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