Concord obstetrician/gynecologist reprimanded for role in botched post-partum care
The state Board of Medicine yesterday released a decision reprimanding a Concord obstetrician for not treating a post-partum woman who reported to the emergency room with signs of an acute infection. The patient later underwent a total hysterectomy and sued Dr. Ashish Chaudhari and midwife Jeanne Browne over the incident.
The terms of the settlements of those suits are confidential, but contain “no admission of fault, no acknowledgement of negligence,” said Chaudhari’s attorney, Peter Meyer of the firm Sulloway and Hollis.
Browne surrendered her license after this and other complaints led to an investigation by the state midwifery council.
A reprimand is the lightest public discipline the state Board of Medicine can issue, and it did so in this case after a full disciplinary hearing.
Very few cases before the board progress through a complete hearing without a settlement: Of the 659 patient complaints closed between July 1, 2011, and June 30, 2012, the board heard nine disciplinary hearings.
Chaudhari, who was a founding member of Concord Women’s Care in 2001, contested the case because he believed his actions did not warrant discipline, or at most warranted a nonpublic letter of concern, Meyer said.
“We respect the board process, but it was our view in October at the hearing, before then, and still now, that a reprimand was not the appropriate response. Dr. Chaudhari felt very strongly about his care and about why it didn’t rise to the level of public sanction. That’s why he went forward with the hearing,” Meyer said.
“This was one moment in a career, a superlative and sterling career at this point,” Meyer wrote.
Chaudhari has not had any other cases before the board, which was a mitigating factor in the decision.
The case began in April 2009, when Jennifer Middlemiss of Canterbury gave birth at home, assisted by Browne. The board called the birth uncomplicated.
Middlemiss later filed suit against Browne, alleging that the midwife failed to take proper sanitary precautions and infection control measures during the delivery. Middlemiss also alleged Browne failed to properly care for her after the birth, when she reported having a fever and abdominal pain.
Four days after giving birth, after reporting a fever and pain to Browne for three consecutive days, Middlemiss went to Concord Hospital’s emergency room.
A physician assistant there called Chaudhari, the on-call obstetrician/gynecologist. Based on preliminary lab results, Chaudhari advised the physician assistant to prescribe a pain reliever and have Middlemiss follow up at Chaudhari’s office the next morning.
When Middlemiss called the next day to schedule her appointment and no longer had a fever, she was told to follow up with her midwife and come into the doctor’s office if her temperature went higher than 101 degrees.
Two days later, Middlemiss went to the emergency room at Catholic Medical Center, which admitted her to the intensive care unit. She was transferred to Dartmouth-Hitchcock Medicaid Center for a total hysterectomy.
In his testimony before the board, Chaudhari said he was concerned about infection, but without more information, he didn’t want to misdiagnose the problem.
“His teaching said don’t treat something you don’t know – he did not want to make things worse,” reads the report of the hearing. “He indicated he simply did not have the information to work with.”
The board, however, sided with a reviewer who said he would have prescribed antibiotics based on the patient’s condition, and that Chaudhari should have gone to the ER to examine her.
“Responding . . . by walking from obstetrics to the Emergency Department to examine the patient and review the lab results would have negated the entire unfortunate outcome, and surgery more likely than not would have been avoided,” the board ruled.
“The consultant, on service call, is responsible for the care of unassigned patients without a physician whether those patients be uninsured, homeless or penniless. The board believes that the medical community is responsible for that crucial medical safety net to these patients and that Dr. Chaudhari failed to provide that crucial net to this patient.”
Chaudhari was ordered to meaningfully participate in 10 hours of continuing medical education in the areas of infectious disease and medical ethics, above and beyond what is required for license renewal.
His privileges at Concord Hospital have not changed as a result of the ruling, hospital spokeswoman Jennifer Dearborn said yesterday.
(Sarah Palermo can be reached at 369-3322 or firstname.lastname@example.org or on Twitter @SPalermoNews.)