A doctor who worked at University Hospital Limerick used his thumb nail to mark the skin of a cancer patient who was to undergo a lumbar puncture procedure, a Medical Council fitness to practice inquiry has heard.
Dr Saqib Ahmed is facing eight allegations of professional misconduct and/or poor professional performance.
He was employed as a junior registrar in medical oncology at the University Hospital Limerick between July and November 2012, after which he was put on administrative leave.
Dr Ahmed, who qualified in Pakistan, is not legally represented at the inquiry and is participating by telephone from Grand Rapids, Michigan in the US.
The inquiry heard Dr Ahmed had previously worked at University Hospital Limerick as a senior house officer in the emergency department and in cardiology. He had no experience in oncology when he took up the role of registrar in July 2012.
He denies the allegations and said he had difficulty understanding differences in clinical practices at Limerick.
It is alleged in September 2012 he marked the area for a lumber puncture on a patient’s skin using his thumb nail when he ought to have known it was inappropriate.
It is alleged that despite being shown how to use a pen to mark the area for the procedure, he continued to mark the area on the patient’s skin with his nail.
Dr Linda Coate, consultant medical oncologist at University Hospital Limerick said in September 2012, a registrar at the hospital made a complaint to her in respect of a patient who was to undergo a lumbar puncture procedure.
Dr Coate explained a lumbar puncture is carried out when a small needle is placed between the vertebrae to extract cerebral fluid. In cancer patients, the procedure is used to see if there is infection, cancer cells or to administer chemotherapy, she said.
Dr Coate said it is important the procedure is done using aseptic techniques to minimize the risk to patients with cancer because their immune systems tend to be compromised any bacteria introduced “could have a fatal effect.”
The registrar told Dr Coate, Dr Ahmed’s manner with the patient “wasn’t very nice” and that he dug his thumbnail “roughly” into the patient’s skin.
Despite being shown how to use a pen to mark the area for the procedure, Dr Ahmed continued to mark the area on the patient’s skin with his thumbnail, the inquiry heard.
The inquiry heard in October 2012, Dr Ahmed failed to order chemotherapy treatment for a patient despite being reminded and requested to do so by the Chief Oncology Pharmacist at the hospital.
Dr Ahmed told the inquiry he did not fail to order chemotherapy for a patient.
He said he was going on exam leave on the Friday of the week in question and passed the work to a fellow registrar to pick up the following Monday.
“I have no idea how this is a concern of negligence on my part,” he said.
It is alleged Dr Ahmed prescribed the incorrect dose and type of drug to a patient who was in respiratory distress.
Clinical nurse manager at Sligo Hospital, Susan Nagle told the inquiry she felt the patient should have been given intravenous anti-biotics instead of oral medication as prescribed by Dr Ahmed.
“She was generally unwell and deteriorating when I took her care over and was struggling for breath,” said Nurse Nagle.
It is alleged Dr Ahmed also ordered an x-ray for the patient when he ought to have known the patient was too ill to be taken for one and that he left the patient unattended when he knew or ought to have known, that he should have stayed.
Nurse Nagle asked Dr Coate to review the patient because she was concerned at Dr Ahmed’s treatment of her.
Dr Coate said “she was worried he hadn’t grasped how critically ill the patient was.”
Dr Coate said when she confronted Dr Ahmed regarding her concern about his treatment of the patient, he became aggressive and would not accept her criticism.
She said he jumped up from where he was sitting and spoke over her in “an aggressive fashion.”
Dr Coate described another incident in October 2012 when Dr Ahmed who was the Registrar on call, failed to attend a ward round that morning and didn’t respond to several calls when he didn’t turn up.
She said he put one or more patients at risk because of he turned up late.
She said she confronted him about being late and told him there would be consequences.
Dr Coate said he replied; “and there will be consequences for you too.”
Dr Coate said she wasn’t sure what he meant by his reply but considered it a threat.
“It is completely unacceptable to be un-contactable while on call and to offer no explanation or apology is frankly unbelievable,” she said.
The inquiry continues tomorrow.