Doctor’s inaction had a ‘serious effect on woman’s health’

A doctor's failure to follow up on an abnormal X-ray had a "serious effect" on the health of a woman who later died from cancer, a Medical Council inquiry heard on Wednesday.

Expert witness Dr Kathleen McGarry said Dr Emmanuel Gbadebo Alabi should have flagged the abnormal report with his superiors.

Dr Emmanuel is the subject of the disciplinary inquiry, which began on Tuesday.

Dr Emmanuel, who is based in Cork but trained in Belarus, was hired on a two-month contract as a senior house officer (SHO) at Mayo General Hospital from January-February 2009. This was his first clinical position in Ireland.

It is alleged that on or about January 29th, 2009, Dr Emmanuel failed to bring a report regarding a chest X-ray examination carried out on patient Evelyn McGinn on January 26th to the attention of his supervisors.

It is also alleged that on or about January 29th, 2009, Dr Emmanuel initialled the X-ray report in circumstances where he knew or ought to have known it required further consideration by his supervisors.

On Wednesday, expert witness Dr McGarry, a consultant physician at Navan Hospital, Co Meath, said the X-ray report from Ms McGinn showed enlarged lymph nodes in her chest.

Because of this, the X-ray report recommended that Ms McGinn should be referred to a respiratory physician.

Dr McGarry explained that sometimes the cause for these enlarged lymph nodes is malign, and sometimes it is malignant.

In the case of Ms McGinn, the cause was subsequently showed to be malignant.

“There’s no doubt that an earlier diagnosis would have helped with various management strategies,” she told the inquiry.

“This failure to not follow up on the X-ray was a serious omission and had a serious effect on the health of Ms Evelyn McGinn.”

Dr McGarry said a referral letter should have been sent to a specialist “relatively urgently” on foot of the abnormal X-ray report.

“I feel, notwithstanding all the serious systems failures, that Dr Alabi, as an SHO, fell short and did not follow up as you would expect an SHO to do,” Dr McGarry said.

She said that it was not Dr Emmanuel’s responsibility to make the referral but she would have expected him to flag the abnormal report with his registrar or consultant.

She also said the recruitment process which resulted in the hiring of Dr Emmanuel was “unsatisfactory” because the hospital did not have any clinical references for him.

However, she said it is difficult for many non-metropolitan hospitals to recruit the required number of staff.

“I’m sure this was a factor in the recruitment of Dr Emmanuel Alabi,” said Dr McGarry.

“He found himself as an underperforming doctor in a system where there were multiple systems failures.”

Conversation

On Wednesday, Dr Emmanuel insisted that he spoke with his registrar – who was his superior within the hospital and whom he was shadowing – about the X-ray report.

Dr McGarry said that, if this conversation did happen, responsibility would lie with the registrar.

However, she pointed out that there is no record of such a conversation.

Earlier on Wednesday, consultant obstetrician and gynaecologist Dr Murtada Mohammed said he would expect an SHO to flag an abnormal X-ray report with a registrar or consultant.

“If you get an abnormal result, you write that in the chart, and then you do what is necessary to be done,” said Dr Mohammed.

In December 2008, around the time of her 50th birthday, Ms McGinn attended Mayo General Hospital complaining of post-menopausal bleeding.

In January 2009, it was decided that an investigative hysteroscopy should be carried out under general anaesthetic.

On January 26th, Ms McGinn was admitted to hospital for the chest X-ray, as a precaution before her surgery, scheduled for the following day.

The surgery took place and she was discharged.

Ms McGinn returned to hospital in March 2010, feeling unwell, and was diagnosed with Stage 4 cancer. She passed away that November.

On Tuesday, Leonie Kilroy, Ms McGinn’s sister, said she believed her sister suffered greatly because she didn’t get a proper diagnosis when she was in hospital in January 2009.

The inquiry has been adjourned until July 11th.