Kathleen Byrne is the mother of Janette Byrne - one of the founders of advocacy group Patients Together. She was told by a surgeon at Dublin's Mater Hospital that he would not perform surgery on her because of her daughter's book, If It Were Just Cancer, which was severely critical of the hospital.

Following this conversation, Arthur O'Hagan, solicitor for the Mater, sent a letter to the Byrnes. It said the Byrne family had "been very critical of the Mater Hospital in the national media. . . The hospital and its staff are naturally acutely conscious of this, " wrote O'Hagan.

He said that staff felt under pressure about undertaking major surgery on Kathleen Byrne that involved "a significant mortality risk. . . with the prospect of media analysis should anything go wrong.

"This pressure has unfortunately but perhaps inevitably served to undermine the doctor/patient relationship and. . . had the potential to adversely influence clinical judgement and jeopardise patient care."

A spokesman for the hospital this weekend said there were a number of factors which influenced the decision to transfer Kathleen Byrne to Beaumont Hospital for surgery.

"The surgeon in Beaumont had more experience, " he said.

"There were many clinical reasons for the decision. However, the surgeon in the Mater has never denied that he said the book was a factor. If you're trying to perform a very complex operation to the best of your ability it shouldn't be done under extreme pressure."

Janette Byrne, who is in remission from cancer, said that the decision had had a "devastating effect" on her family. "We feel that we are being picked upon for speaking out, " she told the Sunday Tribune.

"We have spent three years trying to encourage people to talk about their experiences with the health service, and this decision is just instilling the fear that we've been trying to conquer - the fear that if you complain you will be punished.

"We were so shocked that this could happen in this country. When the surgeon told me that he was not going to operate on my mother because of a book I had written, I just started crying my eyes out. At 46 years of age, crying my eyes out. I think it was a very cowardly decision."

Janette Byrne said that the experience was made worse when it was discovered that her mother had been misdiagnosed with cancer. This news was broken to the family just one day before Kathleen Byrne was scheduled to undergo extensive surgery to remove her stomach.

"They had done a second biopsy and we were very anxious for them to wait until they got the results of that before they operated, " said Byrne.

"We couldn't believe it when we heard that it was negative. We just want answers as to how all of that happened. We were meant to be having a meeting with the surgeon in the Mater next week, but now he has said he won't attend, so we're just not sure where to go from here."

The spokesman for the Mater said that the hospital would never have operated on the basis of just one biopsy, and that they understood that "from a human point of view the misdiagnosis was not a nice experience."