An obstetrician dealing with a Co Wexford woman's pregnancy should have established that the woman was carrying twins, a British medical expert told the High Court yesterday.
Dr Roger Clements, a consultant obstetrician, said it was unacceptable management to leave open the question of whether a woman of 30 weeks gestation was carrying twins.
A medical note written by Dr Harry Murphy, the obstetrician dealing with Ms Patricia Kavanagh, was "not a competent note" for an obstetrician to make, he said.
It posed the question whether Ms Kavanagh should be rescanned to exclude the possibility of multiple pregnancy.
Once twins were suspected, it was essential to make sure whether there was a multiple pregnancy because of the one-in-three possibility of a premature birth, he said.
Dr Clements was giving evidence on the second day of an action by Gary Kavanagh, suing by his mother Patricia, of Curracloe, near Wexford, alleging negligence in the circumstances of his birth at Wexford General Hospital in January 1991.
The action is against Dr Murphy and the South Eastern Health Board.
It is claimed Gary, now aged eight, suffers cerebral palsy due to the alleged negligence. The claims are denied.
Gary's twin Ian, the first born, is now in very good health, the court has been told.
In court yesterday, Dr Clements said a competent ultra-scanner would have no difficulty in detecting a multiple pregnancy.
The possibility of someone "missing" a second baby was so wildly improbable that he could find no reference to it in the medical textbooks.
A patient's doctor needed to tell a woman in those circumstances that she was going to have twins and that there was a risk she would go into labour early.
In 1991, there were no paediatric doctors in Wexford General Hospital, Dr Clements said. No doctor would consider planning to deliver a premature baby, let alone twins, in circumstances where a hospital did not have neo-natal facilities.
When Ms Kavanagh arrived at Wexford General Hospital on January 9th, 1991, just as Ian was about to be born, it was "too late" to have her brought to Waterford hospital where there were neo-natal facilities.
When baby Ian was brought to Waterford next day, Gary should also have been taken there, both for medical and humanitarian reasons, the witness said.
The hearing before Mr Justice O'Donovan continues today.