Expert witness 'simply couldn’t understand' doctor's case notes, inquiry told

The expert witness considered Dr Theodora Christova to have been guilty of poor professional performance. File picture: Pexels

An expert witness at an inquiry into a doctor who failed to refer a woman with lumps in her breasts for an urgent consultation has said that he "simply couldn’t understand" the doctor’s case notes.

Tom Fahey, a professor of general practice at the Royal College of Surgeons in Ireland, stated repeatedly he considered Dr Theodora Christova to have been guilty of poor professional performance with regard to the allegations she faced, which concerned five patients she had seen during her brief time working at the Shannon Medical Centre in Co Clare in October 2019.

On Wednesday morning, the Medical Council fitness-to-practise inquiry heard Prof. Fahey state, regarding the woman who presented with lumps in her breasts, that he couldn’t understand the comments that had been included in her case notes by the respondent.

He said a referral made by Dr Christova for the patient to an ultrasound clinic in Limerick had been the incorrect course of action, given it would just have delayed an urgent review of her condition by a dedicated breast clinic, which he said would have been the “appropriate” course of action.

The 72-year-old woman presented at the Co Clare clinic on October 17, 2019. Despite noting the lumps, Dr Theodora Christova began, but failed to complete, a consultant referral for her condition, while successfully referring the woman for an ultrasound scan in Co Limerick, a course of action Prof. Fahey described as “the wrong type of referral”.

The woman subsequently presented at the same practice four days later to a different doctor, and was then referred for further consultation. On November 1, she discovered she had breast cancer.

“There are some comments there I simply don’t understand,” Prof. Fahey said regarding Dr Christova’s case notes. Regarding a reference to cystitis — a bladder infection — made in the notes, he speculated that the doctor may have been referring to mastitis, a condition of the breasts.

He said it was likely that the doctor had concluded that the female patient had an abscess on her breast, for which the ultrasound referral would have been the correct course of action.

Prof. Fahey said:

She did refer her for urgent imaging, she took them seriously, but it was the wrong type of referral, and I suspect it was because they weren’t familiar with the (referral) system in Ireland.

With regard to an elderly man with terminal cancer who presented at the surgery seeking an endorsement to drive, Prof. Fahey said the notes taken by Dr Christova were inadequate and should have stated whether or not the patient suffered from certain conditions.

Dr Christova had endorsed the man’s application to be allowed to drive. The man had attended the clinic without his family’s knowledge, with his relatives having been of the opinion that he should no longer be allowed behind the wheel due to his medical condition, and had moved his car from his home to that end.

Prof. Fahey said the medication the man was taking, specifically sleeping tablets, should have been taken into account in the consultation notes in the context of his frail and terminal condition, adding that failing to do so on the part of Dr Christova had amounted to poor professional performance.

With regard to a young boy with asthma who presented at the surgery with laboured breathing, Prof. Fahey said that Dr Christova’s suggestion to the boy’s father that he abstain from using his inhalers while taking antibiotics was “completely incorrect”.

“I’ve never heard advice of that sort,” he said, adding that such advice could have “made a patient’s asthma a lot worse” and that to deliver such an opinion amounted to poor professional performance.