Doctor its professional misconduct over patient who suffered fatal brain injury
Seán McCárthaigh
A hospital doctor has itted professional misconduct over an incident in which a patient with meningitis suffered a fatal lack of oxygen to the brain following a dispute with nursing staff over whether a breathing tube had become dislodged.
Ilankathir Sathivel appeared before a medical inquiry to face a series of allegations over his treatment of a patient on February 23rd-24th, 2019, while working as a registrar anaesthetist at Connolly Hospital Blanchardstown in Dublin.
The hearing before the Medical Council’s fitness-to-practise committee heard Dr Sathivel was making a number of issions in relation to the care he provided to the 59-year-old male, identified only as Patient A, who had been itted to the hospital’s intensive care unit (ICU) after being diagnosed with bacterial meningitis.
The committee was informed that Dr Sathivel accepted that his failure to have regard for the stated view of a clinical nurse manager, Rosanne Kenny, that Patient’s A endotracheal tube had become dislodged at around 3.58am on February 24th, 2019, constituted professional misconduct.
Written statements from several nursing staff at CHB showed Ms Kenny had twice raised her concern with the anaesthetist that the tube had become displaced as ventilation alarms had sounded to show Patient A was suffering a lack of oxygen.
However, Dr Sathivel insisted the tube was correctly inserted and was not responsible for a deterioration in the patient’s condition.
Counsel for the Medical Council, Neasa Bird BL, said the anaesthetist’s disregard of the nurse’s concern represented a serious falling short of the standards expected of medical practitioners.
Although Dr Sathivel had responded immediately to a call for assistance, Ms Bird said he had initially conducted his assessment of Patient’s A airway from the foot of the bed.
She claimed he subsequently relied on his view that the tube was not dislodged from observation of the patient’s chest rise and his examination with a stethoscope without carrying out a visual check on the equipment.
The inquiry heard he also delayed re-intubating the patient and in seeking to perform a laryngoscopy to assess the position of the tube.
The inquiry heard Patient A suffered a cardiac arrest at 4.15am lasting 13 minutes as a result of a lack of oxygen which resulted in a severe brain injury.
A postmortem showed he subsequently died on March 2nd, 2019, from a lack of oxygen to the brain with meningitis as a contributory factor.
Ms Bird noted that it was Dr Sathivel’s first-ever shift as the on-call registrar in the hospital’s ICU.
However, she said the challenges of the role should have been with the competency of the anaesthetist.
Ms Bird said the view of two expert witnesses who reviewed the case said it was clear that Dr Sathivel’s failure to deal with the critical incident in a timely manner had resulted in “an adverse outcome.”
The inquiry arose following a complaint made to the Medical Council by the then general manager of CHB, Barbara Keogh Dunne.
Ms Bird said an internal review of the critical incident by CHB had raised a concern that Dr Sathivel’s competency may pose a risk to patient safety.
Dr Sathivel, originally from India and who qualified as a doctor in 2005, has been ed to practise in Ireland since 2012 and currently works as a consultant anaesthetist at the Mater Private Hospital in Dublin.
The anaesthetist also made issions to several other allegations in relation to his treatment of Patient A and accepted they amounted to poor professional performance.
They included his failure to adequately assess the patient’s airway in a timely manner and his failure to have adequate regard for the deterioration in the man’s condition after his skin had turned blue and his heartbeat had slowed to a dangerous level.
Dr Sathivel also accepted that he did not write up any medical notes for 12 hours about his treatment of Patient A in the emergency department as well as failing to inform and brief the consultant anaesthetist at CHB about the critical incident in a timely manner.
Offering his condolences and an apology to Patient A’s family, counsel for Dr Sathivel, Cathal Murphy BL, acknowledged that the allegations against his client related to a serious and tragic event.
However, Mr Murphy said what happened with Patient A was “an isolated incident” in the anaesthetist’s career that was not due to any lack of competence but “human factors.”
He said Dr Sathivel had taken steps to improve his skills set over the following years and had been a consultant since 2020 with no further incidents about his performance and competence.
Mr Murphy claimed the appropriate sanction to be imposed on his client was censure.
Ms Bird asked the fitness-to-practise committee to take into that the issions made Dr Sathivel by related to “a serious matter.”
Based on the anaesthetist’s issions, the chairperson of the inquiry, Paul Harkin, said the fitness-to-practise committee would convey its recommendations on sanction, which are not made public, to the Medical Council in due course.
