Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge:  

A CAC charged that Dr Taylor was guilty of professional misconduct in that he failed to exercise the standard of care and skill reasonably to be expected in regard to his management of his patient's labour and the birth of her child. In particular Dr Taylor:

1. Failed to ensure or to take steps to ensure that a paediatrician was present at the birth.
2. Failed to recognise and/or act upon the cumulative risk factors inherent in the labour and delivery. These risk factors were the foetal abdominal circumference identified on the ultrasound scan at the 5^th centile and gestational hypertension.
3. Failed to ensure the baby was delivered at 2.40 am on 25 May 1996 or shortly thereafter when called upon to review the trace by the midwife.
4. Failed to recognise and/ or act upon the worsening foetal trace and/or act upon the worsening foetal trace expeditiously at his consultations at 1.30 am, 2.40 am, or 4.00 am.
5. Failed to discuss with a consultant the management of his patient's labour at 1.30 am, 2.40 am, or between 3.50 am - 4.00 am.
6. Failed to expedite delivery.

Background:

In 1996 the patient was pregnant with her first child. Her expected delivery date was 16 June 1996. Her pregnancy was uneventful until early May 1996 when she was admitted to National Woman's hospital with vomiting and diarrhoea. She was assessed and discharged on 10th May 1999. She was seen again on 14 May at the foetal assessment unit when a tentative diagnosis of gestational hypertension was made. She was admitted again on 21st May 1996, as there was concern over her 24-hour urine result, her oedema and previous history of increased blood pressure. She was scanned on 24th May 1996, this indicated that the baby's abdominal circumference was on the fifth percentile. On the way home from the scan the patient's membranes spontaneously ruptured.

A decision was made to admit the patient for augmentation of labour. At approximately 7.15 pm the patient was admitted. At 10.15 pm a syntocin drip was commenced. At 1.30 am on 25 May the midwife asked Dr Taylor to review the CTG trace. At 2.15 am the midwife called Dr Taylor again, he reviewed the CTG trace and set-up for a scalp pH but did not carry it out. A vaginal examination showed the patient was fully dilated. Dr Taylor believed delivery was imminent. At between 3.50 am and 4.00 am Dr Taylor was called again by the midwife and reviewed the CTG. Delivery had not then occurred. The trace had been abnormal for some time prior to 1.30 am. Dr Taylor advised that delivery needed to be expedited.

The baby was delivered at 4.25 am. The baby gave sporadic gasps and was floppy. Resuscitation was carried out. Voluntary respiration was not established until 35 minutes after the birth. The child cannot walk, talk or sit up or feed herself and will never be able to.

Finding: 

Dr Taylor pleaded guilty to the charge of professional misconduct.

Penalty:

Dr Taylor was censured, fined $600 (max $1000) and ordered to pay 30% of the costs of the inquiry and hearing. The Tribunal found there was no deliberate neglect by Dr Taylor, but his knowledge and judgement in this case were deficient. The Tribunal could not reach a consensus as to appropriate conditions to be imposed should Dr Taylor wish to practice as a GP obstetrician or a specialist obstetrician. It proposed to formulate conditions after seeking the advice of the Royal New Zealand College of Obstetricians and Gynaecologists.

In a supplementary decision the Tribunal issued the following practice conditions:

1. Should Dr Taylor wish to commence practice as a general practitioner/obstetrician he is required to meet the following conditions:

1. Attend an approved obstetric refresher course comparable to that available at National Women’s Hospital in Auckland.
2. A minimum of 10 deliveries should be supervised by a general practitioner/obstetrician who is prepared to accept responsibility for Dr Taylor’s practice.
3. Such deliveries should take place in a hospital where there is a specialist obstetrician available for consultation if required.

2. In the event that Dr Taylor wishes to resume specialist training in obstetrics and gynaecology he is required to recommence training at the basic or introductory level, i.e., as a member of the Integrated Training Programme endorsed by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists.