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Precis

Charge:  

A Complaints Assessment Committee charged that Dr Lynda Mey Batcheler was guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on her fitness to practise medicine. It charged in regard to her management and treatment of her patient during pregnancy. Dr Batcheler:

1. Failed to maintain records at the standard expected of a specialist obstetrician of her consultations with the patient during the pregnancy;
2. Failed to take adequate account of the patient's expressed concerns about the progression of the pregnancy to the extent that the patient did not feel listened to and lost confidence in Dr Batcheler;
3. When told by the patient at her appointment on 10 or 12 April 1996 [there being a dispute about the date] that there had been a decrease, change or alteration in the baby's movements, failed to take appropriate clinical action;
4. Failed to adequately inform the patient as to the intended role of the midwife with the result that the patient believed that the midwife had a shared care role in relation to ante-natal care whereas the midwife understood from Dr Batcheler that her role was in regard to delivery and post-natal care;
5. On 16 April 1996 when advised by the midwife that the patient had telephoned her expressing concerns about the changes in the baby's movements failed to take appropriate clinical action and failed to ensure appropriate systems were in place to manage the concern expressed by the patient in her telephone call.

Background: 

The charge laid against Dr Batcheler arose out of her care of a patient during her pregnancy. The baby was stillborn on 18 April 1996. At the time of her delivery the baby was a full-term baby and no cause for her demise in utero has been identified.

The patient had one child who was born in 1992. Following the birth of that child the patient suffered a severe case of post-natal depression. Throughout the period 1992-1996, the patient received treatment for her depression.

From approximately 24-26 weeks into her pregnancy the patient said she reported to Dr Batcheler that her baby's movements appeared much quieter than those she had felt in her first pregnancy. The reports of "weaker" or "quieter" movements related to the quality of the movements, rather than to their frequency. Up to and including the morning of 16 April 1996, the patient was able to report feeling at least 10 fetal movements everyday.

On 17 April the patient was visited by her mid-wife. The patient's account of the events leading up to the visit and the reason for it, differs from that given by the midwife and Dr Batcheler. However, the midwife was unable to hear a fetal heartbeat and she referred the patient to hospital for a CTG immediately. The CTG failed to register a heartbeat. An ultrasound was then undertaken and it was apparent the baby had died in utero. Dr Batcheler was immediately summoned. She confirmed that the baby was dead, and arranged for delivery of her the next day.

Finding:

The Tribunal found Dr Batcheler not guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on her fitness to practise medicine. The Tribunal was satisfied that none of the Particulars were established.

When considering Particular 1 the Tribunal was satisfied that the records maintained by Dr Batcheler comprised a true and correct record of her findings and that they were sufficient both as an aide memoire for Dr Batcheler, and as a means of communication to any other practitioner who might require the information to enable them to provide care to the patient.

The Tribunal was satisfied that Particular 2 was not established. It found no evidence that Dr Batcheler failed to take adequate account of any concerns expressed to her either about the baby, or about the standard of care being given to the patient. Dr Batcheler appeared to have seen the patient every time she was asked to do so, as well as in routine appointments. In addition the patient telephoned her on 5 or 6 occasions, and Dr Batcheler responded immediately when summoned in the middle of the night when the patient suffered an adverse reaction to a medication her psychiatrist prescribed for depression and anxiety.

The Tribunal considered Particular 3 was the central issue of the Charge. The Tribunal was satisfied that the patient did tell Dr Batcheler that the baby had "slowed somewhat" and that its movements felt like "flutters". Dr Batcheler examined the patient and her baby by palpation and by listening to her heartbeat. The clinical record indicated that she was satisfied the baby was moving satisfactorily; that the patient's report of baby's movements (10 felt every morning, quiet, slow, flutters) was consistent in terms of previous reports over the term of the pregnancy; the baby's heartbeat was heard and appeared normal; baby's size for dates was normal and there were no clinical signs of anything untoward with either mother or baby. It was suggested Dr Batcheler should have ordered other tests or examinations such as CTG, a biophysical profile or an ultrasound. The Tribunal accepted the evidence given by the medical witnesses that no such additional tests were indicated or are likely to have produced any information which would have altered the outcome of this pregnancy. The Tribunal considered that Dr Batcheler did all that was appropriate.

When considering Particular 4 the Tribunal found that if there was a misunderstanding between Dr Batcheler, the patient and the midwife as to what the role of the midwife was, it was inadvertent. The Tribunal found any such misunderstanding did not arise as a result of an omission on the part of Dr Batcheler.

The Tribunal found Particular 5 was not established. The Tribunal was satisfied the midwife did tell Dr Batcheler the patient had telephoned her, and that she was worried about the baby's movements. However, the Tribunal considered that if Dr Batcheler feared the slightest concern that anything was amiss she would have responded immediately. The Tribunal found the discussion between the midwife and the patient was about movements, not about cessation of movements, or about sudden change to the pattern of movements felt over the last trimester of the pregnancy. The Tribunal determined Dr Batcheler was not advised of any concerns on the part of the patient that required her to take any action.

Appeal:

The CAC filed a notice of intention to appeal to the District Court, but later withdrew the appeal.