Accused doctor 'hit the wall'

6:25 pm on 10 March 2016

A doctor accused of professional misconduct says he hit the wall and became lost and uncertain in the hour that led to the death of an unborn baby in 2011.

The doctor, who has interim name suppression, was appearing before the Health Practitioners Disciplinary Tribunal in Auckland this week.

He was accused of failing to perform an emergency caesarian section, failing to respond to concerns raised by the obstetric registrar, delaying appropriate action and deciding to get a fetal blood sample when indications went against it.

He was also accused of failing to communicate with his patient and her husband, failing to discuss a managment plan and options for progressing the labour and failing to find out what the patient wanted to do to progress her labour.

The woman was 46 and nearly 38 weeks pregnant with her fourth child when she arrived at the hospital after her waters broke in October 2011.

Two and a half days later, she was in induced labour when the baby's heart rate was decelerating.

Two midwives had been monitoring the woman when they became concerned about the baby.

One called the doctor at about 9pm when the cardiotocograph - or CTG - that measures the fetal heart rate was abnormal.

Prosecuting lawyer Nicola Wills told the tribunal that the doctor went into the patient's room at 9.14pm and reviewed the CTG trace which clearly showed the baby had prolonged bradycardia, when the heart rate falls below 100 beats per minute for more than five minutes.

She said that the usual course of action was to do an emergency caesarian to rescue the baby from "significant fetal compromise".

However, the doctor did not follow the accepted clinical course of action but instead took a "wait and see" approach.

Ms Wills said the doctor did not talk to his patient or the midwives about the CTG trace, about how he was going to manage the prolonged bradycardia or the options of speeding up the delivery.

She said by the time the doctor finally called a code red c-section, 29 "precious minutes" had passed.

The baby was delivered stillborn just before 10pm.

The doctor accepted that he made a series of bad errors.

He told the tribunal that he was sitting down in the tearoom with a cup of coffee to watch world cup rugby at 9pm when he was called by a midwife.

He said when he went into the patient's room he "hit the wall" and felt lost and uncertain, and was concerned that he was not reading the situation correctly.

He said he wanted to seek a second opinion and waited until 9.30pm for the registrar to arrive. He said the registrar told him that an emergency caesarian was needed but his mind was set on a vaginal delivery.

He said he "clung to the idea and became dogmatic" that that was what he wanted to do.

He said his behaviour was out or character and finding an explanation has upset his sleeping pattern every since.

The doctor said he was tired after a busy day, starting at 8am and doing a double duty shift as on call obestetrician and registrar.

"I was in the room, out of the room, not communicating with the patient correctly. I couldn't make decisions."

His lawyer, Harry Waalkens QC told the tribunal the doctor was affected by unexplained impairment for a "ghastly" 58 minutes.

He pointed out that the hospital was understaffed and the doctor was thwarted by the two midwives on duty who had not conveyed the urgency of the situation.

An expert witness said there were many failures before the doctor was involved and the whole team should have been proactive.

The doctor has been suspended from acute obstetrics but continues to work in other areas.

The penalty for professional misconduct ranges from censure to being struck off.