High Court confirms sanctions against anaesthetist after man suffered brain injury during surgery

The President of the High Court, Mr Justice Peter Kelly, said the courts' limited powers in applications like this under the Medical Practitioners Act where a doctor does not appeal sanctions meant his own doubts about the adequacy of the sanctions were not relevant and did not constitute a legal basis for refusing to confirm them.

The Council considered the sanction was proportionate, adequately protected the public without need to suspend Dr Deirdre Lohan Mannion and its decision addresed all relevant issues in such a way as would not justify refusing its application, he ruled.

The sanctions censure Dr Lohan Mannion and permit her to remain on the medical register and continue her private practice at Santry Sports Clinic on conditions. She must inform her employers of those but is not required to tell individual patients.

The conditions, to continue for a minumum two years, require her to complete a multi-disciplinary interactive crisis course and a professional development plan to address deficiencies in two areas of her practice - management of anaesthesia in a theatre setting and record keeping.

They arose from her care of then 46-year-old Frank Cowan at the Santry clinic in September 2014.

A lawyer and father-of-two from Clonee, Co Meath, he suffered a catastrophic hypoxic brain injury when he failed to regain consciousness after receiving an anaesthetic during elective surgery for chronic neck pain. He is now competely dependent and has to be tube fed.

Mr Cowan previously settled for €7.1m in a negligence action, brought through his wife Janette, against Dr Lohan Mannion who admitted liability.

Following a complaint by Mr Cowan's CP about his anaesthetic mangement, Dr Lohan Mannion admitted two counts of professional misconduct and five of poor professional performance before a Fitness to Practice Committee of the Medical Council.

Those included twice leaving Mr Cowan while under anaesthetic. She first left him to talk to a secretary. On the second occasion, when he had unrecordable blood pressure, she left him in the care of an anaesthetic nurse to go for a coffee.

Mr Justice Kelly said this care of Mr Cowan was subject to "devastating criticism" by Dr Anna Maria Rollin, a UK consultant anaesthetist who said leaving Mr Cowan with unrecordable blood pressure in the care of an anaesthetic nurse, when such nurses are trained to observe but not treat patients, was a serious failure to care for his safety. Dr Rollin also said Dr Lohan Mannion's failure to record the level and frequency of doses of ephedrine administered to Mr Cowan meant it was not possible to assess the overall effect of that drug.

Apart from Mr Cowan's case, the court heard Dr Lohan Mannion has never, in her 30 years as a consultant, been subject to civil litigation or any other complaint to the Medical Council in relation to her clinical care, had provided "very laudatory" testimonials from other doctors and the Santry Clinic was "fully supportive" of her.

Mr Justice Kelly said he could only refuse to confirm the proposed sanctions if he took the view no reasonable Medical Council could have decided on the sanctions and that “high threshold” had not been achieved. The court must confirm the sanction unless it sees "good reason" not to do so and the phrase "good reason" has to be given a restricted meaning.

While the sanction might be considered to be lenient or one that does not provide protection to the public as comprehensively as it might, it was not so lacking in that regard as to warrant refusal, he said.

He added he was grateful that the Council, on foot of concerns raised by him, is in correspondence with Santry Sports Clinic arising from its lack of a facility to carry out an MRI scan on the anesthetised Mr Cowan after his surgery with the result he had to be taken by ambulance to Beaumont Hospital.