Obstetrician who blamed delay in a Caesarean section on a “stupid midwife” is struck off

BMJ 2014; 349 doi: (Published 07 October 2014) Cite this as: BMJ 2014;349:g6066
  1. Clare Dyer
  1. 1The BMJ

A staff grade obstetrician who delayed an emergency caesarean section for nearly an hour when “every minute counted” has been struck off the UK medical register.

Chandrasiri Abayasiriwardena, who qualified in Sri Lanka in 1968, was working on the labour ward at Wexham Park Hospital in Slough on 10 November 2008 when a 21 year old woman, 32 weeks pregnant, was brought in after a car crash.

At around 6.15 pm Abayasiriwardena obtained a brief tracing of cardiotocography, which appeared to show fetal bradycardia. He then sought to confirm this with ultrasonography, which also indicated bradycardia. At this point he asked a midwife to try to obtain a better trace and left the room.

Irreversible brain damage can occur within 15 minutes in unborn babies if no action is taken when prolonged bradycardia is present, the General Medical Council’s expert witness, the consultant obstetrician Michael Maresh, told a panel at the Medical Practitioners Tribunal Service in Manchester. He said that Abayasiriwardena should immediately have telephoned the consultant on duty and ordered that the patient be prepared for an emergency caesarean.

Abayasiriwardena returned to the patient’s room at around 6.30 pm and telephoned the consultant, who told him to proceed to a caesarean if he could not get a good heartbeat on cardiotocography. But he left again for a further 35 minutes, without checking the patient’s condition, a course of action that Maresh called “unbelievable.”

After a midwife sought him out, he returned, and the procedure was carried out at 7.25 pm. The baby was delivered alive but died two weeks later.

GMC case examiners at first thought that Abayasiriwardena’s case, as a single clinical failure, could be dealt with through a series of undertakings, including drawing up a personal development plan with the postgraduate dean and having a workplace supervisor. Abayasiriwardena wrote to the GMC reporting that he was in constant contact with his supervisor, but a check by the GMC showed that the person he named had not agreed to undertake the role and that Abayasiriwardena had not contacted the dean.

In an email to the GMC in April 2014 he wrote that he was “fed up with this non-stop harassment and as far as I am concerned I have finished with the GMC.” He was only considered a “danger” to the public, he continued, because a “stupid midwife, on her first day in a labour ward, did not report to me about a CTG [cardiotocograph] and did not know what she was doing.”

In the same email he stated, “I have better things to do with my life than get involved with the GMC . . . I will NOT take any further part in your dealings . . . I have voluntarily retired and please Do Not send any post to my address.”

The panel found that Abayasiriwardena “has a serious attitudinal problem and that if he went back to clinical practice, even in a different area of medicine, he may present a similar risk to patients and the public.”


Cite this as: BMJ 2014;349:g6066

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