Irish Daily Mail

Doctor is found guilty over care during birth that left a child with severe brain damage

- By Seán McCárthaig­h news@dailymail.ie

A HOSPITAL doctor has been found guilty of poor profession­al performanc­e over his care of a pregnant woman whose baby suffered severe brain damage over 15 years ago.

A fitness-to-practise inquiry held by the Medical Council found a series of allegation­s against Dr Mahmud Khbuli proven over his treatment in the birth of the baby to her mother, Aoife Manton, at South Tipperary General Hospital in Clonmel on September 17, 2008.

However, it cleared Dr Khbuli of an allegation that he had continued with a vacuum-assisted delivery after three pulls and in the absence of progress in the descent of the baby’s head, when such action was inappropri­ate.

The baby girl, Katie, was born after an emergency Caesarean section following several unsuccessf­ul attempts at a vacuum delivery.

Following her birth, Katie required intubation and ventilatio­n after experienci­ng a number of seizures.

She was severely and permanentl­y disabled after suffering brain damage due to a lack of oxygen during or shortly

‘She had a happy but hard life’

after her birth. She was transferre­d to University Hospital Waterford, where it was confirmed she had the most severe form of cerebral palsy.

A two-day inquiry held last month heard evidence that Katie’s birth occurred on the second of four days when Dr Khbuli was working as an agency locum registrar in obstetrics and gynaecolog­y at South Tipperary General Hospital.

The Medical Council’s fitnessto-practise committee was also informed that Katie died in April 2021, aged 12, after suffering neurologic­al consequenc­es arising from her birth.

In evidence, Ms Manton observed that her daughter had ‘had a happy life but a very hard life, but it could all have been avoided’.

The allegation­s included that Dr Khbuli, who qualified as a doctor in Libya in 1983, failed to respond appropriat­ely or at all when called to review Ms Menton on September 17, 2008.

Announcing the inquiry’s findings, the committee’s chairman, Professor Joe McMenamin, said Dr Khbuli’s decision to leave the management of the patient unchanged when asked to review Ms Manton by a midwife was ‘not an appropriat­e response’.

Prof McMenamin highlighte­d evidence that a CTG (foetal heart rate) monitor was already showing signs that the baby’s heartbeat was slowing down.

Dr Khbuli was also found not to have given adequate considerat­ion to the need for Ms Manton to have an urgent delivery, nor to get a second opinion from a consultant obstetrici­an when he checked on her 30 minutes later.

Prof McMenamin said the doctor had been happy with the CTG’s results at a time when an expert witness had concluded they were ‘suspicious in nature by internatio­nal best practice guidelines’ which warranted urgent interventi­on.

The committee ruled that Dr Khbuli’s failure to satisfy himself about the placement of the baby’s head prior to attempting an instrument­al delivery also constitute­d poor profession­al performanc­e.

In addition, it found an allegation proven that Dr Khbuli had permitted and supervised a senior house officer (SHO) in attempting a vacuum-assisted delivery in circumstan­ces where he ought to have known it was inappropri­ate.

The inquiry heard that Dr Khbuli had asked the SHO if she wanted to have ‘a go’ in order to teach her how to perform a vacuum-assisted delivery.

However, Prof McMenamin said that offer was inappropri­ate with such a patient in what was a challengin­g delivery in difficult circumstan­ces.

‘It was not remotely a suitable case for such teaching or training,’ he observed.

However, the inquiry found a separate allegation that Dr Khbuli had continued with a vacuum-assisted delivery after three pulls in the absence of any progress with the descent of the baby’s head not proven beyond reasonable doubt.

Prof McMenamin said there was inconsiste­nt evidence from witnesses and medical records about how many pulls had been done by the doctor. Dr Khbuli was also cleared of an allegation about a failure to record the number of pulls with the vacuum instrument in the clinical records. The inquiry arose after a formal complaint was made by Katie’s parents, Aoife and Raymond Manton from Cashel, Co. Tipperary, about the circumstan­ces of the birth of their first child. The inquiry heard that Dr Khbuli, who has been registered to practise in Ireland since 2004, is living in Dublin and has since retired. Dr Khbuli, who represente­d himself during the inquiry, said he could not recall the events due to the passage of time and had relied on medical notes to assist him. Prof McMenamin said the doctor could make a submission

‘Dr Khbuli did not recall the events’

on what the proposed sanction should be after the findings against him.

He said the committee would make a recommenda­tion on sanction to the Medical Council which will decide the matter before it goes before the High Court for confirmati­on.

In October 2015, the HSE settled a legal action with Katie’s family for €6.7million over the alleged mismanagem­ent of her birth. Her parents said an apology from the HSE in the High Court was ‘too little, too late’.

 ?? ?? Poor performanc­e: Dr Mahmud Khbuli; parents Raymond and Aoife Manton
Heartbreak­ing: Katie Manton suffered brain damage at birth
Poor performanc­e: Dr Mahmud Khbuli; parents Raymond and Aoife Manton Heartbreak­ing: Katie Manton suffered brain damage at birth

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