Doctor admits to poor professional performace over exposing breast of army officer without consent

Seán McCárthaigh

A GP has admitted to poor professional performance over his physical examination of an army officer during which he inappropriately exposed one of her breasts without the patient’s consent.

The doctor – who was identified only as Doctor C – made admissions at a fitness-to-practise hearing of the Medical Council in relation to four allegations concerning his treatment of the female soldier while working as a locum at the Curragh Camp, Co Kildare on September 19, 2022.

The inquiry heard that Doctor C, who comes originally from Sudan, accepted he had exposed the left breast of the officer – identified only as Patient A – during a physical examination of her chest.

Counsel for the Medical Council, Neasa Bird BL, said the GP’s action was inappropriate and not clinically justified.

Bird said the patient’s breast had been exposed without her consent or without informing her in advance.

Another allegation related to the failure of Doctor C to document any findings of his physical examination of Patient A.

The GP also admitted prescribing an intramuscular injection of ceftriaxone to treat the patient which Bird said was clinically inappropriate and contrary to Irish antimicrobial prescribing practice.

Doctor C acknowledged that he had inaccurately entered the name of a different drug, cefixime, in Patient A’s medication records.

The inquiry arose following a complaint to the Medical Council by another doctor working full-time with the Defence Forces known only as Doctor B.

Bird said the chief executive of the Medical Council accepted the four allegations combined represented just one incident of poor professional performance as they related to “a single episode of care".

She claimed Doctor C’s treatment of Patient A had fallen short “in a serious way” of the standards of competence expected of general medicine practitioners.

Symptoms

The inquiry heard that Patient A – a commandant in the Defence Forces who held the rank of captain at the time – had gone to a medical aid post in the Curragh Camp with symptoms of wheezing, coughing and feeling unwell.

Bird said she declined a request to lift up her bra but subsequently curled it up slightly without uncovering her breasts.

However, she said Doctor C now admitted that he had pulled down one side of her bra without advance warning or consent which exposed her left breast entirely and left it exposed for around ten seconds.

Ms Bird said the patient felt “very uncomfortable” but did not express concern at the time as she was “sick and surprised” over what had happened.

The inquiry heard the GP prescribed ceftriaxone for Patient A which was to be given intramuscularly and told her she would need to go to a pharmacy to have the antibiotic administered.

However, Patient A returned to the surgery later that day after being advised by a pharmacist that it could not administer the medication.

Bird said the patient was seen by Doctor B who also carried out a chest examination “of a different nature” and who described the prescription given by Doctor C as incorrect.

The woman was diagnosed with a lower respiratory tract infection and prescribed more appropriate oral antibiotics. She was subsequently diagnosed with pneumonia.

Ms Bird explained that ceftriaxone was a strong antimicrobial medicine administered intravenously or intramuscularly to treat severe and life-threatening bacterial infections such as E-coli and meningitis but was not given in a community care setting.

Correspondence

In correspondence, Doctor C said it was his second time seeking the patient after she had notified him by phone that she had a severe cough and her symptoms were not improving.

The inquiry heard that the GP claimed he had asked the officer if she wanted a chaperone while he examined her chest but she was happy for him to go ahead without one.

Doctor C said he considered prescribing her a short course of an intramuscular injectable antibiotic as the oral antibiotic he had previously prescribed did not appear to have had any effect.

He claimed a nurse confirmed that it was appropriate to prescribe such a medicine and that it could be administered in a pharmacy – a claim disputed by the nurse.

Bird said the doctor also introduced the possibility of having prescribed a third drug in correspondence as it contained a reference to cefotaxime.

Doctor C said he now knew that the appropriate treatment where an injection was considered necessary was a referral to hospital and he had also familiarised himself with prescribing guidelines.

'Shocked'

The GP told the Medical Council that he was shocked about the complaint against him.

The inquiry heard that an expert witness, Professor Tom Fahey, noted in a report prepared for the Medical Council that the exposure of the patient’s breast was not necessary for an examination of her chest.

Prof Fahey said the doctor’s failure to record his findings was a serious omission in light of the treatment he recommended.

He also pointed out that the HSE’s advice on the treatment of community-acquired pneumonia, which is available online, does not recommend intramuscular injections.

Prof Fahey said the prescribing of such drugs in such circumstances by Doctor C was “most unusual".

Doctor C, told the inquiry that he had come to Ireland in July 2022.

The GP said he had not attended any induction course about prescribing in Ireland but was familiar with antibiotics from having worked over 20 years in Saudi Arabia.

In reply to questions from the committee, Doctor C said he felt oral antibiotics were not working for the patient as she appeared very sick and he could hear some “crackles” in her chest.

“I thought at that stage – maybe if I give her one shot of this injection her condition may improve and there is no need for a referral. That was my plan,” he added.

The inquiry chairperson, Marie Culliton, adjourned the hearing until Monday when the committee will issue its findings and hear submissions on possible sanctions.