Covering up failure

Background

MRS A is admitted to her hospital’s maternity ward at 2.20am and goes into labour. This progresses slowly and the foetus is found to be relatively malpositioned. Dr G, senior specialist registrar for the nightshift team, checks on Mrs A at 8.45pm. He reviews her CTG trace with his senior house officer Dr B and they note decelerations, a possible indication of foetal distress. Dr B then makes a note recording a plan for immediate foetal blood scalp sampling (FBS). But Dr G subsequently makes an entry in Mrs A’s notes without consulting Dr B and suggests a different plan from the one recorded.

Dr G reviews Mrs A around 4.50am the following day and advises FBS. After this, he has Mrs A transferred to theatre for an instrumental delivery. Dr G then applies the ventouse to the baby’s head, pulling several times in the space of 15 minutes. The baby is showing signs of distress but Dr G performs an episiotomy and encourages Mrs A to push before attempting a forceps delivery. This fails and Dr G finally delivers the baby by Caesarean section around 6am. The child requires intubation and is transferred to the special care baby unit.

Following the incident, Dr G is told he will be supervised for future operative procedures and must undergo a formal training assessment. But Dr G resigns from his post and when he applies for a job two months later at another hospital, he removes this period of employment from his CV. He tells his prospective employers that the gap in his employment dates is because he took time out to care for his elderly mother.

Analysis/Outcome

A complaint is submitted to the General Medical Council about Dr G’s clinical care of Mrs A. His case is heard by a fitness to practise panel which judges his standard of clinical care was substandard and put Mrs A and her baby at risk of serious harm.

The panel makes a number of findings. It concludes that Dr G did not formulate and stick to a clear management plan and that this was inadequate, inappropriate, not in the best interests of Mrs A and below the standard to be expected of a specialist registrar in obstetrics and gynaecology. Dr G admits that his notes relating to Mrs A’s care were only partially legible, breaching the standards expected in Good Medical Practice.

The panel also finds that his clinical conduct when delivering the baby was inadequate, inappropriate, irresponsible and not in the best interests of Mrs A or her baby. In terms of Dr G’s decision to omit his employment from his CV, the panel finds that his behaviour was dishonest, misleading and unprofessional and amounts to a serious breach of the duty owed by a doctor to his patients. The panel concludes that Dr G’s fitness to practise is impaired.

Key points

• CVs should not omit relevant information such as suspensions, restrictions placed on your practice and any concerns raised about your performance or conduct.
• Good Medical Practice states that doctors must “keep colleagues well informed when sharing the care of patients”.
• Doctors must recognise and work within the limits of their professional competence.

This case study is based on GMC case files