Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that Professor Mantell was guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on his fitness to practise medicine. It charged that in his management of his patient Professor Mantell:

1. Failed to adequately record in the clinical notes the seriousness of the condition of the patient's unborn baby on her admission to hospital on 7 June 1996.
2. Failed to inform or adequately inform the patient and her husband on the evening of admission of the seriousness of the placenta abruption and the consequences of this for the unborn baby.
3. Failed to consult with a paediatrician concerning the unborn baby's condition within a reasonable time.
4. Failed to transfer the patient to hospital within a reasonable time.

Background:

The patient was admitted to hospital on 7 June 1996, at 26 weeks gestation, with vaginal bleeding and lower back pain. She was contracting every 4 minutes and a fetal tachychardia was noted. She came under the care of Professor Mantell and his team. Professor Mantell initiated management consisting of intravenous Salbutamol and steroids. The patient's condition at the time of presentation suggested placental abruption. The subsequent neonatal course demonstrated a severely compromised fetus which was hypotensive and acidotic. Doctors regularly monitored the patient's condition throughout the night. Scanning was undertaken on two occasions. CTG's were abnormal and showed reduced variability. No foetal movements were felt. The patient was transferred to another hospital the next morning. A decision was made to deliver the baby by caesarean section. A baby boy was delivered at 11.57am. The baby weighed 980grams and was in poor condition. Later that afternoon a cranial ultrasound revealed bilateral intraventricular haemorrhages. Following a case conference with the parents and other relatives it was decided to withdraw intensive care support and the baby died.

Finding: 

The Tribunal found Professor Mantell was not guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on his fitness to practice medicine.

The Tribunal found particulars 1, 3 and 4 of the charge were not established. With regard to particular 3 the Tribunal considered that earlier consultation with a paediatrician might have enhanced the communication process between Professor Mantell and the patient and her husband.

The Tribunal, when considering particular 2, found that Professor Mantell failed to inform or adequately inform the patient and her husband on the evening of admission of the seriousness of the placenta abruption and the consequences of this for the unborn baby. The patient and her husband were not involved in the decision making process. The Tribunal held at all times it is the responsibility of the medical profession to share with patients the information that affects them. The obligation to adequately inform encompasses an obligation to document the nature of the information given to the patient.

The Tribunal was not satisfied that the failure identified although constituting unbecoming conduct, reflected adversely on Professor Mantell's fitness to practise medicine. The Tribunal considered the caveat of showing wisdom with the benefit of hindsight was applicable in this case (see B v The Medical Council (HC Auckland 11/96 Elias J 8/7/96)). The Tribunal took into account Professor Mantell's exceptional references; the fact this was the first complaint of its kind and the first disciplinary charge Professor Mantell had faced.

The Tribunal considered the departure in this case was not so significant that it ought to have attracted sanction for the purposes of protecting the public.

Appeal: 

The CAC appealed the decision to the District Court (CAC v Mantell (District Court, Auckland Registry, 7 May 1999, NP 4533/98)).

The Court found the Tribunal erred in the approach that it took. It found the Tribunal did not confine itself to considering whether the conduct reflected adversely on the practitioner's fitness to practise medicine. The Court found the Tribunal expanded its enquiry and the Tribunal considered whether or not Professor Mantell was a fit person to practise medicine.

The Court considered it could not answer the question of exactly what Professor Mantell said to the patient and her husband. As this was the issue at the heart of the case against Professor Mantell, the Court concluded the matter must be referred back to the Tribunal for further consideration.

The CAC, by majority decision withdrew the charge against Professor Mantell. The Tribunal sought consent from the District Court not to reconsider the matter. The Court issued a minute on the 15 December 1999 setting aside the direction contained in the Appeal judgment.