Findings

Charge Characteristics

Additional Orders

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Cited Cases

Precis

Charge:  

A Complaints Assessment Committee charged that Dr Harrild was guilty of professional misconduct. The particulars were as follows:

1. Prior to attempting delivery of baby S, he failed to perform an abdominal examination on the patient to assess the amount of head palpable abdominally and thereby failed to assess adequately the descent of the presenting part; and/or
2. When performing a forceps delivery of baby S, he failed to observe and/or adequately observe the usual procedures consistent with a trial of operative vaginal delivery including failure to perform the delivery in a theatre in which caesarean section facilities were available; and/or
3. He performed an operative vaginal delivery of baby S prior to full dilatation of the patient’s cervix and when the presenting part was at the level of station -1; and/or
4. At the time of delivery, he failed to keep the patient informed and/or adequately informed of the options for delivery and/or failed to obtain her informed consent to the forceps delivery he performed.

Background: 

This was the patient’s first pregnancy with an expected delivery date around 5 October 1995. She had a shared care arrangement with her general practitioner (GP) and an independent midwife. During the week prior to the birth of baby S, the patient visited her GP. He thought she was probably overdue and was concerned that the baby had a high foetal head. He recommended she visit Dr Harrild, a specialist obstetrician and gynaecologist.

The patient saw Dr Harrild on 6 October 1995. Dr Harrild wrote to the patient’s GP reporting on the consultation. His letter stated that he performed an ultrasound scan and that the baby was overdue. If the patient had not gone into labour by 8 October 1995 Dr Harrild considered she should be admitted for an induction.

The patient was admitted to Masterton Hospital at 12.20 am on 8 October 1995 as she was having contractions and had been advised by the midwife to go to hospital.

At 8.35 pm there were two large foetal heart dips. The cervix was found to be at 9cm with the station -1 with 1+ of caput. The foetal heart was recorded as being satisfactory. The GP had a discussion with Dr Harrild. It was agreed that Dr Harrild should be contacted again if delivery had not taken place within the following two hours.

At 10.45 pm Dr Harrild agreed to come into the hospital to review the patient himself. According to the patient Dr Harrild did a very quick vaginal examination, and the next thing she knew was that she was wheeled out of the room into the delivery suite nearby.

The patient’s medical records showed that once in the delivery suite, Dr Harrild attempted a vaginal delivery of baby S. The “Abnormal Delivery Summary” indicated that Dr Harrild attempted a manual rotation and ventouse. The indication for ventouse noted by Dr Harrild was “posterior lip of cervix. Direct OP”. Dr Harrild recorded the head at station –1 but also recorded it as a “medcavity” (meaning mid-cavity) situation. Dr Harrild then sought to deliver baby S by Kielland forceps and then used Anderson forceps and also undertook an episiotomy when the baby was delivered in an occipito-posterior position.

Baby S was born at 11.37pm that evening, weighing 3.83kg. Apart from facial bruising, he was in good condition. The placenta was delivered by controlled cord traction. Blood loss was recorded as 300mls.

The patient sustained cervical, vaginal and perineal tears which were sutured. She was very unhappy with Dr Harrild’s manner and the way in which he delivered baby S. She described the experience as “horrific” and “very traumatic”.

Finding:

The Tribunal found Dr Harrild not guilty of professional misconduct.

The Tribunal found that with regard to particular 1 there was no case to answer. The Tribunal was satisfied that the patient did not address her mind as to whether or not there had been an abdominal examination until late in 2001, some six years after the event, when she was asked this during an investigation, following her complaint. The Tribunal was further satisfied on the evidence that the patient was not able to see or feel whether or not there had been an abdominal examination as a sheet covered her and she had had an epidural.

However, even if a prima facie case had been made out the Tribunal would not have found this particular proved. The Tribunal concluded that Dr Harrild had, in all probability, performed a bi-manual vaginal examination which is an acceptable alternative to an abdominal examination.

The Tribunal found particular 2 was not established. The Tribunal was not satisfied the CAC proved Dr Harrild failed to observe usual procedures, given the common practice at the time in a provincial hospital with secondary facilities, the uncertainty that a theatre in which facilities for a caesarean section were available, and Dr Harrild’s own experience and capabilities.

The Tribunal found particular 3 was not established. Counsel for the CAC submitted that the baby’s head was at station –1 all along. However, the Tribunal considered that on the balance of probabilities the evidence did not establish that. The Tribunal was of the view that in all the circumstances Dr Harrild was entitled to form the judgment that the baby was deliverable vaginally. The Tribunal was satisfied the use of the ventouse effected full dilatation.

The Tribunal was not satisfied there had been a failure of informed consent and therefore particular 4 was not established.