|Practitioner:||Dr Jeffrey Norman Harrild|
|Charge Characteristics:|| Failure to
act on and/or recognise significance of symptoms and/or test results
Inappropriate and/or inadequate communication
The Director of Proceedings charged Dr Harrild with professional misconduct. The particulars were as follows:
- On 2 October 1997 did not warn his distressed patient that he would be suddenly banging her stomach with the scanner probe whilst undertaking an ultrasound on her.
- On 3 October 1997 at 3.00 pm whilst undertaking an ultrasound Dr Harrild informed his patient and her husband that their baby had died in utero by saying "you're absolutely right, there is no heart beat."
- Spoke abruptly.
- Did not adequately inform them of their options for delivery and explain the process to be followed.
- Failed to offer suggestions for support and/or counselling.
(The Director of Proceedings withdrew Particular 1 at the commencement of the hearing.)
The patient was initially referred to Dr Harrild by her general practitioner in August 1997. On 30 September 1997 the patient felt that her baby's movements had reduced, and she did not record a 10th kick until 9.00pm that night. She felt no movements during the night, and by 10.00am the following morning she was becoming concerned. The patient contacted her midwife, (Midwife A), who told her to go to Masterton Hospital to be monitored.
Midwife A contacted her GP. He was not available to see the patient, but suggested Dr Harrild be contacted. During the first monitor run, the patient felt three faint kicks. Dr Harrild arrived and examined the patient. He took her blood pressure and pulse and he arranged for her to be admitted . The patient felt no further movements that day.
Later in the day, another midwife, (Midwife B), performed another monitor run. After that run was completed she instructed the patient not to have anything to eat as she thought that Dr Harrild might want to deliver the baby by caesarean section. She contacted Dr Harrild and told him the results of the monitor run. In evidence she said that she considered that the recording was "very flat", and it indicated to her that the baby was in trouble. Dr Harrild did not consider that immediate delivery was indicated, and Midwife B told the patient that Dr Harrild had viewed the monitor run and was not concerned.
The patient felt no movements during the night, and the monitor run on the morning of 2 October 1997 showed no change. Dr Harrild visited her that morning, and ordered blood tests and an ECG. He performed a further ultrasound scan and he pushed or prodded the patient's abdomen in an attempt to startle the baby. He thought he saw the baby move as a result, but the patient did not think that the baby moved at all.
At tea time another monitor run was carried out, again by Midwife B, with a similar result to the previous evening. Midwife B again told the patient not to have dinner as she thought Dr Harrild would want to deliver the baby. However, about 6.30pm she returned to the patient and told her she could eat dinner as Dr Harrild had no plans to come in that evening. At this time Midwife B brought a CTG trace from a 'healthy' baby, and showed the patient and her husband the difference between that trace and the trace obtained from their baby. The traces were markedly different. The trace from the patient's baby was flat, with no variability. Midwife B urged them to obtain a second opinion.
The patient contacted Midwife A to ask her advice. She told them that she trusted Dr Harrild's ability, and reassured them. The patient's husband asked one of the other midwives on duty to contact Dr Harrild and to ask him to come in and meet with them. Dr Harrild told the patient and her husband that he thought that there was something wrong with their baby, but he did not know what it was. He said that he was waiting for blood test results, and that, in the meantime, the best place for the baby was where it was.
The patient's husband asked about the possibility of delivering the baby by caesarean section, but Dr Harrild warned of the risks such as difficulties under anaesthesia, and breathing difficulties for a baby born at 37 weeks. He said that he was not overly concerned with the CTG recordings.
Around 4.30 pm the next day, Midwife B carried out another monitor run. She was unable to find a heartbeat, and fetched Dr Harrild. He took the patient for an ultrasound scan and, after pointing out the baby's head, arms and legs to the patient and her husband said, apparently to Midwife B, "You're absolutely right. There is no heart beat".
The husband asked Dr Harrild if he meant that the baby had died. Dr Harrild replied, "Well yes, I'm sorry". After some moments, Dr Harrild pointed out the baby's heart and suggested that there might be some abnormality.
The patient elected to be admitted to Wellington Hospital the next day and Dr Harrild was told that they did not want to continue under his care.
Their baby daughter was delivered stillborn at Wellington Hospital on 6 October 1997.
Dr Harrild was found guilty of professional misconduct.
Dr Harrild admitted particulars 2, 3 and 4. He denied particulars 5 and 6 and he denied that any of the particulars amounted to professional misconduct.
The Tribunal was satisfied that the CTG and monitoring data obtained from the baby was significantly abnormal. It considered Dr Harrild's decision to wait and see was a serious error of judgment. The Tribunal considered that separately particulars 2 to 4 did amount to professional misconduct.
Particular 5 was not established. In considering Particular 5(a) the Tribunal was not satisfied that it was proven either that Dr Harrild failed to warn the patient that he was about to stimulate the baby, or, if he did fail to warn her, that he banged on the baby, rather than merely prodded or pushed on the patient's abdomen. As to Particular 5(b) the Tribunal was satisfied that the allegation was established. However, the Tribunal was satisfied that while Dr Harrild should have coped with the situation better, or more professionally it was not satisfied that his failure to do so amounted to a professional disciplinary offence.
In relation to Particular 6 of the charge, the Tribunal was satisfied that this was established but that it amounted to the lesser charge of conduct unbecoming that reflected adversely on Dr Harrild's fitness to practise medicine.
The Tribunal took into account a number of factors which it considered to be relevant considerations both in the context of the Tribunal's determination of Dr Harrild's culpability, and its ultimate determination as to penalty. (See pages 18 to 20 of the Decision). The Tribunal also considered it appropriate at the penalty stage to take into account that Dr Harrild had been a specialist practitioner for more than 20 years and that this was the first time he had been charged with a professional disciplinary offence.
The Tribunal ordered Dr Harrild be censured, fined $3,000 and pay 15% of the costs and expenses incidental to the investigation, prosecution and hearing of the charge. It was further ordered a notice be published in the New Zealand Medical Journal.
The Tribunal also ordered copies of the Decisions be forwarded to the Medical Council of New Zealand together with a request that the Council consider whether or not a review of Dr Harrild's competence is required, and a competency programme instituted.