Obstetrician reprimanded, fined and suspended for professional misconduct

24 Jan 2019

A specialist obstetrician has been reprimanded, fined $25,000 and had his registration suspended for two months.

He was found to have engaged in professional misconduct during the delivery of a baby.

The Medical Board of Australia (the Board) referred the matter concerning Dr Abhijit Basu to the State Administrative Tribunal in Western Australia (the tribunal) on 10 January 2017. The Board’s allegations related to Dr Basu’s performance during the delivery of a baby in September 2014. The matter was heard in November 2017.

The matter was highly contested with the tribunal having to decide between alternative versions of what transpired during the delivery of the baby. They heard from two expert witnesses as well as from witnesses that had been present during the delivery.

The mother had been admitted under the care of a GP obstetrician for induction of labour as she was five days past her due date. The mother was induced with artificial rupturing of the membranes and the administration of Syntocinon. The GP obstetrician was called when midwifery staff noted decelerations in the fetal heart rate.

The GP obstetrician attended and tried to deliver the baby by vacuum assisted delivery, with seven pulls and then attempted a forceps delivery. As there was insufficient descent of the baby, Dr Basu was called to assist.

Dr Basu attempted a further five traction pulls and another forceps delivery. Eventually, the baby was delivered by caesarean section and has not suffered adverse consequences since the birth.

Concerns about Dr Basu’s performance included that he:

• did not obtain a handover from the GP obstetrician and therefore failed to obtain enough information about the mother and her treatment to enable continuing care of the patient
• failed to ascertain, listen to or correctly interpret information about the mother and her treatment recorded on a Cardiotocography (CTG) Trace and provided to him by other health practitioners
• failed to make records in the mother’s clinical notes
• failed to make any attempt to resuscitate the fetus
• failed to explain and obtain informed consent from the mother about the proposed vacuum extraction
• performed traction pulls, in circumstances when they should not have been performed for a range of reasons described in the tribunal’s ‘Reasons for decision’, including the large number of traction pulls performed and the prolonged application of the vacuum cup to the fetal head
• failed to interpret vaginal examination findings correctly prior to attempting forceps delivery. Dr Basu did not identify the asynclitic position of the fetal head and wrongly concluded that forceps delivery would be possible when it was not
• attempted to apply forceps when he ought to have known there were indications for abandonment
• failed to explain to the patient the forceps delivery procedure he proposed to perform
• failed to advise the patient of alternative procedures including a trial of assisted vaginal delivery in theatre or caesarean section, and
• failed to obtain the patient’s informed consent before attempting forceps delivery.

In its decision dated 16 August 2018, the tribunal found Dr Basu’s conduct demonstrated a series of errors constituting professional misconduct. It noted his actions were ‘substantially below the standard reasonably expected of a registered health practitioner of an equivalent level of training or experience’.

In its penalty decision dated 30 October 2018, Dr Basu was reprimanded, fined $25,000, his registration was suspended for two months and he was ordered to pay the Board’s costs.

The tribunal noted deterrence to other practitioners and maintaining public confidence in the profession were extremely important factors in its decision to fine and suspend Dr Basu. It considered that while Dr Basu demonstrated incompetence on the day, he had taken steps to avoid similar circumstances occurring again and there was minimal risk he would repeat such conduct.

The decision provides a great deal of clinical detail and the evidence upon which the tribunal relied upon. It is available on the eCourts portal of Western Australia website.