Care plan for a mother whose baby boy died was 'not clear', inquest told
The care plan for a mother whose baby boy died less than two days after his birth was “not clear”, an inquiry heard on Friday.
Consultant obstetrician Dr Salah Aziz Ahmed faces allegations at a Medical Council Fitness to Practise Inquiry of poor professional performance and professional misconduct relating to three women who gave birth at Cavan General Hospital between November 2012 and April 2014.
The inquiry has heard details involving one of the patients, a 37-year-old woman, referred to as Patient One, whose baby boy passed away 32 hours after he was born on the night of 22 November 2012.
On Friday Dr Aziz said that when Patient One was admitted to hospital on November 19, 2012 for an induction, “the care plan wasn’t clear”.
He said a registrar administered a prostaglandin gel, used to induce labour, that day but there did not appear to be a clear care plan made at that time by a consultant.
Dr Aziz said that on the morning of November 22, when he met with Patient One for the first time, she was confused and unclear about whether she was going to continue with the induction, which had gone on for several days, or whether she would be having a caesarean section that day.
Dr Aziz described the atmosphere in Patient One’s room, when he returned to hospital that night at 10.45pm, after Patient One had been labouring for a number of hours.
He said the situation was a little stressful at that time, because he and his colleagues knew they might have to perform a caesarean section, but that there was an issue with securing a second theatre.
Dr Aziz emphasised the importance of remaining calm in front of patients.
“I’m doing obstetrics for a long time and panicking is not going to get you anywhere,” Dr Aziz told the inquiry. “You have to be in control in front of the patient. There’s limits to what you can say in front of the patient.”
Expert witness Dr Michael O’Hare, a consultant obstetrician and gynaecologist at the Daisy Hill Hospital in Newry gave evidence on behalf of the doctor.
Dr O’Hare said his hospital oversees 1,800-2,000 deliveries each year, comparable to the number of births that take place in Cavan annually.
It is alleged that Dr Aziz failed to proceed to a caesarean section in a timely manner in relation to Patient One, and that he engaged in prolonged attempts at an instrumental vaginal delivery in inappropriate circumstances.
Upon his arrival in hospital on the night of November 22, Dr Aziz attempted an instrumental birth twice using a vacuum, and twice using forceps. Earlier this week, the expert witness for the Medical Council, Dr Joanna Gillham, criticised Dr Aziz for not proceeding to a caesarean section after the first attempt at forceps failed.
On Friday, Dr O’Hare defended Dr Aziz’s decision to proceed with the second forceps attempt.
During his evidence, Eileen Barrington, SC, counsel for Dr Aziz, asked Dr O’Hare whether it was acceptable for Dr Aziz to apply the forceps a second time, irrespective of theatre availability.
“I think if you accept that a second attempt at forceps was acceptable, I believe it was reasonable to proceed with that attempt,” Dr O’Hare said.
Under cross examination by Lorna Lynch BL, acting on behalf of the Medical Council, Dr O’Hare clarified: “Having been unsuccessful with the first attempt of the forceps, it was not unreasonable to apply the forceps.”
The inquiry will reconvene on Monday, when details regarding the second patient involved in the case, Deirdre Clarke, will be heard.