Consultant gynaecologist who 'went on warpath' towards terrified pregnant mother amid row over C-section and using forceps as she gave birth is suspended
Dr Premila Thampi, 62, from Mitcham, South London, was said to have 'gone on a bit of a warpath' when she realised the woman was unable to have the baby naturally.
It was claimed as colleagues at the Milton Keynes University Hospital in Buckinghamshire looked on, Dr Thampi refused the patient's plea to have a caesarean section.
Instead she declared: 'What you need to understand and appreciate is that I am a Consultant, and it is after six o'clock and I could have gone home and left one of my Registrar's to delivery this baby!'.
She then 'pressurised' the patient into letting her use the forceps adding: 'You need to let me do this as I don't know what is going to happen to your baby. You are putting your own baby at risk.'
The woman begrudgingly agreed to the use of the surgical instrument but shouted: 'I hate you, you haven't listened' at Dr Thampi as the forceps were applied.
She said she was left traumatised by the birth and claimed the forceps caused damage to her baby's head and face.
At the Medical Practitioners Tribunal Service in Manchester Dr Thampi, was found guilty of serious professional misconduct and was ordered to be suspended from practise for three weeks.
The incident occurred in October 2016 when she was working as a Consultant in Obstetrics and Gynaecology at the Milton Keynes University Hospital.
The woman known as Patient A had been admitted at 41 weeks and 3 days' gestation and was transferred to the labour ward and given pain relief whilst her mother was at her bedside.
In a statement Patient A, who suffers from a neuromuscular condition said that Dr Thampi came to check on her after she was admitted and suggested the use of forceps, which she said she clearly refused
She said: 'At around 17.45, Dr Thampi attended to review my progress. She explained I was fully dilated and asked if she could come and give me an instrumental delivery. I told Dr Thampi, "I don't want that, I want a caesarean section"'.
'But Dr Thampi just said that we 'could talk about it later' and left the room. She then next came to the delivery room shortly before 18.30 explained I was fully dilated and that she was going to give me an instrumental delivery.
'She just marched into the room to ask me if I was ready for an instrumental delivery and then marched back out again. Dr Thampi didn't explain what an instrumental delivery would involve, or what the instruments to be used were. I knew about the use of suction and a ventouse, and I verbalised to Dr Thampi that I was against the use of forceps.
'But Dr Thampi didn't explain any alternative options to an instrumental delivery. She just said, "no, you can't have a c-section" when I mentioned it and she didn't give me any explanation as to why I couldn't have a C-section.
Patient A said she was very clear she wanted to have a C-section but felt intimated by Dr Thampi.
The new mother said: 'I remember thinking at the time she was on a bit of a warpath, so I was reluctant to ask. I didn't want to keep pushing back as I was making her angry by refusing to have an instrumental delivery.
'I could tell Dr Thampi was angry by her demeanour, how abrupt she was being with me and her poor bedside manner. She was giving me no explanation as to anything, she just kept waltzing in and out of the room.'
Patient A said prior to the delivery day, she had told her midwifery and antenatal team about her objection to forceps but was ignored by the consultant.
She added: 'Miss Thampi said, "Will you let me try with the suction, the Kiwi cup?". I felt that if I had to agree, I had to agree to that because otherwise, it would be a forceps, and I did not want a forceps. In hindsight, I wouldn't have had either because of the damage it had done to my child's head and face.
'She explained, in reference to the forceps, that, "you need to let me do this as I don't know what is going to happen to your baby." It was due to this comment I felt forced into consenting to the use of forceps. I just said, "do whatever you want, you're going to do whatever you want anyway."
'I was getting louder throughout as I repeatedly declined the use of forceps, and I didn't feel like Dr Thampi was listening to me. Eventually I became so frustrated I swore at Dr Thampi. I was just scared and was trying to get her to stop her doing something to me that I clearly didn't want her to do to me.
'She said "well it's too late for a C-section now, you need to let me use the forceps because I don't know what is going to happen to your baby!" I said "I didn't want forceps I told you that!" but Miss Thampi said, "[Patient A] I am a Consultant I cannot get your baby out, you are putting your own baby at risk by not allowing me to use the forceps."
'During the process of having my legs put into the stirrups, I was saying "I do not want the forceps to be used and I haven't pushed yet." Miss Thampi then said something I will never forget for the rest of my days - "What you need to understand and appreciate is that I am a Consultant, and it is after six o'clock and I could have gone home and left one of my Registrar's to delivery this baby!"
Patient A confessed she felt pressured to do what Dr Thampi wanted and felt that she was being threatened with sub-standard care if she refused.
'I felt Miss Thampi was pressuring me into something I did not want by implying that if I didn't agree I would be left to receive a substandard level of care,' she said, 'I got the impression Dr Thampi just wanted to go home.
'She kept saying, "it's after six o'clock, I could have gone home, you need to let me do this."
'She was implying that I would receive a substandard level of care from her registrar, and instead, she had stayed so I had consultant care. She actually said, "I'm a consultant".
'I think these comments were made coercively to try and scare me into letting her do the instrumental delivery so that I wouldn't have been left in the hands of the registrar, who she made out to be incompetent.
'I felt forced into consenting to the use of forceps. I just said "do what the f**k you want, you're going to f**king do it anyway, you haven't listened to me all day! "I have thought what happened every day - it still rules my life.'
Patient A's mother said: 'When Miss Thampi came back into the room, she said that Patient A would now need to have an instrumental delivery. She didn't give any explanation as to why the instrumental delivery was required, just that it was necessary.
'Miss Thampi said that she was a consultant and that Patient A needed to listen to her. She said that it was now after 6pm and she could have gone home and left a junior to deliver the baby. The discussion went around in circles with Miss Thampi pressurising Patient A to have an instrumental delivery and my daughter kept saying no.'
For the General Medical Council Simon Jackson KC said: 'No patient should be 'pressured' into agreeing to any procedure that they make clear they do not want.
'Dr Thampi's way of treating patients, and her own decision-making processes in relation to the key issues of consenting to an instrumental delivery showed a rigidity of approach, and a lack of willingness to reflect on how things could and should have been done differently.'
Dr Thampi said in a statement: 'I discussed the option of an assisted delivery with Patient A, advised her about the use of Ventouse and also the possible use of forceps.
'She expressed concern that forceps can damage babies, but I did not interpret her comment at that point to indicate a refusal. I provided reassurance that forceps are one of the commonest tools for assisted birth and Patient A gave her consent to proceed with a ventouse delivery and was positioned ready for the delivery.
'She was happy when I said forceps will not damage the baby and she said, 'You can go ahead with the delivery'. I explained to her that we might be able to deliver with the ventouse, possibly forceps.
'Once it was apparent that delivery could not be facilitated solely by the use of ventouse, I discussed further with Patient A the use of forceps and the need for an episiotomy. Patient A said she did not want a forceps delivery but only when, in my clinical judgment, it was too late to safely change to a Caesarean section.
'Patient A's clinical condition and the position of the baby's head meant the use of forceps was the most reasonable option in Patient A's and the baby's best interests. A Caesarean section was more likely to cause harm than using the forceps.'
In her evidence Thampi added: 'I appreciate the effects that a traumatic birth can have on a mother and baby. I am very sorry that Patient A had the birthing experience that she did and I have reflected on this deeply.
'It was undoubtedly a tense and difficult delivery and one that I will always remember. I found it truly upsetting to hear Patient A's evidence. I would never wish for any patient to feel the way Patient A feels about her birthing experience. I am very sorry.'
She denied making the comment about it being 'after six o'clock' saying she was contractually obliged to be at work until 7pm. The panel agreed with that assertion but found her guilty of other charges. She was cleared of misconduct charges relating to two other women.
MPTS chair Mrs Tehniat Watson said: 'Whilst the conduct involved one patient a significant number of years ago, the failure to obtain informed consent, Patient A being pressurised into agreeing to a forceps delivery, and inappropriate communication were serious matters and action is needed to mark the seriousness to uphold the wider public interest.'
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