High Court: Anaesthetist must retrain after poor care caused catastrophic brain injury

About this case:

• Judgment:
  External link

The GP who made the original complaint had not appealed the decision of the Fitness to Practise Committee, therefore President Peter Kelly said that his views as to the leniency of the sanctions were irrelevant in circumstances were the high threshold necessary to quash the FTPC’s findings had not been met.

Background

In September 2014 Mr Frank Cowan, a 46-year-old man underwent an elective surgical procedure at the Santry Sports Clinic in Dublin.

A cervical decompression and discectomy was performed with a view to relieving chronic neck problems which had not responded to non-surgical treatment.

Unfortunately, during the surgery, Mr Cowan sustained a catastrophic hypoxic brain injury which left him completely dependent, tube fed, and with no possibility of any meaningful recovery.

Mr Cowan’s Consultant Anaesthetist for the surgery was Dr Deirdre Lohan-Mannion – the respondent in the proceedings before the High Court.

Complaint to the Medical Council

Mr Cowan’s general practitioner was greatly troubled at what had happened to his patient. He was also the GP to Mr Cowan’s wife and two children.

He made a complaint to the Medical Council on his understanding that there were several “anaesthetic issues which do not appear to have been managed in an appropriate clinical manner”.

In his complaint, he made it clear that the surgical management of Mr Cowan was exemplary; but he took a very different view of the anaesthetic management and expressed his belief that the professional standards of the anaesthetist in question fell below those expected of a consultant anaesthetist.

The GP made it clear that he did not make the complaint lightly but felt he had no other option but to do so in the best interests of his patient and in respect of other patients who might undergo anaesthesia by Dr Lohan-Mannion.

Following receipt of the complaint, the Medical Council’s Preliminary Proceedings Committee formed the opinion that there was a prima facie case to warrant further action being taken against Dr Lohan-Mannion in respect of the complaint.

The matter was referred to the Fitness to Practise Committee (FTPC) of the Medical Council on the grounds of alleged professional misconduct and poor professional performance on the part of Dr Lohan-Mannion

In November 2016, the FTPC conducted an inquiry under Part VII of the Medical Practitioners Act 2007

Fitness to Practise Committee

In respect of sanctioning Dr Lohan-Mannion, the FTPC recommended that Dr Lohan-Mannion required re-education and training in the management of anaesthesia in a theatre setting to include pre-and-post-operative care.

Further, it was recommended that Dr Lohan-Mannion be censured, and that certain conditions be attached to her name on the Medical register.

The FTPC was satisfied that the sanction of censure and the imposition of conditions was fair and proportionate, would allow objective monitoring of Dr Lohan’s practise, and deemed sufficient to protect patients and the public interest.

The recommendations were not appealed by the General Practitioner who made the original complaint, and the Medical Council therefore brought the present application to the High Court of s.76 of the Medical Practitioners Act 2007 to confirm the recommendations made by the FTPC.

High Court

Citing Hermann v. Medical Council IEHC 414; Mr Justice Peter Kelly, President of the High Court emphasised that the protection of the public was a paramount consideration for the Medical Council and the court on an application of this sort.

Justice Kelly stated that although the sanction might be described as “lenient or one which does not address the public interest and provide protection to the public as comprehensively as it might”, it could not be regarded as so lacking in that regard as to warrant a refusal of this application.

The Medical Council was of the view that the sanction proposed was “proportionate and adequately protects the public as it is framed and without the necessity of any suspension”

Justice Kelly explained that the Court could only refuse the order sought in this case if he believed the Medical Council came to such an unreasonable decision that no reasonable medical council could have so done.

Unable to come to that conclusion, Justice Kelly added that the threshold which had to be achieved to demonstrate such unreasonableness was similar to that required to quash the decision of any administrative body on judicial review.

This high threshold had not been achieved.

Granting the Medical Council’s application, the Court confirmed the decision of the Medical Council to attach the aforementioned sanctions pursuant to s.76(3) of the Medical Practitioners Act 2007.