Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that Dr H, a general practitioner, was guilty of disgraceful conduct in a professional sense, or professional conduct, or conduct unbecoming a medical practitioner and that conduct reflects adversely on the practitioner's fitness to practise medicine. It charged on or about 28 September 1990 in the course of Dr H's management of her patient she failed to recognise the significance of and therefore to act upon the deteriorating Gestational Proteinuric Hypertension;

A CAC charged that Dr G, a general practitioner, was guilty of disgraceful conduct in a professional respect or professional misconduct or of conduct unbecoming a medical practitioner and that conduct reflects adversely on the practitioner's fitness to practise medicine. It charged that on or about 29 September 1990 in the course of Dr G's management of his patient he :

1. Failed to recognise the significance of the abnormal CTG trace.
2. Delayed in initiating steps to deliver the baby after his initial assessment of the patient.

Background:  

During her second pregnancy the patient was cared for by her general practitioner, Dr H. Throughout her pregnancy her blood pressure rose steadily. She showed traces of proteinurea at several visits. She was admitted to hospital for bed rest after showing signs of oedema in July 1990. She was referred to a specialist obstetrician on four occasions. Her specialist found no evidence of toxemia. At her final antenatal visit Dr H recorded proteinurea ++ and an increase in weight. The patient went into labour the following morning. She was seen by Dr H who noted signs consistent with foetal distress. A decision was made to transfer her to another hospital but her records were not transferred with her. Dr H did not speak to the doctor into whose care the patient was placed. Following admission, at approx 2pm, she was examined by Dr G. Her CTG showed clear abnormalities, which he incorrectly assessed as being related to sedatives the patient had been given. Dr G planned to monitor the patient hourly. An artificial rupture of membranes was not performed and at 4.55pm the membranes spontaneously ruptured with meconium stained liquor draining. An emergency caesarean section was performed and the baby was delivered at 6.39pm. The baby appeared mature but underweight, she was asphyxiated. She suffered asphyxial brain damage.

Finding:

Dr H

The Tribunal found Dr H guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on her fitness to practise medicine.

The Tribunal found Dr H's management of her patient was deficient. Her treatment of her patient was characterised by a lack of any sense of urgency and awareness of the potential risks either to the patient or her baby. The Tribunal determined that, at a minimum, Dr H should have contacted the hospital to ensure that her patient had arrived safely or to inquire into whose care she had been placed and to speak directly to that doctor. The lack of information passed on to the patient or her hospital caregivers, or the formulation of any management plan by Dr H meant neither the patient or her husband were put in a position where they could have been alerted to the potential risk to their child. The Tribunal considered that a reasonable and prudent practitioner should have recognised the significance of the relatively soft clinical signs and acted accordingly. They considered Dr H failed to bring to bear sufficient clinical judgement in her management of this patient.

Dr G

The Tribunal found Dr G guilty of professional misconduct.

The Tribunal found that Dr G, as a general practitioner with a diploma in obstetrics, should have been able to recognise the CTG tracing for what it was. Given the combination of clinical indicators-proteinurea, raised BP and the CTG abnormalities, the Tribunal considered at minimum he should have artificially ruptured the patient's membranes when he saw her at 2.00pm. If that had been done an urgent caesarean would have occurred at a much earlier time. Accordingly, the Tribunal found both particulars of the charge were proven.

Penalty:

DR H was censured, fined $450 (max $1000) and ordered to pay 30% of the costs of the inquiry and hearing.

Dr G was censured, fined $600 (max $1000), and ordered to pay 30% of the costs of the inquiry and hearing.

Both Dr H and G advised the Tribunal that they no longer practise obstetrics. The Tribunal ordered that they are not to resume such practice, or undertake any obstetric care of a patient beyond the first trimester, unless first advising the Medical Council so that their competencies may be reviewed. Any such resumed obstetric practice is to be carried on under supervision for a period of not less than twelve months.

Publication in the New Zealand Medical Journal was ordered with the proviso that the names and details of the parties are not to be published.