A paediatrician accused of poor professional performance has told a medical council that he did not look for a second opinion about ordering a head cooling treatment for a baby.
Paediatrician Dr Mohammad Ilyas Khan has been accused of poor professional performance for allegedly failing to order the treatment for the baby, who was subsequently left with brain damage.
Dr Khan was working as a locum consultant paediatrician at South Tipperary General Hospital in June 2012 when the alleged incident occurred.
Among the allegations Dr Khan faces are failing to put an adequate plan in place for the treatment of the baby’s diagnosis of hypoxia (lack of oxygen at birth) after he was born; failing to arrange for the transfer of the baby to another hospital for cooling treatment; failing to consider or adequately follow the National Neonatal Transport guidelines; and telling the baby’s parents the child was “fine” when he was having seizures, when he knew or ought to have known it was not the case.
Head-cooling treatment is used to lessen the chance of brain damage resulting from oxygen deprivation during birth. Current protocols require cooling to begin within a maximum of six hours after birth and suggest that cooling as early as possible is the ideal.
A lack of oxygen around the time of birth can result in cerebral palsy, learning disabilities and epilepsy.
The inquiry previously heard the baby's mother, Noelle Tobin, suffered a ruptured uterus. The baby was brought to the special care unit of South Tipperary General Hospital in Clonmel after he was born and given anti-seizure medication.
Dr Khan arrived at the labour ward several minutes after the baby was born and said his condition was critical and said the baby was born “flat” and was “blue, lifeless and limp”.
He said he resuscitated the baby and told the inquiry how the baby’s vital signs began to improve and he was transferred to an intensive care unit.
He said a diagnosis of hypoxic ischaemic encephalopathy (hypoxia), or lack of oxygen to the brain was agreed and a plan was made to continue close monitoring of the bay in the special care unit at Tipperary.
Under cross-examination on Wednesday, Dr Khan said he did not look for a second opinion inside or outside the hospital when deciding whether to order a head-cooling treatment or not.
“I was confident in my own decision,” he said.
Discussed the possibility
The inquiry previously heard when the baby was three hours old and within the six-hour window for cooling treatment, Dr Khan and his registrar discussed the possibility of the cooling treatment with Dr Amin Abdelrahim.
Under cross-examination on Wednesday, Dr Khan said Dr Amin told him during a phone conversation that the baby was irritable and crying.
Dr Khan said Dr Amin did not inform him the baby was clenching his fists, cycling his legs and displaying other signs that can indicate seizures.
Dr Khan said, based on the information he was given by Dr Amin, the baby did not meet the criteria for the cooling treatment.
Under national guidelines, babies who indicate abnormal neurological activity, such as a seizure, in these situations can qualify for the cooling treatment.
The inquiry also heard testimony from expert witness Dr Justin Roche, a consultant paediatrician at South Tipperary General Hospital since 2009.
Dr Roche said information regarding cooling at the time of the incident in 2012 was not as prevalent as it is now.
Referring to guidelines on best practice for cooling, Dr Roche said: “The guidelines are there based on the best available evidence but they need to be applied to each clinical scenario,” he said.
When asked if he would have ordered the cooling treatment if he was Dr Khan, he replied: “There is a high probability I would have taken similar action to Dr Khan at that time.”
The inquiry will conclude on Friday June 26th.