The allegations against Mohammad Ilyas Khan from Clonmel claim he did not put an adequate treatment plan in place following the birth of a baby boy at South Tipperary General Hospital on June 15, 2012, and the subsequent diagnosis of hypoxic ischaemic encephalopathy (hypoxia), or lack of oxygen to the brain.
Specifically, it is alleged that Dr Khan failed to make sufficient arrangements so the baby, now three, could receive hypothermic, or ‘cooling’, treatment.
Research has shown the cooling treatment must be provided within a critical six-hour period after the baby is born, in order to effectively reduce the risk of death or disability.
The baby, however, did not receive the treatment. He suffered brain damage due to lack of oxygen and now has cerebral palsy.
The boy’s mother, Noelle Tobin, brought the case against Dr Khan, who has worked at South Tipperary General Hospital since 1999.
In her closing arguments yesterday, barrister Elaine Finneran, appearing for the chief executive of the Medical Council, pointed to the discrepancy between the Dr Khan’s testimony and that of other witnesses.
Ms Finneran argued that, based on the nursing notes from the night in question, Dr Khan became aware of the baby’s seizing activity at some point between 11pm on Friday, June 15, and 12.15am on Saturday. Under national guidelines, babies who indicate abnormal neurological activity, such as a seizure, in these situations can qualify for the cooling treatment.
Dr Khan, however, said earlier this week that he was not informed of the seizing activity until a later time, nor of an initial prescription of the anti-seizure medication phenobarbitone.
Eugene Gleeson, representing Dr Khan, also pointed to the discrepancies in the testimonies and argued that, if there is any doubt as to what happened on the night in question, the benefit of the law should come down in favour of Dr Khan.
Mr Gleeson pointed out that, earlier in the inquiry, Dr Khan was described by some of his colleagues as proactive, and was someone who cared greatly about his patients.
By the end of Mr Gleeson’s closing remarks yesterday, Ms Tobin was clearly emotional, wiping away tears with a tissue.
She was supported at the inquiry by her husband Liam and other family members. Her son, the boy at the heart of this case, was also present.
On the opening day of the inquiry in April, Ms Tobin, a teacher by profession, gave emotional testimony.
She described the distressing days that followed her baby boy’s birth, as the family adjusted to their new lives and the devastating diagnosis of cerebral palsy.
She said that, instead of reading cards of congratulations, she was reading about all the disability benefits that her family would now be entitled to.
Noelle Tobin’s testimony during the Medical Council inquiry into her son’s injuries after his birth was powerful and moving.
In her evidence against Mohammad Ilyas Khan, Ms Tobin described the frightening moments leading up to the emergency Caesarean section at South Tipperary General Hospital on Friday, June 15, 2012.
She experienced a huge amount of pain as her uterus ruptured and it was “panic stations” because the baby’s heart-rate dropped.
As there was not enough time to prepare the operating theatre, Ms Tobin was taken across the corridor to a room for emergency sections.
Ms Tobin described the panicked scene in the room: “There was pandemonium,” she told the inquiry. “I could see in everyone’s eyes that they were scared.’
Able to feel what the doctor was doing, she was in a huge amount of pain, and she held on to the doctor’s belt, as he tried to shake her off.
In just a few minutes, the baby was delivered and a team of doctors began to resuscitate him.
Ms Tobin told the inquiry: “I began shouting: ‘Girl or boy? Girl or boy?’ Nobody answered.
“Then I began shouting: ‘Dead or alive? Dead or alive?’ Still nobody answered.”
After that, Ms Tobin was fully anaesthetised. When she woke up she did not know exactly what had happened but then saw blood on her hand and remembered what had transpired.
After being resuscitated, the baby was taken to the special care baby unit. It was Ms Tobin’s understanding that he was there as a result of the emergency Caesarean section. She wasn’t aware of anything further.
Ms Tobin said a doctor and nurse came in at around 1am on Saturday. They said her son had been distressed and given medication. She said they did not tell her that the medication was anti-seizure medication, and there was no discussion as to further treatment. “I had been given no reason to be concerned,” she said.
On Saturday morning, she went to the special care baby unit to see her new son.
“He was in an incubator, looking terrible,” Ms Tobin told the inquiry. “Not a bit settled. I got an awful fright and didn’t know what to think. I was very upset.”
Ms Tobin’s sister, Niamh Carroll, a doctor working at a hospital in Boston at the time, arrived at the hospital in Clonmel on Saturday morning. She looked at the medications that the baby was on and became upset when she realised they were anti-seizure medications.
Dr Carroll believed strongly that the baby should be transferred to an intensive care unit, and asked about the cooling treatment. The baby was moved to the National Maternity Hospital, Holles St, Dublin, but Ms Tobin remained in Clonmel.
Ms Tobin told the inquiry that both she and her husband Liam were shocked by the serious nature of the assessment as they had got the impression all along that their baby was going to be fine.
When everyone realised the serious nature of the baby’s condition, Ms Tobin was also transferred up to Dublin so that she could be with her son.
On Monday morning, nearly three days after the baby was born, he still did not have any primitive reflexes and he couldn’t suck properly, which meant that he was not able to feed from a bottle or the breast.
“It was terrible,” Ms Tobin told the inquiry, as she struggled to choke back tears.
Three days later, an MRI scan showed that the baby had, in fact, suffered brain damage as a result of the lack of oxygen during birth, and that there was a high risk of cerebral palsy.
A couple of days later, the baby began to nurse and bottle feed and several days later, on June 26, the family returned home to Tipperary.
The baby was referred to a doctor there, and he was officially diagnosed with cerebral palsy.
Ms Tobin described the distressing days that followed as the family adjusted to their new lives and this devastating diagnosis.
She said that, instead of reading cards of congratulations, she was reading about all the disability benefits that she would now be entitled to.
Since the baby was born, Dr Carroll moved back to Ireland, in part to be of support to Ms Tobin as she takes on the challenge of raising a child with cerebral palsy.
Ms Tobin now cares full-time for her son, and has not been able to return to work outside the home.
Ms Tobin said that, as her son has grown, “every milestone he met was a result of blood, sweat, and tears on his part and on our part”.
She said she and her husband incorporate some kind of therapy into all the games they play with their son, who began to walk just before his second birthday last June. He walks with a crouched gate, and falls a lot, which Ms Tobin said is fine as a toddler but will present more of a challenge as he grows older.
Along with physical effects, cerebral palsy also affects language and speech development. Ms Tobin said that her son has a good vocabulary but that his pronunciation is very poor.
“We try to stay present but it’s very hard not to think about the future,” said Ms Tobin. “It has really devastated us as parents.”