Doctor ‘followed guidelines’ in ectopic pregnancy case

A doctor accused of misdiagnosing an ectopic pregnancy and prescribing drugs to terminate it was following guidelines in what could have been an extremely risky situation, a Medical Council inquiry has been told.

The consultant obstetrician and gynaecologist told mother-of-three Laura Esmonde she could “die in her sleep” and “bleed to death” if she took no action in relation to her suspected ectopic pregnancy in January 2013.

The doctor, identified as Dr A, is accused of poor professional performance in his care of Ms Esmonde at South Tipperary General Hospital. The Medical Council inquiry has heard allegations Dr A wrongly diagnosed Ms Esmonde with an ectopic pregnancy on January 8, when in fact, it was a normal pregnancy. He prescribed her two courses of methotrexate, a medication used to stop ectopic pregnancies from growing, which she took.

Nearly three weeks later, on January 26, subsequent ultrasound scans revealed the pregnancy was not ectopic, the inquiry heard. However, at that stage, it was not viable and she miscarried on February 2.

Dr A is facing a number of allegations including that he misinterpreted ultrasound scans, placed disproportionate reliance on those scans to make a diagnosis of ectopic pregnancy, and prescribed methotrexate without excluding the possibility of an intra-uterine pregnancy.

He did not give evidence at the inquiry, which took place over a number of days in September and November.

In closing submissions yesterday, Neasa Bird, representing the case against Dr A, said the inquiry committee could be satisfied “beyond reasonable doubt” that Ms Esmonde’s pregnancy was intra-uterine, or in the womb.

She said once the drug methotrexate was taken, “there was no going back”.

Simon Mills, representing Dr A, said the consultant was following medical guidelines when he prescribed methotrexate to Ms Esmonde.

He noted that a total of four medical observers were unable to identify a pregnancy in Ms Esmonde’s uterus in ultrasound scans before the decision was made. Her blood levels of the pregnancy hormone HCG were also low and in the medical “discriminatory zone”, Mr Mills said.

“The guidelines applied, the guidelines were followed,” he said, adding, “What is a doctor supposed to follow if not the guidelines?”

Mr Mills pointed to evidence from Rotunda master, Professor Fergal Malone, and consultant obstetrician Dr Peter Lenehan.

“These two Irish experts both say they would have proceeded in the same way, had they found themselves in Dr A’s position.”

The committee will hand down its decision next week.