Doctor acquitted of poor professional performance

A doctor accused of misdiagnosing an ectopic pregnancy which allegedly led to the termination of a potentially viable embryo has been acquitted of poor professional performance.

The doctor, referred to as Dr A during the Medical Council Fitness to Practise Inquiry, was found not guilty of seven counts of poor professional performance.

Inquiry chairman Dr Michael Ryan said Dr A, from South Tipperary General Hospital, was correct to make a diagnosis of an ectopic pregnancy, given the circumstances and information available to him at the time.

The inquiry heard that Laura Esmonde (38) a mother-of-three from Tipperary, attended the A&E department at South Tipperary General Hospital on January 6th, 2013, with a swollen leg. A number of years previously, she had suffered from a clot in her lung. A routine urine test revealed she was pregnant.

“I was shocked, it was a lot to take in, but I was happy to be pregnant,” Ms Esmonde told the inquiry during her evidence.

Ultrasound

The following day an ultrasound of her leg showed she had a clot. Ms Esmonde also asked for an ultrasound of her pelvis, because she wanted to see the baby.

Her husband was due into the hospital shortly and she wanted to tell him the good news in person.

The sonographer said she could not see anything, and called in a consultant radiologist. He also performed a scan, and Ms Esmonde said he told her there was a possibility that she had an ectopic pregnancy.

On January 8th, 2013, Dr A performed a transvaginal scan, and, according to Ms Esmonde, told her she had “an ectopic pregnancy of unknown location”.

“He told me my uterus was empty,” she said in evidence.

Dr A advised that she take methotrexate, a medication used to stop cells from growing before they are passed out of the body.

Ms Esmonde argued that Dr A did not recommend a “wait and see” approach, which can be an option in such cases. Surgery was also not an option, according to Dr A, because of the blood thinners she was taking for the clot in her leg.

Expert witness

Prof Fergal Malone, master of the Rotunda, said Dr A was right to diagnose an ectopic pregnancy – and that conservative management of the case would have put Ms Esmonde's life at risk.

Prof Malone, called as an expert witness of behalf of Dr A, described the situation Dr A found himself in as one of the most “challenging” an obstetrician could face.

“This was amongst one of the most challenging early pregnancy clinical scenarios an obstetrician could find himself or herself in,” he said. “Active intervention with medical management was the best option in terms of protecting the mother.”