4,
184:4, 198:5,
198:7, 203:27
procedures [23]
- 7:28, 36:29,
40:27, 41:27,
43:10, 77:26,
97:28, 98:19,
100:13, 100:24,
122:22, 136:24,
149:27, 171:28,
172:21, 173:1,
173:7, 175:21,
176:3, 191:7,
200:23, 201:27,
203:23
proceed [12] 47:9, 101:12,
122:20, 129:16,
129:17, 130:9,
130:10, 146:16,
146:20, 146:23,
146:24, 177:8
proceeded [1] 102:29
proceeding [3] 4:21, 125:14,
130:11
proceedings [1]
- 185:12
process [12] 31:15, 33:3, 37:5,
61:25, 62:13,
124:9, 155:8,
157:18, 175:8,
176:7, 176:10,
215:10
processes [1] 156:2
produce [6] 26:14, 64:29,
128:1, 200:4,
202:11, 203:19
produced [6] 127:18, 127:29,
128:9, 128:10,
143:24, 200:10
producing [1] 15:16
Prof [77] - 4:22,
13:10, 13:15,
14:28, 15:13,
34:29, 40:10,
54:2, 57:10,
65:18, 74:7, 74:8,
74:9, 84:4, 91:4,
99:19, 103:25,
106:13, 108:15,
115:5, 115:21,
124:3, 124:11,
124:20, 131:15,
135:29, 150:5,
165:3, 165:20,
165:28, 166:10,
170:19, 174:5,
180:21, 181:16,
182:18, 183:10,
185:21, 187:27,
188:1, 188:4,
188:9, 189:13,
190:7, 190:20,
190:25, 191:14,
191:17, 192:20,
193:14, 196:27,
196:28, 197:9,
197:10, 197:12,
197:29, 198:16,
200:17, 201:24,
203:1, 204:12,
204:13, 204:16,
204:22, 206:10,
206:14, 206:21,
206:23, 207:1,
207:4, 207:10,
207:22, 207:24,
207:27, 208:1,
208:2, 209:21
pROF [2] - 1:9,
3:5
PROF [8] - 2:18,
4:24, 80:24,
107:2, 108:12,
171:13, 177:12,
179:1
profession [1] 158:24
professional [5]
- 54:3, 81:14,
203:5, 204:3,
204:10
professionally
[2] - 85:2, 204:7
professor [1] 80:27
Professor [60] 4:27, 5:2, 5:6,
5:8, 5:15, 5:20,
8:14, 8:16, 11:2,
11:5, 11:16, 20:2,
29:24, 38:27,
40:26, 42:3,
47:20, 54:8, 55:1,
59:27, 68:18,
68:21, 68:23,
70:4, 74:23,
76:15, 77:11,
79:22, 79:25,
87:16, 90:19,
91:12, 92:14,
106:27, 116:9,
124:1, 128:5,
132:16, 133:19,
133:24, 134:7,
139:2, 142:21,
149:20, 156:27,
158:12, 166:7,
169:21, 169:27,
170:12, 171:21,
173:15, 177:17,
178:24, 179:6,
179:19, 183:3,
184:27
Professor's [1] 4:29
profoundly [1] 67:16
profusely [1] 67:16
Programme [4] 16:21, 17:4,
18:16
progress [3] -
20:8, 106:26,
173:8
progresses [1] 195:24
progression [1]
- 83:10
proleptic [1] 5:12
prompted [1] 76:9
proof [1] - 91:5
proper [6] 69:25, 73:12,
101:6, 123:24,
184:20, 208:20
properly [6] 34:21, 50:4, 50:5,
51:21, 105:27,
210:10
prophecy [1] 212:28
prophylactic [2]
- 18:29, 70:10
Prophylaxis [1]
- 18:12
proposal [1] 214:22
propose [8] 4:20, 74:23,
170:20, 185:16,
187:6, 198:20,
198:28, 214:21
proposing [1] 60:19
protect [2] 169:1, 177:20
protected [2] 105:24, 106:2
protocol [5] 106:11, 151:26,
173:3, 212:7,
212:12
protocols [8] 106:4, 106:6,
172:16, 173:10,
212:7, 212:8,
212:19
protracted [1] 172:8
proven [2] 81:13, 109:13
provide [1] 110:4
provided [5] 35:26, 105:23,
190:9, 199:7,
200:19
providing [4] 38:16, 38:28,
198:20, 198:29
provision [1] 58:11
public [1] 175:19
pull [4] - 35:9,
101:24, 133:12
pulled [1] 64:25
Punang [1] 32:12
PURCELL [1] 2:14
pure [1] - 159:8
purely [1] 69:20
Puri [5] - 40:10,
74:7, 74:8, 74:9,
135:29
purpose [2] 32:28, 81:15
purposes [1] 127:17
put [45] - 7:4,
20:20, 34:18,
41:25, 43:9, 48:4,
48:10, 48:11,
48:13, 48:19,
49:3, 49:8, 50:23,
53:21, 53:26,
54:5, 55:8, 60:11,
63:5, 64:25,
68:14, 90:4,
93:10, 96:26,
103:29, 109:8,
113:24, 114:20,
121:19, 128:5,
132:16, 138:2,
146:5, 146:13,
149:20, 157:19,
158:16, 160:9,
161:8, 194:12,
194:17, 199:24,
201:14, 203:16,
209:20
puts [1] - 182:23
putting [2] 142:22, 194:8
Q
quadrant [7] 60:16, 60:28,
61:9, 82:23,
82:28, 104:19,
147:19
Quaglia [2] 39:14, 39:15
qualifications
[1] - 196:13
qualified [3] 100:25, 100:26,
196:14
qualify [1] 214:25
qualities [1] 187:29
Quality [1] - 8:9
quality [5] 28:19, 37:17,
37:18, 76:2, 78:5
quarter [1] 107:11
queried [1] 163:24
queries [4] 33:25, 59:15,
93:8, 154:19
query [6] 31:14, 32:15,
32:16, 92:27,
129:29, 130:3
querying [1] 128:7
QUESTIONED
[3] - 3:8, 171:13,
211:25
qUESTIONED
[1] - 3:18
QUESTIONING
[2] - 177:10,
214:12
questioning [4]
- 48:25, 119:8,
177:23, 195:24
questions [19] 49:12, 49:13,
62:27, 79:5, 79:6,
79:26, 106:28,
170:22, 170:26,
171:11, 171:19,
173:24, 174:4,
184:27, 189:21,
192:27, 205:7,
211:22, 213:19
quickly [3] 77:23, 153:17,
156:5
quinn [3] 73:21, 75:13,
99:11
Quinn [2] - 10:6,
31:18
Quinn's [1] 99:11
quite [37] - 9:20,
18:8, 18:12,
20:11, 23:2,
23:28, 38:10,
44:7, 56:22,
25
Gwen Malone Stenography Services Ltd.
57:20, 60:24,
72:1, 72:7, 83:23,
86:22, 88:19,
90:25, 93:25,
95:8, 95:20,
95:24, 96:22,
129:3, 131:8,
135:9, 135:12,
135:14, 135:15,
137:14, 138:24,
143:27, 145:22,
152:28, 153:25,
170:4, 192:15,
208:6
R
radiation [1] 191:7
radiograph [2] 116:9, 166:29
radiographs [9]
- 115:25, 116:4,
116:6, 116:10,
116:12, 148:16,
151:6, 155:12,
160:11
Radiography [1]
- 20:24
radiography [19]
- 109:22, 109:27,
110:25, 111:7,
111:12, 111:18,
112:5, 112:11,
112:17, 113:2,
113:21, 115:7,
115:12, 115:22,
120:29, 148:21,
156:1, 162:13,
163:10
radiological [4]
- 82:12, 82:13,
87:12, 159:27
radiologist [4] 21:10, 25:21,
70:25, 71:7
Radiologist [1] 26:2
radiologist's [1]
- 70:24
radiology [18] 12:3, 20:29,
25:13, 70:16,
70:22, 70:28,
71:11, 71:17,
72:10, 75:6, 75:8,
84:27, 198:9,
198:11, 213:1,
213:2, 213:8
radius [1] - 77:9
rafters [1] 168:25
raise [6] - 30:26,
85:4, 161:15,
176:14, 185:3,
212:5
raised [20] 30:22, 30:25,
31:1, 31:5, 31:14,
31:16, 32:15,
33:14, 34:10,
35:5, 94:5,
110:20, 110:24,
111:7, 111:25,
174:11, 177:17,
195:26, 202:28
raises [1] 181:23
raising [3] 111:13, 158:10,
158:13
ran [2] - 95:19,
97:27
rang [1] - 45:4
ranks [1] 103:10
rate [2] - 90:8,
176:4
rather [8] - 12:6,
55:13, 66:24,
85:19, 99:20,
127:2, 169:21,
175:15
Ray [1] - 191:17
ray [34] - 12:23,
14:10, 14:11,
14:13, 19:19,
19:25, 20:5, 20:6,
20:9, 20:12,
20:16, 20:27,
20:29, 21:6, 21:9,
21:12, 27:17,
27:18, 27:19,
35:9, 50:16,
50:17, 50:18,
51:3, 53:3, 63:18,
64:29, 69:10,
70:26, 102:25,
160:6, 162:7
rays [53] - 19:17,
19:27, 19:28,
20:11, 20:13,
20:15, 20:18,
20:22, 20:27,
21:8, 21:13,
21:22, 21:24,
22:2, 25:13,
27:17, 32:22,
32:25, 32:28,
33:12, 34:14,
35:13, 50:26,
51:16, 51:17,
51:18, 51:20,
52:25, 63:4, 63:6,
64:13, 64:19,
64:25, 71:13,
71:18, 71:19,
71:22, 75:1, 75:2,
89:15, 97:5,
102:24, 104:24,
104:26, 113:28,
162:5, 162:9,
175:3, 176:15,
212:17
re [4] - 34:5,
66:17, 66:28,
176:26
RE [3] - 3:9,
179:1, 185:1
re-assurance [1]
- 176:26
RE-DIRECT [1] 3:9
REEXAMINATION
[1] - 185:1
RE-EXAMINED
[1] - 179:1
re-implant [1] 66:17
re-vascularise
[1] - 66:28
reached [2] 62:27, 106:9
reaction [1] 137:22
read [27] - 81:28,
84:3, 88:1, 94:14,
109:26, 111:12,
111:18, 112:11,
112:17, 115:7,
115:12, 115:15,
115:16, 115:24,
115:28, 116:3,
116:6, 116:9,
116:12, 117:25,
117:27, 184:8,
187:14, 187:16,
189:4, 190:10,
190:12
reading [6] 110:25, 113:1,
113:2, 113:20,
115:22, 159:24
ready [6] 122:23, 130:9,
130:10, 139:5,
139:11, 210:3
real [2] - 213:20
realised [3] -
29:6, 38:15,
136:12
reality [4] 102:24, 122:9,
122:13, 212:23
really [25] 25:28, 28:15,
50:23, 55:6,
83:21, 88:14,
104:26, 110:24,
111:17, 123:15,
139:14, 139:22,
146:10, 151:5,
178:8, 178:20,
181:2, 181:8,
199:8, 199:14,
200:9, 202:27,
208:4, 212:15,
213:12
reason [9] 33:5, 87:8, 92:1,
104:29, 119:17,
139:6, 146:4,
161:3, 161:5
reasonable [9] 72:7, 86:12, 92:5,
93:19, 138:24,
148:20, 168:3,
204:22, 209:2
reasons [2] 55:19, 95:7
reassemble [1] 215:17
recalling [1] 195:17
receive [3] 71:8, 206:10
received [3] 152:19, 181:15,
207:27
recent [1] 173:9
recently [6] 7:29, 9:15, 18:9,
39:7, 69:21,
173:4
reception [7] 45:27, 52:6,
63:12, 127:14,
127:21, 128:26,
164:3
recognise [5] 29:12, 58:26,
59:2, 110:11,
189:6
recognised [2] 108:25, 188:11
recognises [1] 58:21
recognising [1]
- 176:2
recognition [1] 74:3
recollect [1] 134:6
recollection [17]
- 27:1, 49:24,
127:23, 127:24,
128:20, 131:24,
132:15, 133:28,
133:29, 135:19,
135:22, 137:24,
145:11, 146:8,
150:8, 150:27,
163:20
recommendati
on [1] - 104:16
recommendati
ons [6] - 24:27,
69:16, 74:22,
74:25, 160:17,
175:29
recommended
[4] - 24:29, 25:1,
172:13, 175:29
reconstruction
[1] - 23:10
record [10] 14:10, 16:2,
17:22, 47:25,
51:14, 57:12,
66:23, 96:6,
106:15, 128:2
recorded [4] 11:25, 18:26,
25:2, 160:27
recording [2] 14:9, 81:19
records [14] 11:4, 13:1, 62:15,
69:10, 75:16,
81:19, 82:5, 82:7,
82:10, 87:14,
103:5, 151:13,
155:12, 162:12
recount [1] 96:8
rectum [2] 15:13, 15:15
recurrent [5] 18:8, 70:9, 99:7,
99:9, 134:8
red [3] - 29:15,
213:20
redacted [2] 41:2, 199:13
reduced [1] 74:19
redundant [1] 209:12
refer [3] - 24:15,
63:14
reference [6] 36:14, 63:15,
69:11, 161:21,
179:14, 190:23
references [1] 123:24
referral [2] 17:12, 24:20
referred [8] 14:26, 15:22,
17:10, 37:10,
56:9, 74:9, 76:13,
164:6
referring [4] 14:7, 14:19,
129:2, 156:28
refers [3] 13:11, 13:29,
14:4
reflect [2] 62:13, 143:20
reflected [3] 44:27, 78:29,
212:29
reflects [3] 122:27, 150:1,
151:16
reflux [16] 11:26, 12:2, 12:4,
12:5, 12:9, 12:11,
12:12, 12:20,
13:2, 13:11,
13:18, 14:1, 89:3,
164:8, 164:12
regard [12] 24:2, 50:8, 51:10,
85:28, 98:28,
113:27, 140:2,
156:16, 161:27,
175:3, 200:15,
201:26
regarded [6] 39:26, 55:23,
100:20, 156:15,
158:3, 166:16
register [3] 159:3, 172:14,
201:19
registered [1] 201:21
Registrar [20] 6:1, 6:3, 13:9,
13:15, 15:6,
22:23, 22:25,
28:27, 28:29,
30:9, 31:3, 36:21,
37:16, 38:21,
38:28, 39:1, 39:9,
26
Gwen Malone Stenography Services Ltd.
40:5, 46:13, 73:1
registrar [24] 58:20, 58:23,
58:29, 72:5, 73:4,
89:29, 90:14,
90:24, 90:26,
91:7, 91:9, 91:10,
91:14, 91:15,
91:17, 99:21,
99:25, 101:22,
158:26, 163:20,
163:28, 173:7,
193:22, 197:5
registrars [10] 89:23, 89:26,
91:1, 91:18,
91:24, 91:27,
91:29, 97:28,
106:5, 180:20
Registrars [5] 10:25, 16:10,
22:28, 38:24,
39:7
regrettably [2] 20:10, 27:10
regular [4] 24:9, 55:10,
57:28, 91:9
relate [4] 53:17, 55:2, 55:4,
174:25
related [4] 14:24, 16:1,
213:17
relates [2] 72:24, 73:8
relating [2] 179:6, 194:23
relation [35] 15:10, 16:6,
17:15, 26:10,
31:14, 38:3, 46:4,
51:4, 54:19,
55:17, 56:10,
56:11, 57:17,
58:11, 59:15,
61:26, 68:3,
68:19, 70:7,
70:17, 71:4,
76:16, 77:23,
85:14, 118:28,
173:10, 179:6,
190:28, 194:24,
195:1, 195:2,
197:8, 197:9,
197:16, 200:12
relations [1] 6:19
relationship [3]
- 55:22, 159:2,
193:13
relatively [5] 18:10, 91:13,
91:23, 98:24,
103:18
relatives [1] 78:20
relaxed [1] 105:28
release [3] 20:6, 71:18,
133:12
released [1] 19:29
relevant [3] 110:5, 110:24,
180:13
reliable [1] 77:29
reluctance [1] 130:2
reluctant [1] 195:14
remained [3] 24:23, 34:16,
196:22
remaining [3] 81:5, 81:10,
199:6
remains [1] 48:2
remember [7] 43:25, 77:2,
105:5, 105:6,
132:9, 134:12,
134:24
remind [4] 83:27, 83:29,
84:10, 179:19
removal [4] 70:1, 132:21,
133:2, 166:11
removals [1] 98:23
remove [4] 41:3, 65:11,
65:26, 65:28
removed [12] 34:1, 65:6, 65:10,
67:9, 67:13,
67:27, 70:14,
109:22, 160:13,
161:20, 163:4,
163:8
removing [1] 112:14
renal [16] 15:23, 17:26,
18:19, 65:22,
65:23, 65:27,
65:29, 66:3, 66:4,
67:6, 87:20,
87:25, 99:9,
100:8
repair [13] 43:3, 44:6, 44:7,
44:9, 45:28,
61:11, 99:2, 99:3,
130:26, 131:10,
131:23, 133:27,
135:3
repairs [2] 98:22, 98:23
repeat [2] 116:7, 152:1
repeatedly [1] 213:19
repercussion
[1] - 157:29
rephrase [1] 34:26
replicated [2] 12:16, 87:19
replication [1] 13:4
replied [2] 64:13, 88:29
report [131] 11:22, 11:25,
11:29, 12:4,
12:13, 13:5,
14:14, 19:18,
19:20, 19:21,
21:10, 21:11,
21:13, 21:19,
21:26, 21:29,
25:6, 25:12,
25:16, 25:18,
25:20, 25:21,
25:23, 25:29,
26:5, 26:14,
26:15, 26:16,
26:20, 26:21,
26:27, 26:28,
27:5, 27:6, 27:9,
27:12, 27:14,
27:16, 27:18,
27:20, 28:8,
30:27, 64:27,
64:29, 68:21,
68:24, 68:25,
68:27, 69:2, 69:4,
69:16, 72:10,
74:6, 87:4, 87:12,
87:25, 88:15,
88:21, 88:25,
92:3, 93:28,
94:27, 96:8,
96:10, 111:23,
116:25, 117:18,
117:22, 117:25,
117:27, 117:29,
118:2, 118:4,
118:7, 123:21,
123:27, 124:1,
124:2, 124:23,
155:7, 156:17,
156:23, 156:25,
156:26, 179:26,
179:27, 180:1,
180:7, 180:10,
180:18, 180:22,
180:29, 182:18,
182:21, 182:23,
198:18, 198:21,
198:26, 198:28,
199:3, 199:5,
199:11, 199:13,
199:26, 200:8,
205:16, 205:19,
205:24, 205:27,
206:2, 206:6,
206:15, 206:16,
206:18, 206:20,
206:26, 207:3,
207:6, 207:29,
208:6, 208:9,
213:14
Report [5] 92:15, 92:16,
94:13, 116:21,
116:23
report...(
INTERJECTION
[1] - 181:27
reports [28] 19:13, 19:16,
19:21, 19:23,
20:9, 20:12,
21:12, 25:6,
25:26, 25:28,
26:4, 26:6, 26:8,
31:7, 31:8, 69:10,
69:18, 69:23,
75:17, 82:13,
86:13, 88:18,
88:19, 124:12,
175:3, 200:5,
206:17
reports...(
INTERJECTION)
[1] - 21:3
representative
[1] - 171:21
reproduced [1] 2:26
Republic [1] 208:25
reputation [1] 6:9
request [6] 58:3, 58:7, 66:23,
104:6, 151:15,
207:28
requested [4] 45:14, 97:1,
125:15, 137:13
requesting [2] 66:24, 151:21
requests [2] 76:7, 76:8
require [2] 113:4, 202:8
required [5] 27:27, 52:20,
150:20, 153:14,
172:1
requirement [1]
- 200:11
requires [1] 191:3
requiring [1] 18:11
research [1] 6:14
resection [2] 99:7, 99:8
resolve [1] 178:8
resolved [1] 94:8
resource [1] 57:4
resources [2] 77:28, 151:24
respect [14] 61:27, 79:15,
79:18, 85:25,
90:19, 109:29,
110:8, 129:3,
135:6, 144:10,
158:13, 159:10,
181:24, 197:11
respectful [2] 78:17, 78:18
respectfully [1] 128:27
respond [1] 199:23
respondent [1] 2:27
responding [2] 180:29, 181:4
response [6] 46:8, 92:27,
116:4, 176:9,
177:22, 180:28
responsibile [3]
- 93:17, 101:29,
203:3
responsibility
- 52:2, 59:1,
68:12, 68:13,
82:4, 83:19, 84:8,
85:5, 85:11,
85:12, 85:15,
85:17, 85:22,
85:24, 85:27,
86:7, 86:9, 86:15,
95:16, 104:2,
104:4, 113:20,
113:26, 113:27,
114:1, 123:16,
124:10, 124:19,
149:23, 150:24,
169:5, 169:8,
169:9, 169:14,
169:15, 171:23,
171:27, 172:4,
175:19, 202:29,
203:4, 203:8,
203:17, 203:18,
203:21, 203:22,
203:29, 204:2,
204:21, 204:24,
205:1, 209:5,
209:6, 212:21
responsible [16]
- 7:13, 84:14,
84:21, 85:2, 85:7,
85:8, 113:1,
173:20, 191:1,
203:1, 203:9,
203:12, 203:26,
203:27, 214:6
rest [3] - 104:22,
161:8, 170:29
restored [1] 170:21
result [4] 25:23, 70:22,
73:29, 74:14
resulted [2] 24:20, 69:26
results [8] 16:29, 18:24,
19:12, 20:21,
22:28, 26:10,
71:1, 165:25
resume [7] - 4:8,
80:21, 107:12,
108:6, 153:6,
171:10, 171:17
RESUMED [4] 4:1, 80:18, 108:1,
171:6
retain [1] - 42:15
retained [2] 16:24, 21:4
retired [2] [54]
27
Gwen Malone Stenography Services Ltd.
190:18, 190:29
retrieval [1] 20:15
retrieved [2] 20:25, 109:7
retrograde [1] 16:22
retrogradely [1]
- 12:7
retrospect [2] 12:1, 34:12
return [3] - 6:24,
23:23, 160:19
returned [3] 39:10, 40:7,
159:4
revascularise
[3] - 34:2, 67:14,
109:18
revascularised
[1] - 108:20
revert [1] 161:20
review [55] 10:24, 12:3,
19:11, 22:2,
28:25, 29:7, 29:8,
29:19, 47:20,
52:25, 55:26,
64:26, 68:18,
72:10, 72:22,
72:29, 73:4,
73:16, 74:5,
74:22, 76:16,
79:23, 82:5,
82:12, 89:9,
89:11, 89:14,
89:18, 92:8,
92:10, 94:10,
95:17, 97:5,
101:15, 104:9,
116:20, 117:25,
122:12, 122:16,
123:7, 124:11,
124:20, 124:21,
125:7, 125:10,
149:29, 155:12,
157:8, 157:18,
160:5, 160:11,
161:22, 179:26,
206:19, 215:14
Review [3] 27:12, 92:7, 96:2
reviewed [24] 12:24, 21:10,
22:6, 25:21,
29:10, 70:17,
75:2, 82:7, 88:9,
92:22, 92:28,
93:21, 93:28,
94:7, 95:26,
103:23, 123:20,
155:29, 161:23,
162:1, 176:15,
177:2, 197:19,
197:29
reviewers [1] 183:3
reviewing [3] 51:17, 113:28,
197:16
rib [1] - 60:28
right" [1] 174:15
right-hand [3] 16:4, 92:13,
92:18
right-sided [1] 89:6
risk [4] - 26:6,
76:10, 175:14,
176:9
Risk [1] - 8:9
Rob [1] - 206:19
robust [1] 213:4
role [14] - 7:13,
38:4, 68:3, 78:23,
96:21, 99:25,
152:22, 171:26,
173:14, 191:9,
191:18, 194:20,
197:5, 204:14
roles [2] 117:21, 171:26
roll [1] - 60:11
room [13] 22:19, 22:20,
22:22, 22:24,
26:22, 59:17,
64:2, 64:3, 65:19,
105:16, 153:28,
203:22, 203:26
rooms [2] - 22:8,
26:18
root [1] - 175:8
rota [2] - 9:13,
10:10
rotate [1] - 7:16
rotating [1] 40:10
rotation [1] 6:21
rotations [1] 90:20
roughly [1] 17:5
round [13] 29:22, 30:10,
30:11, 30:12,
30:14, 32:7,
32:22, 32:24,
33:8, 51:19,
92:26, 93:6
rounds [5] 8:22, 23:14,
23:25, 30:7, 30:9
routine [1] - 64:6
routinely [2] 56:20, 152:8
row [1] - 183:15
Royal [4] - 5:9,
172:29, 173:15,
173:27
run [4] - 8:14,
37:11, 57:19,
154:21
running [3] 67:1, 94:15,
117:4
runs [1] - 55:14
rush [2] - 167:3,
193:20
rushing [1] 167:7
RYAN [1] - 2:13
S
sacral [1] 15:18
sad [1] - 67:10
sadness [1] 29:17
safe [5] - 152:13,
203:19, 203:27,
210:29, 213:29
safely [2] 209:17
Safer [2] - 8:10,
8:14
safety [2] 84:14, 176:19
saline [1] - 16:22
salvage [1] 44:24
SAME [4] - 5:1,
5:4, 11:8, 40:27
sample [12] 56:17, 57:23,
57:26, 57:29,
58:2, 77:19,
151:21, 152:1,
152:2, 152:16
samples [1] 77:18
sat [1] - 39:19
satisfied [7] 104:11, 148:21,
160:29, 161:7,
162:16, 162:25
Saudi [1] - 72:5
saw [10] - 15:6,
16:10, 19:7,
26:25, 76:13,
109:9, 138:8,
139:18, 192:8,
192:9
SC [2] - 2:8, 2:21
scan [11] 17:26, 18:21,
18:24, 18:25,
18:26, 19:9, 65:4,
88:5, 88:8, 88:11,
88:25
scanned [1] 19:13
scans [4] - 18:1,
25:7, 26:11,
212:18
scar [10] - 60:19,
61:1, 61:3, 61:4,
61:7, 61:8, 61:9,
61:13, 61:27
scarred [2] 70:13, 88:2
scarring [1] 88:22
scars [1] - 60:21
scenario [2] 27:13, 37:10
schedule [1] 23:28
scheduled [1] 179:10
scheduling [1] 179:7
school [1] - 40:2
score [1] - 77:9
scores [1] 78:29
screen [9] 20:16, 25:26,
26:26, 27:21,
44:25, 50:17,
50:18, 63:5,
109:8
screening [1] 64:26
scripting [1] 175:5
scrub [1] - 134:9
scrubbed [2] 44:24, 65:5
second [31] 31:17, 37:22,
42:20, 57:14,
57:23, 58:3, 58:8,
60:4, 60:5, 60:7,
69:9, 73:19,
73:20, 81:26,
97:29, 115:9,
115:14, 116:26,
123:5, 126:6,
126:12, 126:17,
126:26, 129:13,
129:23, 172:22,
173:29, 175:17,
183:16, 184:10
secondary [1] 40:2
secondly [1] 81:12
secretarial [1] 69:23
secretaries [1] 77:8
secretary [1] 69:24
secure [1] - 59:2
securing [1] 114:23
see [66] - 10:20,
10:23, 10:28,
13:29, 14:17,
17:19, 23:1, 24:5,
26:28, 28:21,
29:21, 30:3,
33:28, 49:27,
54:24, 54:26,
59:14, 90:23,
92:12, 92:19,
94:18, 94:24,
98:5, 99:14,
110:18, 111:24,
112:1, 115:5,
117:7, 118:26,
120:8, 120:19,
123:23, 127:4,
127:15, 127:22,
127:26, 133:20,
133:24, 135:20,
135:25, 136:15,
136:21, 137:15,
138:9, 138:14,
139:14, 139:17,
139:19, 139:26,
142:29, 143:3,
143:5, 144:12,
144:13, 144:14,
145:3, 154:4,
154:5, 154:21,
156:14, 168:22,
174:17, 184:17,
201:15, 206:5
seeing [2] 154:26, 189:17
seek [2] - 74:24,
134:7
seem [10] 14:20, 31:19,
32:20, 42:19,
96:6, 99:6, 126:8,
173:16, 204:24,
213:11
sees [1] - 30:5
selection [1] 145:26
self [2] - 124:1,
212:28
self-fulfilling [1]
- 212:28
send [2] - 136:8,
168:27
sending [3] 140:12, 154:3,
177:4
senior [22] - 7:4,
15:14, 31:28,
32:4, 39:6, 39:7,
44:26, 58:24,
75:14, 86:15,
97:28, 99:25,
100:17, 100:22,
103:9, 158:27,
171:25, 172:3,
173:7, 178:17,
197:5, 202:9
Senior [7] 28:26, 28:29,
31:3, 36:20,
37:16, 39:6,
46:13
seniority [2] 61:21, 168:28
seniors [2] 157:19, 158:17
sense [16] 16:27, 97:11,
104:3, 104:15,
105:13, 110:23,
113:17, 135:18,
143:29, 148:9,
209:14, 210:24,
210:25, 210:26,
210:27
sensed [1] 212:11
sensible [1] 214:27
sensitised [1] 161:16
sensitivities [2]
- 162:19, 162:22
sensitivity [1] 162:23
sent [17] - 17:28,
56:15, 57:23,
71:11, 75:6, 75:8,
28
Gwen Malone Stenography Services Ltd.
77:3, 119:23,
136:19, 136:26,
137:12, 137:23,
139:24, 139:28,
151:21, 152:2,
153:13
separate [2] 20:28, 127:2
SEPTEMBER [3]
- 1:15, 4:2,
215:20
September [9] 8:6, 17:9, 17:18,
84:12, 120:2,
120:17, 120:24,
181:20, 182:6
September...(
INTERJECTION
[1] - 181:1
sequence [3] 48:14, 93:13,
175:6
series [3] 29:14, 100:12,
173:21
serious [11] 15:20, 75:15,
99:4, 99:5,
100:15, 100:28,
105:21, 109:10,
124:13, 124:21,
137:21
seriously [6] 25:28, 85:29,
86:20, 86:24,
106:18, 209:8
seriousness [2]
- 98:20, 99:16
serum [1] 56:17
service [21] 7:10, 9:17, 10:17,
23:7, 24:4, 28:27,
35:22, 35:26,
35:27, 36:6,
36:12, 57:27,
74:13, 74:19,
78:6, 83:12,
95:21, 97:1,
100:3, 106:3,
125:4
Services [3] 1:27, 2:26, 2:27
services [1] 24:5
serving [1] - 7:3
sessions [2] 10:14, 74:4
set [8] - 7:21,
77:14, 95:16,
122:25, 166:18,
169:4, 191:12,
196:13
sets [1] - 153:22
setting [3] 70:2, 154:23,
173:23
settled [1] 167:24
seven [3] - 23:4,
23:5, 104:28
several [8] - 7:9,
71:16, 75:20,
87:24, 117:24,
117:26, 123:11,
123:12
severe [3] 18:8, 28:17, 70:9
shaped [1] 16:24
share [2] 26:19, 203:18
sheet [2] 127:18, 127:25
Sheridan [3] 11:13, 12:28
shining [1] 51:2
ship [4] 203:12, 203:13,
212:4, 212:5
ship's [2] 203:11
SHO [22] - 5:23,
22:23, 22:24,
32:7, 32:9, 41:10,
58:18, 58:23,
58:29, 71:27,
71:29, 72:7,
72:11, 72:12,
72:19, 72:29,
111:23, 150:21,
150:22, 172:21,
172:22
SHO's [1] 71:27
shocked [3] 64:23, 76:4
shoes [1] - 55:8
SHORT [4] 80:16, 80:18,
171:3, 171:6
short [27] 42:25, 43:10,
44:14, 80:11,
80:13, 85:29,
86:20, 86:24,
94:22, 95:11,
95:18, 95:24,
96:22, 97:2,
100:14, 102:10,
103:14, 117:11,
124:13, 125:21,
166:27, 170:20,
186:2, 186:25,
201:10, 201:17
short... [1] 124:21
shorthand [1] 1:29
shortly [5] 8:12, 45:11,
124:24, 127:21,
157:16
SHOs [2] 10:25, 22:27
show [1] 172:23
showed [2] 13:17, 88:2
showing [1] 13:2
shown [1] 164:2
shows [4] 15:28, 57:5,
57:14, 65:22
shrunken [1] 104:21
siblings [1] 191:9
sick [5] - 35:22,
70:11, 91:19,
100:12, 191:22
side [53] - 12:5,
12:9, 12:12,
12:25, 13:18,
16:4, 25:9, 27:2,
28:3, 33:1, 34:14,
34:15, 35:4, 35:5,
35:10, 50:13,
51:28, 60:11,
60:12, 81:20,
82:25, 82:28,
83:9, 88:26, 89:3,
92:27, 103:21,
103:22, 103:23,
145:17, 145:25,
145:28, 147:22,
147:27, 148:4,
148:6, 148:10,
148:11, 148:13,
148:22, 148:23,
148:24, 148:27,
149:24, 156:21,
163:14, 163:17,
163:18, 163:22,
163:24, 163:25
side" [1] - 62:8
sided [14] -
11:26, 12:1,
12:20, 13:11,
14:1, 14:4, 14:8,
14:10, 14:19,
89:3, 89:6,
147:28, 184:4
sight [1] - 73:9
sign [2] - 176:7,
176:8
signed [4] 25:12, 25:22,
26:1, 76:12
significance [2]
- 11:28, 111:2
significant [25] 7:22, 9:11, 9:13,
10:9, 12:8, 18:8,
24:20, 28:17,
29:18, 36:12,
42:11, 69:13,
69:22, 75:16,
83:22, 95:21,
99:29, 100:4,
117:21, 137:25,
138:17, 164:8,
202:5, 202:7
significantly [7]
- 24:22, 24:23,
56:28, 61:5,
75:26, 100:8,
195:4
signs [1] 165:24
similar [2] 22:22, 149:26
simple [13] 100:6, 100:9,
100:14, 100:19,
100:25, 133:6,
133:12, 152:11,
174:26, 175:4,
202:27, 210:4,
210:5
simplistically
[1] - 93:25
simply [8] 26:25, 90:17,
95:8, 97:9, 132:9,
142:22, 159:22,
214:25
simultaneous
[1] - 74:4
simultaneously
[3] - 37:8, 94:15,
117:4
single [4] 35:24, 191:14,
203:21, 203:25
sink [1] - 22:20
sit [4] - 22:21,
22:23, 22:25,
55:25
site [7] - 73:6,
82:26, 93:9,
145:27, 147:13,
148:9, 163:13
siting [1] - 73:12
sitting [1] 153:28
situation [33] 16:17, 17:7, 28:8,
29:6, 32:2, 32:29,
35:8, 37:10, 57:1,
63:4, 63:16,
63:22, 68:7, 70:9,
76:3, 76:7, 85:21,
97:1, 106:5,
111:1, 150:3,
150:26, 152:15,
158:2, 160:2,
161:19, 168:16,
177:2, 178:3,
207:26, 208:14,
211:7, 212:24
situations [5] 51:26, 95:20,
160:13, 164:29,
165:23
six [12] - 6:6,
39:10, 39:23,
40:8, 40:9, 40:12,
90:20, 90:21,
90:22, 90:27,
91:24, 99:29
sixth [1] - 71:24
size [1] - 22:22
skill [1] - 77:24
skills [3] - 7:25,
78:7, 78:21
skin [9] - 47:22,
48:1, 48:5, 49:21,
51:24, 52:1,
52:21, 53:6, 53:9
skipping [1] 59:27
sleep [1] 128:26
slides [1] 159:27
slight [1] - 5:14
slightly [1] 41:24
Sloan [13] - 6:7,
6:10, 6:18, 6:20,
6:21, 6:24, 39:11,
39:15, 40:7,
100:1, 100:2,
159:5
SloanKettering [13] -
6:7, 6:10, 6:18,
6:20, 6:21, 6:24,
39:11, 39:15,
40:7, 100:1,
100:2, 159:5
slot [1] - 37:3
slow [3] - 16:14,
20:2, 123:17
small [11] - 11:7,
16:1, 16:23,
22:19, 59:10,
76:6, 81:19,
104:20, 133:23,
174:10, 174:12
smaller [3] 11:14, 12:27,
208:24
socially [3] 16:26, 16:28,
17:6
soiling [1] - 16:7
solely [1] 130:20
solicitor [2] 125:23, 157:1
solicitors [1] 207:28
SOLICITORS [3]
- 2:14, 2:20, 2:24
solid [1] - 39:12
solved [1] 69:27
someone [9] 64:26, 68:15,
84:22, 103:15,
104:6, 112:13,
147:3, 209:4
sometimes [5] 10:22, 41:23,
89:14, 90:21,
151:29
somewhat [6] 96:28, 101:16,
109:13, 139:21,
168:17, 209:12
somewhere [2] 53:12, 84:2
soon [2] - 9:26,
74:16
sooner [3] 169:22, 169:23,
170:5
Sorry [4] 87:15, 97:8, 99:8,
185:29
sorry [63] - 20:4,
38:27, 39:2, 42:6,
45:3, 47:5, 48:4,
54:28, 59:28,
60:24, 63:19,
29
Gwen Malone Stenography Services Ltd.
65:8, 68:21,
72:17, 76:18,
80:8, 81:25,
86:22, 114:10,
114:11, 114:29,
116:26, 119:28,
120:5, 120:6,
122:17, 122:18,
128:1, 128:5,
128:9, 128:17,
131:16, 132:25,
133:21, 133:23,
135:16, 138:2,
138:29, 139:1,
139:2, 139:3,
140:9, 142:14,
143:8, 143:9,
143:22, 145:5,
149:5, 151:28,
151:29, 152:8,
155:13, 156:24,
156:29, 157:3,
158:20, 162:14,
176:14, 176:15,
182:2, 205:21
sorry...(
INTERJECTION
[2] - 73:27, 142:17
sort [10] - 15:24,
28:18, 75:3, 75:6,
122:22, 132:29,
139:22, 153:25,
153:27, 192:11
sorts [1] - 95:7
sought [1] 188:21
sound [1] 34:24
source [2] 19:5, 67:25
South [1] 165:29
Southampton
[1] - 195:19
space [2] 140:21, 142:27
spare [2] 145:4, 145:7
speaking [4] 17:5, 72:18,
160:29, 201:13
speaks [1] 190:23
Specialist [2] 39:9, 173:4
specialist [9] 99:21, 101:22,
106:5, 159:3,
172:14, 180:7,
180:20, 196:20,
196:21
specialists [1] 191:4
specific [7] 25:14, 50:6,
88:28, 118:21,
132:15, 158:15,
173:6
specifically [3] 48:12, 49:9,
173:10
speed [1] 211:11
spend [5] 116:24, 196:24,
197:2, 209:18
spent [6] - 6:22,
40:8, 139:18,
159:24, 196:26,
197:4
spina [1] - 10:15
split [2] - 25:17,
183:6
spoken [6] 23:22, 45:18,
45:24, 46:1,
55:21, 78:13
SPR [16] - 22:23,
30:20, 38:6,
38:12, 39:23,
40:9, 41:10,
72:15, 72:16,
72:22, 117:4,
117:7, 117:10,
173:7, 183:29,
184:4
SpR [5] - 94:16,
94:18, 94:21,
103:10, 103:15
SpRs [3] - 16:9,
38:24, 97:28
SRI [2] - 1:9,
2:21
Sri [16] - 52:15,
108:17, 112:10,
112:16, 112:22,
113:7, 115:11,
121:18, 123:8,
124:29, 145:17,
145:25, 145:29,
161:1, 193:7,
193:21
ST [1] - 2:15
St [1] - 196:10
staff [24] - 6:20,
9:21, 26:12,
31:22, 31:27,
32:4, 44:25,
53:17, 55:2, 55:3,
55:4, 70:27, 74:1,
74:2, 75:4, 77:7,
111:26, 111:28,
188:23, 189:1,
189:10, 190:27,
192:9
staffing [1] 189:1
stage [26] 14:21, 15:7,
21:21, 26:19,
29:2, 31:11,
33:24, 45:7,
47:18, 53:19,
59:5, 65:11,
65:18, 66:12,
70:6, 85:18,
92:22, 107:10,
111:27, 121:5,
121:12, 130:23,
132:17, 182:1,
193:23, 204:21
stages [2] 14:19, 191:12
stand [1] - 70:5
standard [13] 32:23, 35:6,
37:17, 37:18,
56:13, 70:13,
112:13, 113:23,
114:23, 150:23,
151:25, 152:26,
160:17
standards [11] 55:11, 55:12,
83:5, 83:13,
83:20, 85:29,
86:21, 86:25,
124:14, 171:24
standing [2] 64:10, 78:7
stapling [1] 183:13
start [38] - 23:25,
41:19, 41:28,
42:1, 42:23, 43:3,
43:7, 43:14,
44:12, 44:19,
51:25, 62:6,
74:16, 95:26,
95:27, 114:17,
122:22, 122:23,
123:18, 125:12,
125:13, 126:22,
127:8, 129:19,
139:5, 143:10,
143:20, 153:21,
179:16, 198:5,
208:12, 209:18,
209:19, 210:20,
214:22, 214:24
Start [1] - 127:18
started [8] - 6:3,
47:28, 53:9,
63:28, 69:22,
142:10, 143:17,
156:13
starting [5] 12:28, 51:24,
101:15, 147:7,
198:7
starts [7] 51:29, 52:1,
101:9, 113:26,
114:24, 123:19,
167:2
stasis [1] - 19:6
state [4] - 25:28,
30:29, 151:14,
188:9
State [1] - 159:9
statement [6] 72:2, 117:13,
118:10, 151:16,
207:25, 210:4
statements [2] 117:16, 206:15
states [3] - 47:4,
62:6, 71:8
station [1] - 22:9
status [2] 46:14, 158:26
Stenographer
[1] - 20:3
Stenographers
[1] - 153:5
Stenography [3]
- 1:27, 2:26, 2:27
step [3] - 16:19,
203:17, 213:3
steps [2] 31:21, 74:24
stewart [1] 179:9
Stewart [4] 29:26, 30:21,
84:1, 84:3
still [16] - 10:13,
16:15, 16:16,
21:8, 31:16,
52:13, 62:1,
71:17, 90:25,
125:5, 138:9,
159:11, 162:8,
200:9, 202:25,
211:10
stimulant [1] 16:22
stimulate [1] 16:13
stock [1] - 63:3
stood [2] - 64:4,
191:21
stop [8] - 25:26,
101:14, 122:12,
149:5, 195:15,
208:12, 210:1,
210:19
stopped [2] 4:6, 42:4
straight [1] 181:11
straightforwar
d [8] - 39:27, 44:7,
56:25, 98:24,
98:26, 98:28,
100:14, 103:18
Street [22] 5:29, 6:26, 10:18,
27:11, 40:14,
73:25, 92:16,
94:13, 95:5,
97:17, 116:19,
116:21, 116:22,
117:14, 117:15,
119:9, 179:27,
180:7, 180:10,
196:22, 197:2,
197:5
Street...(
INTERJECTION
[1] - 184:6
strictly [1] 73:11
strikes [1] 171:22
structure [1] 208:26
structured [2] 173:3, 208:23
structures [1] 65:26
Student [1] - 8:7
students [3] 77:7, 78:8,
175:11
study [2] 76:10, 76:25
sub [1] - 92:9
sub-heading [1]
- 92:9
subject [1] 153:12
submission [4] 98:8, 181:29,
182:12, 182:16
submissions [2]
- 187:4, 215:11
submit [1] 201:7
submitted [2] -
181:19, 181:20
subsequent [7] 19:9, 30:1, 31:15,
56:18, 71:17,
111:27, 212:27
subsequently
[6] - 32:11, 47:17,
60:3, 61:12,
88:23, 148:29
substance [1] 164:14
successful [2] 15:17, 40:15
suction [1] 64:5
sufficient [10] 37:17, 56:6,
89:27, 102:21,
103:4, 103:20,
166:24, 167:5,
169:10, 212:13
suggest [24] 27:5, 58:15,
91:25, 93:20,
95:9, 96:29,
103:17, 110:22,
114:15, 121:16,
121:27, 121:29,
125:25, 125:28,
128:28, 137:18,
138:11, 148:19,
153:10, 161:6,
162:26, 167:10,
178:11, 210:8
suggested [14] 60:15, 61:16,
104:6, 111:22,
130:3, 147:13,
147:16, 147:19,
179:12, 179:16,
197:28, 198:15,
200:14, 203:2
suggesting [13]
- 56:5, 80:8,
102:8, 111:5,
112:1, 135:3,
137:7, 141:8,
143:1, 143:15,
147:25, 185:8,
209:8
suggestion [5] 38:1, 53:22, 62:1,
64:14, 186:24
suitably [1] 89:25
suite [1] 128:13
summarise [1] 208:9
summary [2] -
30
Gwen Malone Stenography Services Ltd.
14:4, 14:7
Summer [1] 190:19
summoned [1] 134:1
summons [1] 133:25
Sunday [3] 168:7, 169:19
super [1] 196:21
superb [1] 193:10
superior [1] 33:19
supervision [3] 78:8, 101:23,
101:28
supplied [1] 2:26
supply [2] 65:13, 66:13
support [1] 159:10
suppose [9] 111:11, 123:21,
143:24, 160:28,
168:14, 175:18,
185:11, 212:20,
214:26
sure...(
INTERJECTION
[1] - 208:4
surely [2] 99:19, 121:17
surface [4] 51:2, 51:3, 64:9,
66:5
surgeon [87] 8:18, 32:10,
38:26, 39:25,
41:5, 41:6, 41:8,
41:9, 41:11,
41:12, 41:13,
41:27, 41:29,
42:22, 42:23,
43:2, 43:3, 43:6,
43:7, 44:13,
44:20, 44:21,
44:22, 51:25,
51:27, 51:29,
58:5, 58:21, 67:7,
74:15, 83:6,
83:14, 83:26,
86:1, 86:2, 86:21,
86:25, 95:15,
95:24, 95:28,
96:22, 98:11,
100:22, 101:8,
101:17, 104:3,
109:26, 110:4,
113:4, 114:20,
114:24, 116:5,
122:9, 122:23,
122:26, 123:17,
125:9, 125:13,
140:2, 140:3,
143:28, 146:4,
149:25, 150:19,
150:20, 150:23,
153:22, 157:8,
167:27, 171:25,
172:1, 172:3,
184:2, 191:16,
193:16, 197:16,
197:21, 197:22,
198:6, 202:3,
202:18, 202:19,
204:25, 208:11
Surgeon [6] 5:6, 7:1, 7:4,
32:12, 40:17,
196:7
surgeon's [5] 52:1, 59:1, 95:16,
105:13, 197:24
Surgeons [11] 5:9, 7:15, 7:24,
9:27, 10:5,
172:29, 173:15,
173:19, 173:27,
174:1, 196:16
surgeons [26] 9:15, 9:16, 9:26,
9:29, 10:6, 10:7,
37:20, 37:21,
44:13, 47:22,
60:20, 71:25,
73:20, 74:17,
98:1, 100:24,
105:24, 106:5,
131:7, 135:8,
135:10, 192:4,
202:12, 210:25,
212:16
surgeries [1] 39:13
surgery [85] 7:11, 7:12, 7:17,
7:27, 8:1, 8:20,
8:23, 9:17, 9:18,
9:19, 23:11,
23:12, 29:26,
30:6, 30:11,
30:18, 33:23,
33:24, 36:7,
36:19, 39:22,
40:19, 42:4,
42:10, 45:9,
45:21, 50:27,
51:10, 51:20,
52:28, 58:14,
59:5, 59:7, 59:13,
60:2, 60:10,
61:18, 62:9,
65:18, 68:1, 68:4,
71:21, 71:23,
72:4, 72:28, 73:3,
75:29, 82:27,
83:9, 89:15,
89:21, 92:4,
92:24, 93:7,
93:24, 124:5,
149:28, 155:17,
155:24, 157:3,
157:8, 157:9,
159:7, 159:9,
160:18, 161:19,
172:22, 173:5,
173:21, 176:8,
179:7, 179:9,
180:3, 188:13,
196:18, 197:13,
197:14, 197:17,
197:20, 204:14
Surgery [4] 5:9, 8:11, 39:9,
39:20
surgery" [1] 157:9
Surgical [4] 5:7, 13:9, 16:9,
39:15
surgical [50] 6:15, 7:28, 9:5,
9:9, 9:17, 9:28,
23:24, 24:5,
24:16, 37:28,
42:7, 42:16, 44:5,
45:12, 52:11,
59:17, 70:27,
72:12, 74:27,
74:28, 75:25,
83:11, 86:3,
89:23, 96:12,
103:9, 105:16,
106:12, 114:23,
128:24, 138:20,
142:19, 143:21,
144:2, 157:20,
158:18, 166:20,
172:5, 172:12,
172:28, 173:20,
173:24, 175:23,
176:2, 176:3,
176:6, 189:11,
191:19, 196:17
surgically [1] 143:29
surmise [1] -
25:16
surprise [1] 206:25
surprised [2] 51:12, 145:23
Suska [2] 33:18, 151:18
suspect [1] 90:4
Swiss [1] 213:28
SWORN [4] 4:24, 187:8,
190:2, 196:1
symbols [1] 175:16
symptomatic [1]
- 18:12
symptomatolo
gy [1] - 70:20
system [28] 20:13, 20:15,
20:19, 20:20,
21:9, 22:5, 22:9,
31:23, 69:19,
69:25, 69:29,
71:19, 75:9,
85:24, 86:14,
101:21, 106:24,
109:27, 157:14,
157:15, 158:24,
208:22, 213:2,
213:4, 213:8,
213:17, 213:27
systems [16] 29:11, 83:11,
83:20, 85:1, 86:9,
86:10, 109:25,
110:3, 110:4,
110:10, 110:16,
171:24, 203:15,
208:27, 212:19,
214:5
T
tab [6] - 68:23,
81:2, 119:27,
179:24, 180:19,
182:29
Tab [2] - 84:11,
119:28
table [3] - 47:8,
60:8, 145:6
taken...(
INTERJECTION)
[1] - 127:16
talented [1] 38:26
Tallaght [1] 73:25
Tanzania [1] 192:20
Tareen [12] 29:1, 30:17,
38:11, 38:17,
73:2, 89:28, 90:9,
90:11, 90:13,
90:16, 90:29,
91:2
tareen [1] 30:19
task [2] - 67:11,
191:2
tasks [2] - 57:6,
124:13
taught [1] 174:24
teach [1] 174:19
teacher [1] 175:11
teaching [5] 7:14, 7:18,
173:19, 173:20,
192:8
team [32] - 9:2,
14:27, 15:5,
28:29, 30:5, 32:8,
32:13, 32:18,
66:18, 67:22,
72:13, 75:25,
78:22, 86:3,
94:29, 95:4,
96:18, 97:23,
97:26, 98:10,
106:21, 116:18,
123:1, 123:3,
123:8, 125:28,
191:13, 203:6,
204:6, 207:2,
207:4, 207:11
Team [2] - 96:2,
119:9
teams [2] 70:27, 83:11
technical [6] 57:20, 77:25,
104:14, 159:11,
165:21, 176:6
technically [1] 100:20
technique [1] 16:20
Temple [4] 5:29, 10:18,
40:14, 73:25
temporising [2]
- 27:25, 27:26
ten [27] - 9:7,
16:15, 23:9,
24:10, 69:1,
73:14, 77:27,
78:16, 78:19,
82:3, 122:10,
122:24, 129:20,
141:2, 141:8,
141:10, 141:19,
142:25, 144:1,
144:5, 145:4,
145:7, 154:13,
154:14, 167:17,
173:17, 184:1
tend [1] - 38:6
tendency [1] 24:15
term [3] - 36:14,
149:18, 203:9
terms [23] - 9:17,
15:16, 51:23,
52:26, 65:25,
85:4, 93:13,
97:10, 98:12,
98:20, 99:15,
102:11, 108:29,
113:22, 134:9,
165:16, 168:19,
172:15, 178:5,
191:5, 203:4,
215:7
terrible [3] 155:2, 204:19,
214:3
terribly [1] 155:13
testimonial [7] 187:5, 187:13,
187:26, 188:3,
189:3, 190:7,
192:18
testimonials [2]
- 186:26, 187:3
testimony [2] 128:23, 213:14
THAMBIPILLAI
[1] - 1:9
that...(
INTERJECTION
[1] - 62:19
THE [19] - 1:2,
1:3, 2:11, 2:15,
3:8, 3:18, 4:1,
80:18, 108:1,
171:6, 171:13,
177:10, 185:26,
211:25, 214:12,
215:20
the...(
INTERJECTION
31
Gwen Malone Stenography Services Ltd.
- 118:11
theaters [1] 37:25
theatre [95] 8:21, 27:16,
29:20, 33:16,
33:18, 36:27,
37:1, 37:3, 37:4,
37:5, 37:16,
37:22, 37:23,
37:24, 38:4,
40:27, 45:1,
45:27, 47:7, 51:1,
52:18, 53:11,
58:13, 58:23,
58:26, 59:18,
63:7, 63:12,
63:25, 64:1, 64:3,
66:3, 71:12,
71:22, 72:27,
73:12, 73:14,
73:21, 73:22,
73:28, 74:4, 75:7,
82:7, 89:19,
92:29, 96:13,
97:25, 98:9,
105:17, 108:26,
109:7, 126:17,
127:14, 128:3,
128:12, 128:13,
128:21, 128:25,
129:27, 131:9,
132:12, 135:10,
135:14, 135:23,
137:23, 138:24,
138:26, 141:2,
142:25, 143:11,
144:15, 150:21,
150:22, 151:10,
153:12, 153:17,
153:19, 153:21,
154:3, 154:5,
155:27, 162:3,
164:3, 176:10,
176:12, 176:13,
176:18, 176:19,
184:3, 213:22,
213:26
Theatre [41] 37:26, 38:2, 38:6,
38:7, 43:26,
43:27, 43:28,
44:1, 44:2, 94:15,
94:16, 94:16,
94:18, 94:18,
117:4, 117:4,
117:5, 117:5,
117:6, 117:7,
130:19, 130:20,
131:26, 131:28,
133:25, 133:26,
[1]
134:26, 135:12,
136:6, 136:11,
136:20, 138:25,
139:19, 141:11,
143:10, 143:16,
145:4, 151:19
theatre" [1] 183:27
theatre...(
INTERJECTION)
[2] - 141:5, 149:4
theatres [6] 37:6, 101:28,
131:8, 134:5,
135:7, 135:11
themselves [6] 20:23, 21:4,
21:24, 25:13,
172:26, 198:8
THEN [7] 108:12, 171:13,
177:12, 179:1,
185:26, 187:8,
215:20
theoretically [1]
- 20:17
theory [1] 21:20
thereabouts [1]
- 127:9
thereafter [2] 5:23, 14:17
therefore [15] 45:7, 58:28,
91:28, 112:28,
136:13, 137:28,
147:25, 149:22,
162:25, 180:27,
190:20, 202:20,
208:17, 209:29,
210:23
thin [1] - 164:15
thinking [6] 60:22, 181:18,
212:21, 213:9,
213:12, 213:23
thinks [3] 47:25, 195:9,
195:25
third [6] - 4:6,
13:1, 16:1, 32:16,
62:7, 69:28
thirty [65] 112:16, 112:19,
112:21, 112:23,
112:25, 112:26,
112:29, 113:10,
113:14, 113:15,
113:17, 114:3,
114:14, 114:17,
114:22, 114:25,
115:11, 115:14,
115:17, 115:19,
115:20, 115:24,
116:2, 116:5,
116:12, 118:17,
119:3, 120:28,
121:18, 122:1,
122:4, 122:6,
122:27, 123:3,
123:4, 123:9,
125:1, 125:27,
126:6, 126:25,
127:5, 128:27,
129:2, 129:5,
130:5, 130:24,
135:1, 136:17,
137:10, 137:29,
138:13, 139:8,
139:12, 141:26,
141:27, 142:7,
142:12, 142:16,
142:23, 142:24,
144:20, 147:5,
150:6, 151:3,
151:5
thoroughly [1] 162:1
threat [1] 159:14
threatening [2] 23:20, 100:16
three [16] - 8:28,
9:1, 10:8, 11:18,
19:25, 20:4,
38:23, 43:1,
65:25, 89:26,
91:23, 91:27,
91:29, 103:15,
141:15
throughout [3] 21:1, 93:21,
176:22
thrown [1] - 57:3
thrust [1] - 68:25
Thursday [4] 10:14, 10:22,
23:4, 23:5
THURSDAY [2] 1:15, 4:1
tie [4] - 42:22,
65:28, 65:29,
164:17
tied [5] - 65:6,
65:10, 65:26,
66:4, 66:7
time-out [8] 175:23, 175:26,
175:28, 176:7,
176:8, 176:10,
176:23, 203:23
timed [2] 47:20, 66:23
timeframe [6] 131:11, 138:2,
139:12, 143:14,
147:6, 210:28
timeline [1] 210:15
timing [12] 41:18, 41:19,
42:2, 51:23,
55:18, 97:18,
122:22, 155:6,
179:5, 179:6,
179:18, 181:24
TO [3] - 1:3, 5:4,
215:20
to...(
INTERJECTION
[3] - 54:6, 133:14,
134:3
today [7] 155:2, 155:4,
169:14, 186:19,
206:22, 210:16,
215:9
today's [1] 185:12
together [3] 55:26, 183:13,
192:13
toilet [1] - 15:26
tomorrow [5] 185:12, 185:13,
186:18, 215:3,
215:18
tongue [1] 42:22
took [25] - 5:11,
5:26, 6:29, 27:17,
48:12, 48:20,
49:7, 49:9, 71:29,
72:3, 75:20,
84:27, 93:11,
99:11, 114:2,
114:27, 117:16,
129:6, 138:7,
143:17, 146:17,
150:13, 160:20
top [3] - 25:29,
183:15, 184:15
total [8] - 9:29,
12:22, 74:17,
127:1, 127:2,
172:15, 196:24,
197:4
totally [3] 30:29, 31:27,
159:28
towards [7] 78:19, 108:17,
131:2, 163:6,
163:13, 175:19,
208:23
track [1] - 51:14
tract [4] - 17:27,
18:9, 18:18,
70:10
tradition [1] 208:29
traditional [1] 38:5
traffic [2] 166:2, 166:4
tragic [2] - 76:9,
106:23
train [1] - 7:26
trained [5] 15:26, 32:9,
89:25, 99:28,
103:12
trainee [17] 46:16, 46:25,
46:26, 56:2,
100:23, 103:4,
103:9, 103:14,
106:9, 157:15,
157:17, 157:19,
158:5, 158:17,
173:13, 202:9,
202:14
trainees [10] 55:28, 103:9,
103:12, 106:8,
157:14, 157:15,
157:28, 172:29,
202:4, 202:10
training [25] 5:12, 5:23, 6:7,
7:14, 7:15, 39:13,
39:28, 40:11,
46:13, 51:13,
52:23, 76:27,
86:16, 89:27,
97:5, 99:26,
106:12, 118:24,
150:1, 166:19,
172:28, 173:9,
196:17, 196:20,
196:22
transcribed [1] 26:25
TRANSCRIPT
[1] - 1:14
transcript [5] 1:28, 4:13, 83:29,
102:3, 156:28
Transcripts [1] 2:25
transferred [2] 10:17, 126:3
transfuse [1] 56:19
transit [1] 19:29
transiting [1] 46:13
transplant [2] 67:7, 67:22
transplantation
[1] - 5:12
transverse [4] 60:16, 82:23,
104:20, 147:19
trauma [3] 9:18, 75:28,
167:4
treat [1] - 35:23
treating [1] 84:15
treatment [5] 16:11, 19:9,
19:12, 24:28,
79:10
tree [1] - 6:13
tremendous [1]
- 131:6
trial [1] - 76:24
Tribunal [5] 113:9, 124:4,
124:8, 124:17,
146:19
tried [3] - 16:11,
25:25, 74:19
trigger [1] 212:25
trolley [4] 52:13, 52:17,
162:6, 162:9
trouble [1] 59:24
true [16] - 1:28,
16:27, 35:14,
81:12, 81:21,
82:1, 82:11,
87:10, 90:25,
95:1, 95:3, 95:4,
95:5, 110:21,
158:1, 188:13
truly [2] 110:13, 204:19
trust [1] - 46:18
try [22] - 5:15,
10:2, 16:12,
16:14, 24:12,
26:9, 44:24,
69:22, 85:19,
138:20, 139:27,
140:4, 140:10,
32
Gwen Malone Stenography Services Ltd.
141:13, 143:3,
156:4, 156:7,
156:12, 175:15,
178:8, 192:23
trying [24] 9:21, 20:19, 23:1,
37:20, 54:29,
60:22, 68:7,
69:19, 84:25,
84:26, 85:12,
85:14, 85:20,
86:18, 101:24,
121:6, 121:21,
135:8, 140:2,
140:6, 151:7,
169:25, 177:27
Ts [1] - 101:10
Tuesday [2] 10:14, 10:16
Tumour [3] 23:27, 56:27,
191:13
tumour [7] 23:9, 23:27,
39:12, 56:27,
99:7, 99:9, 100:8
turn [8] - 13:7,
14:27, 21:20,
33:18, 57:13,
78:11, 140:15,
167:19
turning [2] 13:21, 48:18
tutorial [1] 173:22
twelve [3] - 9:7,
24:10, 126:16
twenty [10] 122:11, 122:24,
126:14, 126:15,
127:5, 140:21,
141:20, 141:23,
142:26, 142:28
twice [7] - 10:19,
145:22, 145:25,
146:5, 146:7,
146:10, 201:16
two [60] - 9:14,
9:15, 9:26, 10:4,
10:6, 10:13,
10:23, 10:29,
11:1, 11:6, 12:27,
17:6, 19:25, 20:4,
20:21, 22:15,
23:2, 35:8, 36:23,
37:6, 37:21,
37:25, 41:14,
43:5, 43:10,
47:10, 47:12,
56:3, 81:6, 81:18,
81:26, 85:10,
85:26, 86:28,
91:1, 94:28,
102:27, 104:14,
104:24, 107:11,
109:21, 118:13,
118:22, 124:11,
125:6, 126:2,
126:24, 127:2,
131:7, 135:14,
141:15, 141:18,
152:28, 186:2,
197:4, 197:10,
212:15, 215:1
tying [1] - 66:9
type [8] - 24:1,
41:18, 51:9,
56:14, 83:24,
101:21, 201:7,
213:28
typically [2] 24:7, 56:22
typographical
[1] - 26:5
U
UCD [1] - 173:26
UK [2] - 37:14,
173:5
ultimate [1] 85:11
ultimately [14] 6:28, 16:10, 17:9,
29:29, 84:14,
101:2, 102:1,
165:25, 166:1,
166:3, 166:5,
170:3, 203:9,
203:12
ultrasound [7] 17:26, 18:6,
18:21, 70:20,
87:21, 87:25,
88:2
umbilical [2] 172:23, 172:24
umbilicus [2] 61:13, 147:15
un-filed [1] 86:13
unacceptable
[1] - 75:17
unaided [1] 29:3
unanimously [1]
- 172:14
unavoidable [1]
- 74:21
unclear [1] 194:13
uncomfortable
[3] - 55:17,
159:14, 159:15
uncommon [1] 96:23
UNDER [1] - 1:3
under [28] 14:7, 16:5, 60:11,
60:28, 64:8,
68:14, 68:29,
77:22, 83:12,
86:8, 88:5, 88:12,
101:21, 101:23,
101:28, 140:4,
140:5, 146:6,
146:14, 157:28,
159:13, 160:15,
167:11, 183:29,
189:1, 201:2,
201:5, 204:5
undergoing [1] 70:1
Undergraduate
[2] - 5:19, 7:14
undergraduate
[1] - 173:20
undermine [3] 110:28, 111:1,
152:22
undermining [1]
- 111:4
understaffed [1]
- 188:12
understating [1]
- 37:29
understood [9] 21:16, 22:4,
33:22, 60:2,
61:23, 71:2,
134:29, 135:16,
177:23
undertake [1] 94:10
undesirable [1] 102:12
undoubtedly [1]
- 168:24
unfairness [1] 201:16
unfiled [1] 69:18
unfortunately
[13] - 14:20,
25:24, 29:22,
33:13, 34:2, 67:1,
67:5, 74:20,
75:20, 105:23,
120:1, 167:10,
167:12
unhappy [5] 96:26, 96:28,
146:20, 146:23,
146:24
unhesitatingly
[1] - 191:23
unilaterally [1] 19:26
unit [12] - 56:18,
56:21, 138:10,
138:14, 139:18,
139:25, 144:7,
144:9, 144:11,
145:2, 155:29
United [2] 196:23, 208:22
united [1] 203:24
units [2] 175:23, 176:2
universal [1] 176:1
universally [3] 176:20, 176:22
University [3] 5:21, 8:8, 39:29
unless [1] 197:13
unlikely [1] 91:20
unofficial [14] 25:16, 25:18,
25:20, 25:23,
25:26, 25:28,
26:3, 26:6, 26:15,
26:20, 27:20,
31:7, 87:4, 88:25
unreasonable
[1] - 157:16
unsatisfactory
[1] - 31:4
unscrub [1] 63:5
unsuccessful
[3] - 34:3, 40:15,
67:15
unsupervised
[4] - 89:26, 94:22,
95:2, 117:11
unthinkingly [1]
- 174:27
unusual [11] 19:22, 38:21,
38:27, 45:20,
96:29, 150:26,
152:3, 160:2,
166:17, 166:18,
200:16
up [32] - 5:16,
6:29, 9:15, 12:14,
14:15, 14:21,
21:20, 28:14,
29:15, 32:11,
53:3, 73:20,
76:12, 78:6, 91:4,
93:2, 93:17,
95:27, 97:14,
99:15, 105:29,
118:28, 169:4,
174:5, 174:20,
183:6, 190:22,
191:12, 191:23,
206:27, 211:11,
212:1
up-to-date [1] 78:6
upfront [1] 178:12
upper [7] 60:16, 60:28,
82:23, 82:28,
99:15, 104:19,
147:19
upset [1] 167:22
ureter [12] 12:7, 13:3, 65:6,
65:10, 65:23,
66:1, 66:6, 66:8,
66:9, 164:9
urgency [2] 17:19, 152:18
urinary [6] 17:15, 17:16,
17:27, 18:9,
18:18, 70:10
urine [3] - 12:5,
12:8, 19:1
urological [1] 15:23
urologist [2] 194:21, 196:9
Urologist [1] 196:7
urology [1] 159:8
V
valid [1] - 204:1
valuable [1] 57:4
value [1] - 51:15
values [1] 78:21
variance [1] 127:22
variety [3] -
16:11, 76:22,
96:10
various [8] - 8:3,
14:19, 77:22,
125:17, 187:29,
191:11, 199:23
vascularise [1] 66:28
vein [5] - 65:23,
65:27, 65:29,
66:4, 66:14
veinous [1] 133:4
vena [1] - 56:28
verbal [1] 118:14
verbally [2] 118:12, 184:3
verified [1] 33:10
verify [1] - 62:10
version [5] 45:9, 47:5, 96:8,
183:9, 205:25
versions [1] 194:17
vesicoureteral
[1] - 164:8
vessels [1] 164:17
viability [2] 66:10, 66:12
viable [1] - 67:5
Vietnam [2] 7:27, 192:21
view [21] - 19:8,
30:28, 34:8,
34:21, 38:3,
50:15, 50:22,
50:25, 69:6, 74:5,
81:13, 129:24,
162:11, 192:14,
194:18, 197:12,
200:28, 201:28,
204:3, 204:15,
209:3
viewed [4] 20:16, 34:23,
127:2, 197:14
viewing [4] 176:28, 194:23,
194:24, 195:3
views [5] 79:15, 193:9,
194:19, 199:27,
199:28
virtually [2] 53:21, 160:28
visiting [1] 6:29
33
Gwen Malone Stenography Services Ltd.
visual [1] 164:17
vital [2] - 188:14,
188:28
voice [1] - 5:16
voiding [1] 19:4
volition [2] 168:9, 169:18
vomiting [1] 18:13
VUR [2] - 14:4,
14:10
VUR" [2] - 14:8,
14:19
W
wait [2] - 153:19,
170:10
waited [1] 143:16
waiting [6] 71:18, 74:21,
75:18, 143:10,
153:20, 186:11
Waldron [2] 13:22, 13:29
wall [3] - 23:9,
64:10
wander [1] 134:1
wandered [2] 132:9, 132:13
ward [23] - 8:22,
29:21, 30:8, 30:9,
30:11, 30:12,
30:14, 31:6, 32:7,
32:22, 32:24,
33:8, 45:4, 51:19,
66:25, 71:11,
71:18, 72:10,
75:7, 75:8, 92:25,
93:6
wards [1] 173:23
warn [1] 109:21
WAS [14] - 4:24,
80:24, 108:12,
171:13, 177:12,
179:1, 187:8,
190:2, 193:4,
196:1, 205:12,
207:17, 211:25,
215:20
was...(
INTERJECTION
[1] - 48:6
washes [1] 16:24
washing [1] 17:5
Washout [4] 16:20, 16:21,
17:4, 18:15
waste [1] - 57:3
wasteful [1] 151:24
wasting [1] 136:2
watch [1] - 204:5
ways [1] - 50:24
Wednesday [5] 8:25, 8:29, 37:24,
70:25, 73:23
week [13] - 7:6,
8:24, 10:8, 10:19,
22:14, 23:3, 23:6,
24:8, 30:19,
154:12, 173:16,
191:13
welcome [3] 4:5, 158:7,
158:11
welcomed [1] 40:18
West [1] - 5:27
whatsoever [7] 34:16, 39:25,
50:2, 56:1, 59:26,
166:20, 172:11
Wheeler [33] 28:7, 34:18,
35:28, 36:5,
48:11, 48:14,
49:14, 53:22,
56:4, 101:4,
102:7, 103:7,
123:22, 124:16,
124:28, 125:16,
125:26, 156:17,
156:19, 160:10,
177:3, 181:27,
194:12, 194:17,
194:18, 195:5,
195:11, 195:26,
198:14, 200:26,
200:27, 208:21,
209:21
wheeler [7] 50:22, 102:9,
102:19, 113:24,
194:9, 197:11,
201:22
wheeler's [2] 156:25, 208:18
Wheeler's [4] 96:25, 166:21,
206:19, 209:2
whereas [2] 27:29, 177:21
whereby [1] 157:15
whilst [5] 51:26, 64:29,
69:14, 88:21,
151:19
White [3] - 14:3,
14:7, 14:9
WHO [3] 175:28, 203:22,
203:23
whole [4] 111:17, 115:8,
150:3, 175:8
wholly [1] 210:9
wields [3] 113:24, 113:25,
114:20
willing [3] 63:5, 142:6,
153:10
willingly [1] 38:10
Willis [4] 16:20, 16:21,
17:4, 18:15
Wilms' [2] 56:26, 99:7
window [1] 53:15
wish [12] 104:26, 110:28,
111:1, 134:2,
144:22, 152:22,
166:9, 169:2,
170:22, 177:8,
186:12, 186:20
wished [4] 28:17, 53:14,
114:26, 169:1
wishes [1] 114:22
withdrawn [1] 4:14
WITHDREW [1] 185:26
Withdrew [3] 189:27, 194:3,
214:14
witness [17] 49:4, 54:3, 54:9,
62:20, 107:9,
155:15, 174:6,
185:19, 185:29,
194:6, 195:8,
195:17, 198:17,
199:1, 200:24,
201:5, 214:29
Witness [3] 189:27, 194:3,
214:14
WITNESS [3] 3:4, 5:4, 185:26
witness...(
INTERJECTION
[1] - 201:8
witnessed [1] 26:3
witnesses [6] 49:1, 185:9,
185:17, 186:3,
186:25, 215:1
wonder [8] 8:16, 20:2, 22:12,
107:7, 133:7,
184:7, 185:14,
199:5
wonderful [1] 213:15
wondering [4] 130:4, 175:20,
181:28, 212:18
word [7] - 84:20,
111:16, 111:20,
149:18, 174:15,
174:18, 175:9
wording [1] 98:29
words [6] 82:10, 101:24,
134:17, 142:1,
146:22, 175:15
workload [3] 24:22, 72:22,
180:8
workloads [1] 138:17
works [6] 10:12, 36:24,
157:15, 189:5,
189:16, 201:5
workshop [3] 7:26, 165:11,
166:8
world [3] 96:20, 102:20,
102:23
world's [1] 6:11
worry [1] 213:20
worse [2] - 68:7,
213:28
worthwhile [1] 166:8
wound [2] - 42:8
write [6] - 28:22,
122:28, 174:14,
174:18, 174:27,
175:15
writes [1] 70:21
writing [7] 28:24, 86:29,
89:6, 122:14,
174:20, 183:22,
206:15
written [19] 2:27, 31:29,
62:11, 72:2,
88:11, 92:2,
106:6, 106:10,
127:25, 172:16,
174:12, 175:9,
198:18, 198:21,
198:26, 198:27,
200:8, 205:16,
205:24
wrongly [1] 12:24
wrote [12] - 18:2,
27:22, 70:16,
87:8, 88:10,
122:29, 172:12,
174:21, 175:2,
180:27, 206:16,
207:2
X
x-ray [30] 12:23, 14:10,
14:11, 14:13,
19:19, 20:6, 20:9,
20:12, 20:16,
20:27, 20:29,
21:9, 21:12,
27:17, 27:18,
27:19, 35:9,
50:16, 50:17,
50:18, 51:3, 53:3,
63:18, 64:29,
69:10, 70:26,
160:6, 162:7
X-ray [4] - 19:25,
20:5, 21:6,
102:25
X-rays [6] 89:15, 97:5,
102:24, 104:24,
104:26, 212:17
x-rays [47] 19:17, 19:27,
19:28, 20:11,
20:13, 20:15,
20:18, 20:22,
20:27, 21:8,
21:13, 21:22,
21:24, 22:2,
25:13, 27:17,
32:22, 32:25,
32:28, 33:12,
34:14, 35:13,
50:26, 51:16,
51:17, 51:18,
51:20, 52:25,
63:4, 63:6, 64:13,
64:19, 64:25,
71:13, 71:18,
71:19, 71:22,
75:1, 75:2,
113:28, 162:5,
162:9, 175:3,
176:15
XY [5] - 92:29,
94:15, 94:19,
117:3, 117:8
XY's [1] - 92:22
Y
Yeap [4] - 32:7,
32:20, 143:27
year [28] - 5:11,
5:27, 6:16, 6:22,
6:25, 8:2, 8:14,
9:2, 9:4, 32:11,
39:17, 40:11,
40:16, 69:17,
69:26, 75:9,
84:13, 100:2,
105:3, 165:3,
172:21, 172:22,
176:3, 205:24,
205:25, 206:4
years [34] - 6:13,
9:22, 10:3, 15:11,
15:21, 15:25,
18:9, 19:26, 20:4,
24:19, 39:21,
69:3, 71:20, 72:3,
103:15, 104:28,
155:3, 159:2,
159:6, 159:8,
172:10, 173:8,
190:18, 190:21,
190:22, 191:29,
192:12, 196:19,
196:24, 196:26,
197:2, 197:4,
203:24
yesterday [21] 4:6, 34:18, 35:28,
47:27, 48:11,
54:15, 56:3,
64:15, 102:3,
34
Gwen Malone Stenography Services Ltd.
104:6, 113:12,
113:24, 125:16,
126:1, 148:15,
156:18, 156:28,
160:10, 160:25,
174:5, 174:13
York [1] - 159:5
Youngson [4] 8:15, 165:3,
165:20, 165:28
Youngson's [1]
- 166:10
your...(
INTERJECTION
[1] - 9:12
yourself [18] 5:3, 8:27, 10:9,
10:28, 30:3,
38:13, 38:28,
43:13, 44:13,
55:8, 100:28,
122:28, 134:1,
158:27, 169:21,
182:24, 183:9,
189:7
Z
Zaidi [1] - 32:18