Following a decision by the Health and Disability Commissioner, in which an anaesthetist was found to have breached Right 4 of the Code of Rights by failing to provide sufficient anaesthesia in connection with a caesarean section (13HDC00515), the anaesthetist was referred to the Director of Proceedings.  The Director laid a charge of professional misconduct against the anaesthetist. 

The Health Practitioners Disciplinary Tribunal dismissed the charge, concluding that there was insufficient evidence that the patient's pain had been adequately communicated to the anaesthetist such as to call for additional intervention.  Among other factors, the Tribunal considered that there was a "significant element of judgment call" in the anaesthetist's response to the situation, and that after the baby had been delivered (and before the suturing) the attending obstetrician could have stopped the procedure and requested further analgesia if she had significant concerns about the patient's pain or discomfort. 

The Tribunal did, however, note that the anaesthetist's "situational awareness was below the standard expected," as the anaesthetist claimed he was unaware of certain physical indications of the patient's pain levels during the procedure.  Others present at the time recounted the patient moving her legs and having unusually tight abdominal muscles.  However, the Tribunal did not think that the anaesthetist's "inadequate situational awareness" amounted to malpractice or negligence or were likely to bring discredit to the profession such as to warrant disciplinary action.

The Tribunal also commented on subsequent meetings where the obstetrician, midwife and patient discussed the event, and the obstetrician and midwife indicated that they were unhappy with the anaesthetist's actions.  The anaesthetist was not present at these meetings. The Tribunal viewed these meetings as setting the framework for their perception of the events, and the basis for their written reports and evidence.  This reiterates the importance of carefully managing any situation where concerns are raised about care.  (760/Med15/323D)