Not guilty verdict in FGM case - what do we think?

I would have thought that, in an inner London hospital, FGM should be pretty high up on the list of subjects that any member of staff in oby/gyn should be fully briefed and educated in?

Caillin - from the Guardian report linked to upthread, it sounds like his workload that day was enormous - he was needed to attend to an emergency CS immediately after, did what he genuinely (if mistakenly) believed to be the best repair he could at the time, then afterwards, when he had a moment to think about it, realised it probably wasn't the best course of action and raised it with a supervisor.

When I was a student I rememebr a mentor saying that a confident, experienced practitioner will reflect in practise, so at the time but a less experienced person will reflect on practise, so afterwards.

Sounds like he was still at the stage of reflecting on practise. Which may well have been exacerbated by working in a busy labour ward and feeling under pressure to be at another emergency.

Ive see senior registrars who are incompetent at more basic stuff than an unusual tear so this doesn't suprise me that a junior reg might have struggled here. If he'd taken a few minutes to think this through there may have been a different outcome, but that doesn't warrent prosecution.

What I'm saying is, he might not be au fait with FGM (although as a doctor with any interest in obs, lack of knowledge of FGM seems ridiculous to me) but he would be able to see with his own eyes the state the woman's vulva was in, and I would expect a competent doctor to deal with the immediate emergency and then go about solving the more long term issue of the labial damage, rather than just sticking a stitch in and moving on. I know he alerted his supervisor at a later stage but still it seems very odd that he didn't consider the whole issue serious enough at the time to warrant immediate and proper treatment.

But Viva, don't you think it's odd that rather than doing what you described, which is what the normal approach to a typical labial tear would be, he just stitched the infibulation back together? It seems odd for a doctor to see an obviously poorly stitched wound, to open it, as necessary, and to then just close that poor stitched wound again rather than going about repairing the old wound (or at least packing the wound to help stop bleeding until a further consult could be obtained).

It seems sloppy and unprofessional to me.

I'm sure he did know how to repair a normal labial tear. It sounds to me like he didn't know the legalities about resuturing an FGM lady. So he should have put some stitches in one labia on one side. Then with a new thread stitched the other side to stop any bleeding. Instead it sounds like he sewed them back together.

The hospital should have covered this on induction if it's an area with a high rate of FGM which it sounds like it is.

It's weird that being a consultant you would call a junior reg (who was very shortly afterwards promoted to a senior reg - so clearly not new to the game) a "very junior doctor." I would consider an FY1 or FY2 to be "very junior." I would also expect someone who's working as a junior reg in obs to know something about the injuries they could encounter (given they will be required to stitch vaginal/labial tears) and what to do in those circumstances.
I would consider understanding of how to stop labial bleeding, no matter what the cause, to be very basic knowledge for an obs doctor. I had labial damage having my DS and the midwife did the stitching. I'd find it very odd for a junior reg not to have that knowledge, such that he simply closes up an old area of scar tissue.

Calinndana I do know what a junior reg is being a consultant myself. Thanks for the patronising explanation.

Most of that 5 years post medical school wouldn't even have been in Obs & Gynae, and in many parts of the country you can practice quite happily and never meet anyone with FGM. How to deal with FGM is far from basic knowledge, given there are specialist clinics for it.

There is vast quantities of hospital policy and procedure I have never read, and even if I have read I've forgotten. To say he should have read the hospital policy is a cop out on the part of the hospital to cover up the fact they hadn't trained or supported their junior effectively.

From what has been reported it sounds as though it was a total over-reaction. As someone said above there are grounds here for re-training and a slap on the wrist. The doc in question was professional enough to admit he was totally sure he had done the right thing and asked for advice.
It feels a little like he's been punished for this.

To be clear, I think this case was an entirely political move on the part of the CPS and that this doctor was unfairly targeted. That said, he did do the wrong thing and should have had a mild slap on the wrist for not being up to date on what to do to best serve his patients.

It just seems very sad - I can't see how this sort of case would've been the main intention of the law. As far as I can tell from what I read, it was accepted that there was no intention on his part to conduct an illegal procedure, nor did the woman feel that anything illegal or unwanted was done to her and yet it still got this far.

Very glad he and she can now, hopefully, get on with their lives.

I did read that he had denied a couple of motions to dismiss, or something - does anyone know why? I'm assuming that these were offers to let him off if he admitted some degree of guilt and that's why he refused.

The woman came in in obstructed labour.
She suffered significant birth injury due to the pre-existing FGM.
The doctor saved her baby's life.
He sutured her to stop serious bleeding.
He was worried about whether he had done the correct procedure and later asked his consultant to review the case. The consultant agreed that he had acted correctly to save baby and mother.

This is a case of a soft target being prosecuted for political reasons.
Luckily the jury saw that.

The doctor is still suspended and has to face a GMC enquiry.
This is every HCP's worst nightmare.

I can't see that he did anything but his best for the mother and baby at the time.

Especially horrendous because he raised it with his supervisor, realised there may have been an issue and there was an internal inquiry that highlighted the problems in the woman's treatment (both antenatal and during the birth) and measures were put in place to increase training etc.

The CPS strikes again, was listening on radio this morning and was just eyes rolling, case dismissed in 30 mins, yet person from CPS going on about its up to the Jury to make a decision and they have a different criteria to what we have. Presenter goes on to read criteria that shows that this shouldn't have proceeded from the start. The CPS person then goes on about how difficult its going to be to get a true case.

Do females in the UK not attend smears etc so there is no real surveillance or are GPS aware of it and its not escalated?

I feel really sorry for the Dr. Sounds like he was hung out to dry by the hospital who were the ones who reported him to the police.

He was a junior Reg, junior Regs should have the support of a senior Reg. He had quite probably only had two years of specalist obstetric training at SHO level.

He was very new to the Whittingdon and had never seen any FGM before. It's quite possible if he came from an area with no FGM that it hadn't crossed his mind as something he needed to know about. Where I work ive never seen a black woman on the labour ward, never mind a black woman that's come from Africa and actually had FGM.

Sounds to me it was a busy shift, no support from the senior reg. The article says he had to rush from this woman to an emergency section. So I imagine the senior reg was tied up with the other woman who ended up with the section. Sounds to me he treated it like he would any tear and stitched it back to how it was before childbirth.

It's horrendous that this came to trial.

What do you mean Bonsoir? If someone comes into hospital with a particular medical history that means they require specialist care, surely midwives and doctors should be responsible for providing that care? FGM is a previous injury, which the doctors didn't create but which they are required to take into account when treating a patient. They can't just ignore it.

He wasn't a very junior doctor Kundry, he was a junior registrar, which is an old fashioned term which means he would have had at least 5 years training post medical school and was working towards becoming an obs consultant. A junior registrar can work alone without supervision, which means that someone working at that level should be fully aware of important practices like those surrounding FGM. He admitted himself he hadn't read the hospital guidance.

The more I think about it, the more outrageous I think it is to make British midwives or doctors in any way responsible for FGM.

I'm glad he has been let off but I'm also glad that it's in the media. I hope this does mean massive training all round. I thought it was unfair to blame the midwives too as we don't actually know if they saw her do we? I didn't have any vaginal exams and if she dind't tell them about the FGM how would they know?

This case is utterly outrageous.

Obviously it is not an ideal scenario, but so very many things about the gynecological history, pregnancy and labour of this woman were not ideal that it seems extraordinary to pinpoint the ignorance of procedure (not failings) of a doctor who was acting in good faith to save her life in pressurized circumstances.

Which is franly racist - brown doctor with a funny name, oh yes he must do FGM.

A moment's thought would have shown the co-accused (a relation of the woman) was Somali and Muslim while he was Sri Lankan and Hindu. They shared no cultural background at all and there is no culture of FGM in Sri Lanka.