Breast surgeon faces six allegations of professional misconduct after patient death

A woman who died after her diagnosis of breast cancer was delayed by 10 months was worried about her "daughter and her will" when she received her diagnosis, her GP told a Medical Council fitness-to-practise inquiry yesterday.

The GP said Ms K was “very upset” and felt “very hard done by” when she called him in June 2008 having been diagnosed with the condition. The GP had referred her to a consultant breast cancer surgeon the previous year, in August 2007.

The surgeon, who was not named at the Medical Council fitness-to-practise inquiry, is facing six allegations of professional misconduct and or poor professional performance. He is accused of failing to consider adequately or at all his patient’s condition, failing to carry out an adequate examination, failing to refer her for specialist review and failing to arrange adequate follow up. He also allegedly carried out an ultrasound without being qualified.

The unnamed woman, then aged 40, was referred by the surgeon in August 2007, suffering from lumps in her left breast. Dr C carried out a physical examination of Ms K at the first appointment and also carried out an ultrasound himself, but did not refer her for a mammogram. She was not diagnosed with breast cancer until June 2008, Rory Mulcahy BL, for the Medical Council said.

Ms K was given the option of a follow up appointment in December, but did not take it. She made contact again in February, still concerned, was seen in March and received a mammogram in June. She was then diagnosed with breast cancer. After diagnosis, she asked for a second opinion and was referred to the Mater hospital in Dublin. She was given a mastectomy, chemotherapy and radiotherapy there, but died in September 2012. She had made a complaint to the Medical Council about Dr C in April 2012.

Dr C is currently on sick leave, Mr Mulcahy said.

Cathal Murphy BL, for the doctor, said his client did not accept that the events that took place amounted to professional misconduct. He also said Dr C had undertaken a two-day course in the use of ultrasounds and was qualified to carry them out.

Giving evidence, the patient’s GP, who was also not named for fear of identifying the surgeon, agreed he had no complaints about Dr C and had continued to refer patients to him after the delayed diagnosis.

Consultant surgeon Maurice Stokes of the Mater hospital, who subsequently treated Ms K, told the inquiry if he had seen Ms K from the start he would have organised a mammogram.

“I tend to work on the cautious side; I would want a 40-year-old to have a mammogram,” he said.

Expert witness for the Medical Council, consultant surgeon Anthony Peel from the Royal Marsden Hospital in London agreed.

“Unfortunately clinical examination is unreliable,” he said.

“At 40, the image of choice is the mammogram.” He also said he believed if Ms K had a mammogram in August 2007 the “calcification” discovered in June would have been detected.

Mr Murphy said an expert witness for Dr C would say that at the first appointment there was no clinical evidence that indicated Ms K needed a mammography and he would not have sent her for a mammogram.

Also giving evidence, clinical nurse Ms R described Dr C as “very impressive, very professional and easy to work with”. She said she regularly got compliments from patients about him and about the “care and attention” he gave them.

At the opening of the case, chairman of the inquiry, Dr Michael Ryan, said the committee had agreed to “anonymise” Dr C in the case after hearing “compelling evidence” in private for not naming him.

The case continues.