‘Junior doctor could not take pulse’: inquiry

A Coleraine-based junior doctor, who was unable to take a patient’s pulse, has been found guilty of poor professional performance following an inquiry by the Medical Council’s Fitness to Practice committee.

The inquiry upheld a number of allegations against Dr Asia Ndaga, who was not at the inquiry, but did not find her guilty of professional misconduct.

The inquiry was told there were concerns about the competency of Dr Ndaga (31), who qualified in Romania in 2008, from the moment she joined the hospital in July last year.

A clinical incident had been noted formally whereby a nurse had to show her how to certify the death of a patient and how to write up medical notes in relation to a patient transferred from Dublin.

There were concerns that her medical knowledge was “weak” for a senior house officer, at the slow speed of her assessment and diagnosis of patients and about her ability to calculate drug dosages.

Chairman Brendan Broderick said the 31-year-old Romanian doctor, who worked at Letterkenny General Hospital in Donegal, failed to meet standards of competence that could be reasonably expected of medical practitioners.

The inquiry was told that efforts were made to contact Dr Ndaga, who has an address in Adelaide Avenue, Coleraine, and is also registered with the British General Medical Council.

Counsel for the Medical Council, JP McDowell, said concerns were raised by staff in early August last year about Dr Ndaga’s competence.

Dr Ken Mulpeter, a consultant geriatrician at the hospital, undertook an assessment of her competency on August 18 after concerns had been raised.

He took her to see a patient with chronic obstructive pulmonary disease and an irregular heartbeat and asked her to take the patient’s pulse. She tried to do this by putting her fingers “on top of the patient’s wrist” rather than underneath it and said the patient was in normal rhythm.

“I obviously got a bit of a shock with that, so I asked her to take the patient’s pulse in his feet,” said Dr Mulpeter. “She put her two fingers on areas of the foot where you would not feel a pulse.”

He said how to take a patient’s pulse was something learned in first or second year in college. He said Dr Ndaga was unable to say how much oxygen the patient was on, something which could be read from the patient’s oxygen mask and a device on the wall.

She also did not know why the man had a barrel-shaped chest. It was an indication of lung disease but she suggested rickets.

In addition, she failed to take an adequate patient history, partly due to some language difficulties. Dr Mulpeter felt she was not competent to continue working in the hospital as a senior house officer and her contract was terminated.

Dr Ndaga said she felt the assessment was too brief; that it was her first employment in Ireland and she did not have experience in the Irish health system.

Dr Mulpeter said that at the time the hospital had experienced some difficulty in recruiting doctors.

“We were prepared to apply more close supervision,” he said. “Usually in the first few weeks, whenever a new cohort of doctors arrive you try to suss out the weak doctors and offer them some support, if necessary. You identify very quickly who the very competent doctors are.”

The inquiry heard that there had been difficulties contacting Dr Ndaga by letter, email and phone.

Dr Jose Miranda, one of the consultants who had supervised Dr Ndaga, before going on leave at the end of July, said he did not see her references.

Dr Ahmed Elleth said the interview was performed by the Royal College of Physicians as Dr Ndaga was on its training scheme. Dr Elleth said July is always a challenging time for hospitals as they take on a large number of new junior doctors.

He later took the view that Dr Ndaga was an under-performing senior house officer.