A DOCTOR LIKELY mistook a woman’s ovary for an ectopic pregnancy before giving her medication to terminate it, an expert has said.
Dr Philip Owen also said it was more than likely the woman had a continuing normal pregnancy in her womb when she was given the medication.
It is alleged at a medical council inquiry that a consultant obstetric and gynaecologist, identified as Dr A, wrongly diagnosed an ectopic pregnancy in the case of mother-of-three Laura Esmonde at South Tipperary General Hospital in January 2013 when the pregnancy was actually in the womb.
The medical council inquiry previously heard that Dr A advised the woman that the safest course of action was for her to take two courses of methotrexate, a medication used to stop ectopic pregnancies from growing. Surgery was not an option, according to Dr A, because of the blood thinners she was taking for the clot in her leg.
On the evening of 8 January, Esmonde took her first dose of methotrexate. On 17 January, she was readmitted for a second dose. No further ultrasound was conducted before this second dose, she said, although her husband requested one.
A week later, she was transferred to Cork University Hospital for treatment of the leg clot, where a scan indicated her pregnancy was not ectopic. A further scan showed a normal pregnancy but it was no longer viable. Ms Esmonde miscarried on February 2.
On day five of the hearing Dr Owen, a consultant obstetrician and gynaecologist in Glasgow, said he couldn’t say for sure that an ectopic pregnancy didn’t exist but that it was “extremely unlikely”.
He also told the committee hearing the case that he couldn’t be certain the woman had an ongoing normal pregnancy because no one ever detected a heartbeat but that it “seems overwhelmingly likely” she did.
The inquiry heard that the woman underwent four ultrasound scans and that three medical professionals said they believed they were “at least suspicious of an ectopic pregnancy.” The committee asked Dr Owen about the assertion by one doctor that one of scans showed a “right tubal ectopic pregnancy”.
Dr Owen said:
My interpretation is he was looking at small fluid area within the right ovary and mistook it for an ectopic pregnancy.
The committee asked him if it was possible that “group-think” could take hold in these situations, with everyone agreeing with the first diagnosis.
Dr Owen said this can happen and that is why a consultant must step back and assess the situation “because the final decision rests with him”.
Counsel for Dr A, Simon Mills BL, asked Dr Owen about the decision by his client not to review the diagnosis between the first and second doses of methotrexate.
Dr Owen said he would have taken this step himself but that he couldn’t point to any guidelines or practise rules which mandate it.
Dr Owen said that if there was a pregnancy in the womb, the “uncomfortable question” is why it was not detected.
He added:
The likelihood, I’m reluctant to say, is that the scan technique in the ultrasound was not up the appropriate standard.
Mr Mills said Dr A was entitled to reach the conclusions he did based on the information he had, even “if he turned out to be wrong.” Dr Owen said he could not agree.
The inquiry continues on Wednesday.
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