Three doctors working in the same hospital are the subject of a Medical Council disciplinary hearing after disagreements among staff over the correct diagnosis of a patient who died of a perforated intestine.
All three doctors were involved in the care of Seamus Kavanagh (52), a father of three who died in Naas General Hospital on March 10th, 2014, days after being admitted with chest pains.
Mr Kavanagh died of shock and peritonitis secondary to a perforated duodenum, it was determined after his death.
Two of the doctors are admitting charges of poor professional performance while the third is not present at the inquiry.
Consultant physician Dr Syed Quadri has admitted failing to consult with the consultant surgeon who was on call at the time about an X-ray carried out on Mr Kavanagh and on the basis of which the patient had been discharged by the surgical team.
Dr Quadri has also admitted failing to get an opinion from a radiologist about the X-ray, to have other tests such as a CT scan carried out, and to devise an appropriate management plan or ensure adequate monitoring for Mr Kavanagh.
A further allegation that he failed to correctly interpret the X-ray was withdrawn by the Medical Council during Monday’s fitness-to-practise hearing.
Professional misconduct
Dr Quadri accepts the charge of poor professional performance but an expert witness to be called by the council will tell the inquiry that collectively the allegations amounted to professional misconduct.
Surgical registrar Dr Muhammad Azam has admitted failing to correctly interpret the chest X-ray and to diagnose the presence of air in the abdominal cavity, to ensure appropriate investigations were carried out on Mr Kavanagh and to consult with the consultant surgeon who was on call.
Dr Michael Arotiowa is accused of failing to take an adequate history of Mr Kavanagh, to carry out an adequate clinical examination and to have regard to the opinion of Dr Thirasan Moodley, the emergency department registrar, who diagnosed air in the abdominal cavity – a sign of a perforated organ – from reading the X-ray.
The hearing went ahead on Monday in the absence of Dr Arotiowa, who is from Nigeria. Committee chairman Paul Harkin said exhaustive attempts had been made to contact Dr Arotiowa and it would be unfair to the two other doctors, and to the strong public interest involved, not to proceed.
X-ray
Mr Kavanagh presented at the emergency department on March 7th, 2014, with ongoing chest pain and was referred initially to the surgical team.
However, the surgical team incorrectly referred him to the medical team after failing to correctly read an X-ray that showed the presence of free air under his diaphragm, his family alleged in a subsequent complaint.
Neasa Bird, barrister, for the Medical Council, said Dr Moodley, on reviewing the X-ray, determined there was free air in Mr Kavanagh's abdominal cavity and it was therefore a surgical issue. He contacted Dr Arotiowa, who did not agree.
In written responses to the complaint made by the family, Dr Arotiowa has said he had just done what any other doctor would do and would do the same “one million times” over if presented with the same situation.
He described the case as unusual because Mr Kavanagh had not complained of abdominal symptoms. If he had, the case would have been escalated, he said, adding “he is old enough to tell us what is wrong with him”.
In pain
Mr Kavanagh’s daughter Lisa said her father was not a complainer or “one for saying anything is wrong”.
She visited her father every day he was in hospital. On the Saturday – two days before he died – her father was in pain and couldn’t settle. His stomach was very bloated, and his shirt couldn’t close. “He wasn’t a big man so that was an eye-opener to me.”
On the Sunday, he was mumbling and was asking for paper towels as “there were buckets of sweat coming off him. He looked like he’d aged 30 years, his stomach was massive. I was terrified, he was deteriorating every day”.
She said she was not shocked to be told by a nurse on her arrival at the hospital on the Monday that Mr Kavanagh had died. “I said to the nurse, ‘he’s gone, isn’t he?’”
The hearing continues on Tuesday.
