An inquiry heard this afternoon that a mother was given a drug that put her at serious risk during the birth of her sixth child.
Dr Vimla Sharma told an ongoing Medical Council inquiry that she was "shocked" when she learned that Dr Andrea Hermann had given a blood-thinning drug to a mother who was already at risk of heavy bleeding.
Dr Hermann, who previously worked as an obstetrics and gynaecology registrar at Sligo General Hospital, faces allegations of professional misconduct and poor professional performance, as well as a contravention of a provision of the Medical Practitioners Act 2007.
Dr Hermann is facing a number of clinical claims in relation to the care she provided to six patients, who attended the hospital between August 2013 and February 2014.
Dr Sharma, a consultant gynaecologist at Sligo General Hospital, told the inquiry this afternoon that on the evening of 12 August 2013, she was the consultant on call, and so she went to check in with a mother who was labouring with her sixth baby.
She saw that the mother had cellulitis on her right leg and noted with concern that Dr Hermann had arranged for the mother to be given the blood thinner Innohep, or Tinzaparin, an anti-coagulant used to treat deep venous thrombosis.
"I was shocked because Innohep is an anti-coagulant, which we avoid during labour," said Dr Sharma.
She explained that as the mother had given birth multiple times, this put her at a greater risk of blood loss - and that Innohep also placed her at risk for this.
Dr Sharma said she was also concerned because the administration of Innohep had implications for the rest of labour.
"If you use Innohep during labour, you can't have an epidural for 12 hours," she said, adding that a mother, after taking the drug, can also not have a spinal anaesthetic, if an emergency caesarean section is needed.
One of the allegations faced by Dr Hermann, which she admits to, is that she prescribed Tinzaparin to this patient when it was not appropriate to do so.
Dr Sharma told the inquiry that she spoke with the patient, and then with Dr Hermann, telling her it was a serious mistake. The mother later gave birth without any complications.
Along with the clinical allegations against her, Dr Hermann also faces claims that she did not disclose to Sligo General Hospital the conditions attached to her registration with the Irish Medical Council, although Dr Hermann denies these claims.
Dr Hermann was the subject of a previous inquiry at the Medical Council, in 2009 and 2010.
On foot of this, the Medical Council recommended that Dr Hermann be suspended for one year and that certain conditions be attached to her registration, such as agreeing to certain supervision, once she began work again.
Martha Saba, the manager of the Medical Manpower - or HR - at the Sligo hospital, said Dr Hermann was interviewed for the post of obstetrics and gynaecology registrar on 28 June 2013.
Ms Saba said Dr Hermann admitted that she had some previous difficulties with the Medical Council.
One of the consultants conducting the interview, Dr Heather Langan, then asked Dr Hermann whether she had any conditions attached to her registration.
Ms Saba told the inquiry that Dr Hermann said she did not have any conditions attached to her registration, and that she just needed an offer of a job and to pay the registration fee with the Medical Council in order to be reinstated.
In late July, Ms Saba received an email from the Medical Council confirming that Dr Hermann had been reinstated on the register, and that they would be sending a letter with the list of conditions in the post.
The following morning, Ms Saba looked up Dr Hermann on the Medical Council's website and saw she was registered.
She told the inquiry she did not recall whether she clicked on Dr Hermann's registration number, which one must do to see any restrictions placed on a doctor.
She said she never received the letter outlining conditions from the Medical Council.
Ms Saba said during 2013 recruiting registrars to the obstetrics and gynaecology departments was a "national problem" for hospitals in Ireland.
The inquiry continues tomorrow.
