Updated 15.55
A DOCTOR MISDIAGNOSED a serious womb infection in a 45-year-old woman who had given birth to twins via caesarean section, a Medical Council fitness to practice inquiry heard today.
57-year-old Dr Saleem Sharif, originally from Pakistan but based in Cork, has admitted a number of allegations concerning poor professional performance regarding the case.
Those allegations relate to the case of the woman, Alison Hickey, who had become pregnant with twins via IVF fertilisation treatment. Dr Sharif has likewise admitted to misdiagnosing a serious womb infection known as endometritis as a urinary tract infection (UTI).
The specific allegations Dr Sharif has admitted are:
Prior to falling ill, Hickey had presented with preeclampsia and delivered her twins via emergency caesarean section after 32 weeks of pregnancy at the Rotunda Hospital in Dublin. Both babies were born healthy.
Three weeks following the birth she presented to Dr Sharif, who was working as a locum general practitioner at the GP Now Clinic in Sandyford, south Dublin, on 28 October 2014 with flu-like symptoms and abdominal pain.
“I was in pain after the birth, but I was fine,” she told the inquiry this afternoon.
But then I began to feel really, really unwell. I thought I had a vomiting bug but then I got progressively worse.
She described how she attended her appointment with Dr Sharif at 5.30pm on 28 October 2014 and had informed him that she had had a caesarean section.
During the course of Sharif’s examination, which lasted just five minutes, Sharif asked his patient just two questions. a question about her discharge, and an inquiry as to whether or not she had a sore throat.
He then concluded that she had a urinary tract infection and prescribed her the antibiotic Distaclor. He did not examine her in any way.
“It wasn’t until I got out of the clinic that my sister-in-law commented: ‘you were very quick’,” said Hickey. “And I was like, yeah I was wasn’t I?”
It was my first pregnancy so I really didn’t know. I just wanted to get my antibiotics and get home.
At the time of her diagnosis Hickey’s children remained in neo-natal care at the Rotunda due to the premature nature of their birth.
In the 24 hours following her appointment Hickey’s condition got progressively worse.
“I was stiff and sick, and then I woke at 1am feeling absolutely dreadful,” she said.
I was having spasms, I was very very cold, and I couldn’t talk. We called the midwife and she said call an ambulance straight away.
She agreed that Dr Sharif had failed to examine her in any way or to perform any relevant tests, and that he failed to discuss a follow-up appointment.
“There were very few questions, there was very little interaction,” she said.
Expert witness
Barrister for the Medical Council Eoghan O’Sullivan then called GP Dr Catherine Wann as an expert witness.
“Dr Sharif took a history of Mrs Hickey having a temperature, and noted she had no allergies, and that was really the extent of it,” she said.
He didn’t attempt to investigate what the cause of the illness might have been, he didn’t try to determine whether the illness was related to her pregnancy.
Asked whether or not Sharif was in a position to make a definitive diagnosis of a urinary tract infection Wann replied: “no, I would say not.”
She said that endometritis is the most common source of infection for a lady in Hickey’s position.
She added that the tests that Sharif had failed to perform would be an important part of forming an ultimate diagnosis. A urine test would have confirmed what bacteria were present in order to prescribe the correct combination of antibiotics, while a high vaginal swab would have either confirmed or otherwise Sharif’s diagnosis and whether or not appropriate treatment was being delivered.
She said that a uterine infection would be the most common diagnosis for a woman who had a caesarean section and had presented with a temperature.
“It’s a serious failing. A uterine condition can lead to sepsis, which is a very serious condition. Mrs Hickey was very unwell. It is critical to perform the relevant examinations and then instigate appropriate treatment to minimise the potential for a very serious infection,” Wann said.
She explained that sepsis is a very serious condition with a high mortality rate, and that “early diagnosis is very important”.
Asked by the medical expert on the committee as to whether or not the 5.30pm appointment time could be relevant given that most doctors finish working at about that time, Wann replied that she couldn’t say.
“If someone comes in with that presentation they need to be medically assessed,” she said.
Given her caesarean section she would be a lot more prone to a uterine infection. I would expect a GP to make that connection. It’s very likely I would have advised her to return to the maternity hospital.
Wann added that she would have expected the consultation to last “at least 15 minutes”.
After being diagnosed, Hickey’s condition deteriorated substantially over the next 24 hours. She became increasingly unwell, and woke during the night with her body in spasm and a temperature of 39.6 degrees centigrade.
Having contacted the Rotunda Maternity Hospital, where she had previously given birth, an ambulance was dispatched on 29 October to bring her to hospital.
Staff there were concerned she had a significant infection, and took a number of vaginal swabs which confirmed Hickey was suffering from endometritis, an inflammation of the inner lining of the uterus, and a condition that can lead to sepsis, and organ failure in certain extreme cases.
Her condition responded well to intravenous antibiotics, and she was discharged from hospital on 1 November 2014. Her husband then contacted the Medical Council concerning Dr Sharif’s treatment of his wife.
Formal apology
Dr Sharif has acknowledged that he misdiagnosed the woman’s condition, and had made a formal written apology to her and her husband regarding “any inconvenience” he may have caused them.
His counsel, solicitor Simon Mills, offered that his client make an undertaking under Section 67 of the Medical Practitioners Act 2007, not to repeat the mistakes he had made, in order to accept censure in lieu of a hearing. Such censure would have to be disclosed to any future prospective employers. This suggestion was rejected by the sitting committee.
O’Sullivan contends that Sharif should have asked a number of questions of Hickey, including questions concerning her type of birth, her symptoms, and any complications she may have suffered.
He should have recognised that endometritis is the most common cause of high temperatures in such situations, and that sepsis can result if the condition is left untreated, O’Sullivan said.
He should also have recognised that the statistical probability of endometritis “[is]only heightened after operative delivery” such as a caesarean section.
The hearing continues.
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