Northern Ireland doctor might not have read medical notes before wrong diagnosis of man who later died
A doctor who was allowed to "circumvent" the system to become a consultant in a hospital in Northern Ireland "almost overnight" admitted at a patient's inquest he may not even have read the man's notes before wrongly diagnosing him.
Dr Mohammod Asaduzzeman (44) wept in Armagh Courthouse as he addressed the family of Lurgan businessman Denis Doran (57), who died of a heart attack around two months after being told his chest pains were due to a hiatus hernia condition.
Yesterday the Bangladeshi-born doctor admitted failing to identify textbook symptoms of a cardiac problem while working as a locum consultant in Craigavon Hospital on August 29, 2016. The married father-of-two, known as Danny, died on November 19, 2016.
The inquest also heard:
- how a junior doctor believed Danny's problem was heart related - but felt they couldn't challenge a more senior medic she thought was better qualified;
- the coroner express concerns over how locum consultants not deemed suitable for permanent positions are being appointed if they have been trained outside the UK - even if that experience isn't up to NHS standards;
- that locum consultants are being appointed without interview to fill gaps due to staff shortages; and
- how it is "down to luck" whether patients see a locum consultant who may not have the required experience to be a NHS consultant, or one who has been undergone the proper training.
"I'm sorry," the doctor told the businessman's widow and two children. "I know I made a mistake but it was not my intention. I cannot change what happened. I did it, but I have learned from it.
"I've done my best to go through the process to make sure it never happens again."
The inquest was adjourned for a short time when Mr Doran's widow, who broke down and sobbed, asked to speak with Dr Asaduzzeman - who was referred to in court as Dr Asad - in private.
Junior doctors had believed Mr Doran's symptoms were heart related. But when Dr Asad was asked four times if he had failed to read his patient's medical notes, he replied: "Anything is possible."
"I should have considered cardiac causes," he said. "I cannot say why I didn't."
Dr Katherine McMillen, who was a trainee at the time, said she believed the symptoms to be cardiac related. But she told the inquest that she lacked the confidence to correct a superior whom she falsely believed to be a cardiologist by background.
"I knew he'd been in England and the Middle East," she said. "It was a conversation in passing. I didn't see his qualifications."
Dr Asad, an acute medical consultant who graduated from medical school in Bangladesh in 2000 before going on to complete some cardiology training in Saudi Arabia, worked in a number of UK hospitals before being recruited as a locum consultant by the Southern Health and Social Care Trust. But Patrick Mullarkey, the solicitor representing Mr Doran's family, expressed serious concerns that Dr Asad had not held any "substantial NHS post" prior to taking up the role.
"You went from a locum registrar to a locum consultant almost overnight," he said as he addressed the witness.
The revelation prompted Coroner Patrick McGurgan to express his "alarm" over recruitment practices in all five health trusts.
"Unlike UK medical students who can take longer than seven years to specialise and are subjected to rigorous competency testing, locums can circumvent all that by training elsewhere and sending in a CV," he said.
"That, quite frankly, is appalling."
The coroner said he was not satisfied that Dr Asad was formally interviewed after it emerged such a process is uncommon during the recruitment of locum consultants.
Dr Michael Moore told the inquest that there is currently only one locum cardiologist consultant working in Craigavon Hospital and that he was "checked out" before being appointed based on his CV - although he was never properly interviewed. The consultant chair of the Southern Trust said the practice is widespread across hospitals here, and blamed the need to "fill holes" on staff shortages and the absence of government at Stormont. "I apologise to Mr Doran's family - it is clear the Trust has failed them," Dr Moore added.
Mr McGurgan indicated he is planning to write to the Permanent Secretary of the Department of Health, Richard Pengelly, regarding the issue.
"What concerns me is that Dr Asad would not be deemed suitable to be employed as a standard consultant but is [deemed suitable] to be a locum consultant."
Dr Moore confirmed that medics in both categories see patients from the same cohort and conceded it is "down to luck" which one they encounter in a hospital.
It came after Dr Asad said he was "not aware" of the existence of the Rapid Access Chest Pain Clinic in Craigavon Hospital at the time Mr Doran presented with chest pains "up to his throat".
"There was no formal orientation process because I was a locum - that's what happens," he added. However Dr Moore revealed that two week waiting targets for the clinic were being missed and when Mr Doran was eventually referred, he was told he had to wait 11 weeks. He died before his appointment.
Dr Moore described the situation as "disappointing" and conceded there was a risk to public safety as a result. The medic claimed waiting times are currently around five weeks, despite an additional Rapid Access Chest Pain Clinic being set up to tackle delays.
Consultant cardiologist Dr McGlinchy told the inquest that if Mr Doran's chest pains were recognised as "classic symptoms of angina" he would probably still be alive. "If a cardiologist had been aware of him he would have gone for treatment within one or two days," he said.
He said the "very successful" treatment would have involved stents being inserted into Mr Doran's heart to prevent the narrowing of his arteries.
The Doran family's solicitor claimed the deceased was given a false assurance as a result of the diagnosis which stemmed from Dr Asad's erroneous interpretation of an abnormal ECG as normal which is why he did not present to hospital on the night he suffered the heart attack. Mr Mullarkey said Mr Doran was instead at home with his wife "stretching his arms" to relieve hernia symptoms.
Dr Asad, who became a father for the first time last year, told the inquest he has taken training courses and read articles including "heart attack or heartburn" since the death of his former patient.