Doctor failed to proceed to Caesarean section with adequate speed, inquiry told

A Medical Council inquiry has heard allegations that a consultant gynaecologist failed to proceed to Caesarean section with adequate speed when delivering a baby at Cavan General Hospital. The child died hours later.

Dr Salah Aziz Ahmed faces allegations of poor professional performance and professional misconduct relating to the care provided to three mothers who gave birth at the hospital.Two of the mothers have not been named.

Dr Aziz provided care to the first mother, Patient One, at Cavan hospital in November 2012. It is alleged Dr Aziz engaged in prolonged attempts at a vaginal delivery in inappropriate circumstances, and failed to proceed to a Caesarean section with adequate expedition.

The inquiry heard that the baby of Patient One, referred to as Baby One, was born in very poor condition on the night of November 22nd, 2012, and died on November 24th.

After qualifying as a doctor in 1980 in Egypt, Dr Aziz came to Ireland in 1988 and worked in a number of hospitals. He was accepted as a member of the Royal College of Obstetrics and Gynaecologists in Ireland in 1992.

His legal counsel Eileen Barrington SC told the inquiry that Dr Aziz's actions "were not causative" of the death of Baby One.

Patient One, whose pregnancy was considered high risk due to an increased BMI level, was admitted to Cavan hospital on November 19th, 2012, 11 days past her due date.

Midwife Breege Lavin, who cared for Patient One throughout her labour and the birth of her baby, told the inquiry she began to provide care at 8pm on November 22nd, when her shift began.

Patient One continued to have Syntocinon, which is used to help progress labour by increasing contractions, and began active pushing at 9.30pm.

Ms Lavin said that at 10.25pm, birth was still not imminent, and Patient One was exhausted. Protocol dictates that after an hour of pushing, if nothing is happening, a midwife must obtain input from an obstetrician.

The midwife said she was aware of this, and the fact that the obstetrician working in the hospital that night was in theatre conducting a Caesarean section.

Ms Lavin rang Dr Aziz at 10.30pm, as he was the consultant on call, and he arrived at the hospital at 10.45pm. He examined Patient One and made a first attempt at an instrumental birth, using a vacuum.

Ms Lavin told the inquiry that there was no discussion of any other type of delivery at this time.

The vacuum extraction was unsuccessful. Dr Aziz performed an episiotomy and then attempted a forceps delivery, which was also unsuccessful.

Ms Lavin told the inquiry a failed instrumental delivery would be a very rare occurrence.

She said Dr Aziz first inquired at 11.10pm about whether a theatre was available, adding that it would be a very rare occurrence to have two caesarean sections taking place at the same time.

Patient One was prepped for theatre and Dr Aziz began the surgery at 11.32pm. Patient One was put under general anaesthetic. The baby’s head was jammed in his mother’s pelvis and so he was born feet first at 11.40pm.

The baby was in very poor condition. He was resuscitated and ventilated, and later transferred to the Rotunda in Dublin. He died 32 hours after his birth.

Associated risks

Dr Aziz also faces allegations in relation to the obstetric care he provided to two other mothers,

Deirdre Clarke

and a woman referred to as Patient Three.

In relation to Ms Clarke, Dr Aziz faces claims, among others, that he failed to adequately counsel Ms Clarke about options and associated risks for mode of delivery with regards to a vaginal birth after Caesarean section, and that he failed to provide adequate counselling with regard to the induction of labour after a Caesarean section between September 2012 and June 2013.

In relation to Patient Three, it is alleged that Dr Aziz failed to attend at Cavan hospital in order to assess Patient Three within an adequate timeframe on April 26th, 2014.

It is also alleged that he failed to diagnose in a timely manner that a catastrophic event in utero was occurring, which required an urgent delivery, and that he failed to carry out or arrange a Caesarean section within an adequate timeframe.

The inquiry continues.