A consultant obstetrician and gynaecologist at Cavan General Hospital has told a Medical Council inquiry into allegations against him relating to three women and childbirth that he performed a trial instrument delivery in the labour ward in one of the cases because the theatres were busy.
Giving evidence on the fourth day of the hearings, Consultant obstetrician Dr Salah Aziz said that on the evening in question in November 2012, along with Patient 1, there were two other emergency caesarean sections at Cavan General being dealt with by other staff.
Dr Aziz said Patient 1 needed delivery, adding that the baby's head was well-engaged in the pelvis and he thought he could deliver the baby by doing a trial instrument delivery.
He said a theatre was the best place for this procedure but the theatres were busy, so he had to perform the instrument delivery in the labour ward.
Dr Salah Aziz is facing allegations of professional misconduct and poor professional performance.
The three cases relate to events between November 2012 and April 2014 at the hospital.
Two of the three patients are not being named.
Giving evidence for the first time today, Dr Aziz said he was the consultant on-call on 22 November 2012 at the hospital.
He said he first saw Patient 1 at 10am that day.
She had a high body mass index, and had been admitted for induction on 19 November.
On the evening of 22 November, he was called at home at 22.25pm to be told Patient 1 was fully dilated for a considerable period but the baby's head was not visible.
He was asked to come in and do an instrument delivery and recommended Patient 1's epidural be topped up in preparation.
Dr Aziz said he reviewed Patient 1 and told the inquiry he was surprised to learn that another C-section was still going on in a theatre.
He told the inquiry that management at the hospital had reduced working hours in theatre and had re-deployed nursing staff to other wards.
Dr Aziz said there was no system to call in a second theatre team.
He said this had caused friction and low morale.
He said that Patient 1 had been pushing for more than an hour and he needed to get the baby out.
Dr Aziz told the inquiry he qualified in Egypt in 1980 and had worked in Libya.
He came to Ireland in 1988 and worked at a number of hospitals, including Holles Street and Belfast City.
Dr Aziz was appointed to Cavan General in September 2004 and became the senior consultant there in 2005.
He said he developed clinical guidelines for the obstetric unit.
Expert witness Dr Joanna Gillham this morning told the inquiry there was a delay by Dr Aziz in alerting staff at the hospital that he would require a theatre if his plan to perform an instrument delivery of a baby failed.
Lawyers for Dr Aziz say his case is that he had difficulty in getting access and staffing a second theatre, as a caesarean section on another patient was under way.
Dr Gillham, consultant obstetrician at St Mary's Hospital in Manchester, said it was hard to staff hospitals for all eventualities.
She said that sometimes management come at these things from a financial perspective, while obstetricians have a different view.
In the case of Patient 1, it is alleged that on 22 November 2012, Dr Aziz engaged in prolonged attempts at an operative vaginal delivery in inappropriate circumstances and that he failed to proceed to C-section with speed.
Dr Aziz told the inquiry that at 11.15pm when it was clear the baby could not be delivered using forceps, he decided Patient 1 would need a caesarean section and had to go to theatre.
When he arrived to theatre there were no staff members there and staff had to be gathered.
The caesarean section began at 11.32pm.
Dr Aziz said the baby's head was jammed into the pelvis.
It took about five minutes to get the baby boy out.
Dr Aziz said the baby was born "flat", needed resuscitation and had to be transferred to the Rotunda Hospital for care.
He expressed sympathy to the parents, as the mother had a difficult labour.
Three cases under examination
In relation to Patient 2, Deirdre Clarke has agreed to be identified.
It is alleged that between September 2012-June 2013, Dr Aziz failed to adequately counsel Ms Clarke of the risks of a vaginal birth, after a C-section.
It is also alleged he failed to cooperate with Cavan General's efforts to conduct a review of the case.
In the case of Patient 3, it is alleged that on 26 April 2014, Dr Aziz failed to attend Cavan General to assess the patient within an adequate time frame.
It is alleged he failed to diagnose in a timely manner, that a catastrophic event in utero had, or was occurring, which required an urgent caesarean section.
It is also alleged Dr Aziz directed that the monitoring of Baby 3's foetal heartbeat be discontinued and that he failed to keep adequate medical records.
Dr Aziz said he was put on leave after the HSE made a complaint in September 2014 after the case of Patient 3.
He told the inquiry he felt "very stressed" being on leave and looked forward to vindicating his name and going back to work.
Dr Aziz said he was put on leave after the HSE made a complaint in September 2014, after the case of Patient 3.
He told the inquiry he felt "very stressed" being on leave and looked forward to vindicating his name and going back to work.
Dr Aziz said he was human and if he made mistakes he would like to learn from them.
His wife was a Cavan woman and it had all been very difficult, he added.
The inquiry has adjourned and will resume on Thursday.
