This is one of the damning conclusions in the government-ordered report into the scandal at Our Lady of Lourdes Hospital, Drogheda, by Judge Maureen Harding Clarke. Her report is scheduled to be released this week.

The judge strongly criticises Neary and the hospital that allowed him to carry out a "shocking" number of unnecessary hysterectomies on women over a 24-year period.

The inquiry report says that probably more than one person "working within the hospital and with a good knowledge of the recording systems" must have spent hours retrieving the files and had to be familiar with the maternity unit so as not to raise suspicion.

Judge Harding Clark's report, which has been submitted to the government, says, "This is not a simple story of a surgeon with poor surgical skills or a doctor deficient in academic excellencef It is a story of a committed doctor with a misplaced sense of confidence in his own ability."

The judge concludes that the number of hysterectomies carried out by Neary from 1974 to his suspension in late 1998 was "truly shocking". There is also strong criticism of hospital staff for failing to expose Neary's practices. "What happened should not have been tolerated, and serious questions should have been asked long before October 1998."

During the inquiry, it was discovered that someone had made deliberate changes to the maternity theatre's register in an attempt to thwart the emergence of the truth.

"Some very alarming alterations were detected in this register. These alterations indicate deliberate attempts to prevent a full determination of the numbers of peripartum hysterectomies carried out in the unit". A handwriting expert was consulted and an examination of three alterations to the theatre register confirmed they were made by the same person.

Of the 188 patients who underwent a peripartum hysterectomy between 1974 and 1998, charts for 44 patients are missing. Thirty-eight of the 44 charts relate to patients of Michael Neary. "The conclusion that they were intentionally identified, traced and removed from the hospital is inescapable, " the report concludes.

Neary told the inquiry that someone may have been trying to "blacken his character by removing so many records relating to his patients". Judge Harding Clark, however, notes that the missing files also "obliterates all trace of those who were present or assisting at the operations", including midwives, junior doctors and anaesthetists.

The report notes that Neary was given a photocopy of the 1991 maternity theatre register, which runs to 1998, and which was copied after the alterations were made. "It was clearly photocopied by at least two women, as photographs of the fingers of two different hands were clearly visible on a number of pages. One of the hands was wearing nail varnish which we are informed would make it extremely unlikely to be those of a midwife or a surgical nurse." The report suggests the individuals responsible most likely had "sympathies to Dr Neary".

The report also reveals there were three break-ins at the offices of the inquiry while it was investigating practices at Drogheda hospital. The government is expected to come under pressure to respond to Harding Clark's report by setting up a redress board for the women who suffered at the hands of Neary.