Anaesthetist's 'striking lack of empathy'

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An anaesthetist who gave insufficient anaesthesia to a pregnant woman whose legs had to be held down as she reacted to the pain during a Caesarean section has been criticised by a health watchdog for a "striking lack of empathy".

A Health and Disability Commission report, released today, found the anaesthetist and an obstetrician breached the woman's rights during the operation.

Neither of the doctors nor the district health board (DHB) were named in the report.

The anaesthetist has been referred to the Health and Disability Commissioner's director of proceedings for possible charges before the Health Practitioners Disciplinary Tribunal.

In February last year, the woman was admitted to hospital in labour, but because progress with the birth was slow, it was decided an emergency Caesarean section should be performed, the report said.

The anaesthetist conducted an "ice test" to check the woman's sensation, and she said she could feel the ice was quite cold.

However, he advised the obstetrician she could begin the surgery in two minutes' time.

Initially, the woman could not feel anything, but when the obstetrician cut into her abdomen, the woman complained of pain. The anaesthetist assured the obstetrician she could continue with the surgery.

When the obstetrician attempted to deliver the baby, the woman complained of pain and began lifting both her knees, which were held down by nurses, the report said.

The woman continued to complain of pain, but the anaesthetist told her she was feeling pressure rather than pain. He said she could not have any more pain relief unless they "put her under", which would not be good for the baby.

After the delivery the woman, still in pain, was given no pain relief.

In his report, Commissioner Anthony Hill said the anaesthetist's failure to provide adequate anaesthesia/analgesia during the operation was "suboptimal".

"The anaesthetist's communications with the woman displayed a lack of sensitivity, and he treated her with a striking lack of empathy."

It was also unacceptable for the obstetrician to complete the surgery while the woman was in significant pain, Mr Hill said.

Once the obstetrician became aware of the pain she should have ensured that appropriate analgesia was administered, he said.

Recommendations:

* the Medical Council to review the anaesthetist's competence;

* the anaesthetist be referred to the Health and Disability Commissioner's director of proceedings;

* the DHB to review the orientation of locum staff and audit the implementation and effectiveness of its policies and protocols for epidural anaesthesia;

* the DHB to include information in its training that the practice of asking questions and the reporting of concerns was expected and accepted from all members of the multidisciplinary team.