Findings

Charge Characteristics

Additional Orders

Commonly
Cited Cases

Precis

Charge: 

A CAC charged that the Doctor between 22 April 1993 and 7 May 1993, in the course of his management of his patient:

1. He failed to convey to her the information that growth retardation and polyhydramnios suggest a possibility of congenital and/or chromosomal abnormality;
2. He failed to expedite a level III ultrasound scan at xx hospital;

This being disgraceful conduct in a professional respect or professional misconduct or conduct unbecoming a medical practitioner which reflects adversely on his fitness to practise medicine.

At the beginning of the hearing the CAC did not continue with the assertion that any misconduct on the part of the Doctor was disgraceful conduct in a professional respect or professional misconduct. The CAC did not proceed with the prosecution of a third particular which was abandoned.

Background:  

The patient was referred to the Doctor in the 29th week of her first pregnancy, following the results of an ultrasound scan which reported the presence of excessive hydroamniosis and intra-uterine growth retardation. The scan did not reveal any foetal abnormalities. The Doctor saw the patient on 22 April 1993, within a day of the scan. The patient had another scan on 29 April (at 30 weeks, 5 days) which also reported polyhydroamniosis and referred to the existence of asymmetrical intra-uterine growth retardation. The patient did not see the Doctor again. She was admitted to hospital on 7 May 1993 for relief of abdominal pressure. Her condition was assessed as being acute polyhydroamniosis. It was then she learned for the first time that a genetic abnormality such as Downs Syndrome was a possibility. The baby was delivered by Caesarean section on 8 May 1993. The child suffered from Downs Syndrome, premature lung disease and a small congenital heart defect. The baby died on 9 May 1993.

Finding: 

The Tribunal found the Doctor was not guilty of conduct unbecoming a medical practitioner and that conduct reflects adversely on the practitioner's fitness to practise medicine.

The Tribunal held that the Doctor had an obligation to convey to the patient the information that growth retardation and polyhydroamniosis suggest a possibility of congenital and/or chromosomal abnormality and that he failed to do so. In making this finding the Tribunal placed weight on a report of the medical assessor and on the opinion of a medical specialist. The Tribunal also relied on guidelines contained in a June 1990 Medical Council Statement for the Medical Profession on Information and Consent.

The Tribunal considered that the unbecoming nature of the Doctor's conduct in this case could lead to the making of a finding that such conduct reflects adversely on that practitioner's fitness to practise medicine. However in the circumstances of this case it declined to make such a finding. The Tribunal considered that there were a number of mitigating factors.

• The Doctor had retired from practice so that protection of the public was no longer an issue.
• The patient sought recognition of her complaint, by a finding that the Doctor's conduct was unbecoming, rather than an extreme or adverse penal sanction,
• The evidence of the medical assessor that research showing babies which have asymmetrical growth pattern have foetal abnormalities, is different from the teaching we had when training and from that published in standard text books.
• The evidence of the medical assessor that in "absolute terms" the baby was probably not growth restricted. Other features of the pregnancy did not really fit with a baby suffering from placental vascular failure where the usual situation is markedly reduced amniotic fluid.
• It was unclear what was said on the patient's admission to hospital and whether what was said was deemed to be a serious consideration. No foetal blood sample was taken on the patient's admission.
• He considered the scan reports somewhat unhelpful in that there were a number of inconsistencies.
• The medical assessor also stated that some general obstetricians and gynaecologists might not have much idea about the results of studies showing that in babies with non-immune hydrops there was a 12% chance that the baby could have a chromosomal abnormality.

The second particular of the charge was not proven.