Failure to look into patient blood condition a ‘significant omission’

The alleged failure of a doctor to look into a patient’s low blood platelet count, was a “significant omission” an expert witness told the Medical Council’s fitness to practise inquiry today

The patient (77) , known only as Mr E, was admitted to Roscommon General Hospital on March 14th 2011 with a chest infection but died some three weeks later.

Acute thrombocytopenia (low blood platelets) was the main cause of death listed by the coroner along with several other factors, the inquiry heard .

Dr Sardar Ali, a former consultant respiratory physician at Roscommon General Hospital, is facing five allegations of poor professional performance including failure to investigate and consider in a timely period the patient’s platelet count.He denies the allegations.

Expert witness Michael Keane, a medicine professor at UCD and consultant respiratory physician at St Vincent's University Hospital reviewed the medical notes . Prof Keane under cross-examination from Dr Sardar, who is representing himself, raised a question over the named cause of death due to lack of bleeding at the time .

Blood tests around the time of admission showed Mr E had a blood platelet level of 27, which would “cause some alarm bells to ring”, Prof Keane said.

Prof Keane would have expected thrombocytopenia of that degree to “be at least documented” and for Mr E’s nose bleeds to have been “commented on”.

He found no evidence in notes that Dr Sardar had considered the low platelet level until some two weeks after the patient’s admission. At that point Dr Sardar sought advice from blood specialist in Galway.

If there had been a definite diagnosis about the cause of Mr E’s low platelet count it would have “smoothed out the care” over his last few days and helped with prognosis, Prof Keane said. However Prof Keane did not think it would have “altered the outcome” for the patient.

He described alleged failures by Dr Sardar as amounting to “poor professional performance”.

The inquiry also heard from Dr Sardar who described some days in the hospital as a “nightmare” with many patients on trollies.

Dr Sardar said he had believed it was “highly likely” that the cause of the low blood count was blood condition myelodysplastic syndromes (MDS) and had addressed the patient on that basis.

Neasa Bird BL for the Medical Council put it to Dr Sardar that it was "simply not credible" that he considered MDS the main secondary problem the patient had but it was "not referred to once" in the records over a fortnight. Dr Sardar said "not recording" it did not mean he "did not know the diagnosis".

The case continues.