Obstetrician found guilty of poor professional performance

An Cavan-based obstetrician has been found guilty of one count of poor professional performance in relation to the care he provided to one out of three patients.

The Medical Council fitness-to-practise hearing found Dr Salah Aziz Ahmed failed to decide that the immediate delivery of a baby – the son of a woman referred to as patient C – by emergency Caesarean section was required.

The consultant obstetrician and gynaecologist was found not guilty of poor professional performance in relation to six other allegations that were proven as to fact. He was also cleared of professional misconduct on two counts.

Patient C, who had a very poor obstetric history, gave birth to a baby boy by emergency Caesarean section at Cavan General Hospital on April 26th, 2014. He was born with no signs of life, and did not respond to resuscitation. It was later discovered patient C had suffered from her third placental abruption.

Serious failure

Referring to the failure to decide that immediate surgery was required, Mary Duff, chair of the inquiry committee – which rules on the case – said: “The committee were satisfied that this was a serious failure to meet the standards of competence that can be reasonably expected of [an obstetrician].”

Sanctions will be determined at a later date by the Medical Council.

Legal counsel Eileen Barrington SC, for Dr Aziz, said he admitted as to fact the one allegation that was found to amount to poor professional performance. She said a sanction “should be on the lower end of the scale, and that more than adequately protects the public”.

Ms Barrington added that Dr Aziz has “demonstrated insight into the criticisms made of him”, adding there was no allegation that the outcome for patient C’s baby would have been any different had he been delivered earlier.

The Medical Council inquiry has examined the care Dr Aziz provided to three women, one whose baby died in utero, one whose baby died two days after his birth and one whose baby was born in very poor condition.

Tuesday marked the 25th day of the inquiry, which first began in November 2016.

Anonymity waived

It heard that patient A gave birth to a baby boy by emergency Caesarean section on November 22nd, 2012, but he died two days later.

The second patient, Deirdre Clarke – who waived her right to anonymity – gave birth to a baby boy by emergency section, on June 5th, 2013 after her uterus ruptured. Her baby was born in very poor condition, although he made an eventual recovery.

On May 18th, the inquiry committee – which rules on the case – found seven out of the 14 allegations against Dr Aziz in relation to these mothers to be proven as to fact.

In relation to patient A, the committee found that on November 22nd, 2012, while patient A was labouring, Dr Aziz instructed that the administration of labour drug syntocinon be increased from 90ml per hour at 9.40pm to 180ml per hour at 10.57pm in the presence of evidence of prior hyperstimulation.

Dr Aziz also performed an episiotomy on patient A in circumstances where it was not justified, and failed to catheterise her prior to attempting a Caesarean section delivery.

In relation to the care Dr Aziz provided to Ms Clarke, the committee found he directed that the administration of syntocinon be increased at or around 6.05pm, while Ms Clarke was in labour, and he instructed for syntocinon to remain infusing at 60ml at 10.30pm.

Contractions

Syntocinon is a drug used to progress labour, but can lead to hyperstimulation of the uterus and extra-strong contractions. This can distress a baby and increase the risk of uterine rupture in a mother such as Ms Clarke, who was trying for a vaginal birth after a Caesarean section.

In relation to patient C, the committee found Dr Aziz failed to decide that immediate delivery of a baby by emergency Caesarean section was required. He also failed to attend at Cavan General Hospital in order to assess patient C within an adequate timeframe on April 26th, 2014.