Doctor at Letterkenny hospital couldn’t take pulse

A junior doctor working at Letterkenny General Hospital could not take a patient’s pulse, a Medical Council fitness to practise inquiry has heard.

A junior doctor working at Letterkenny General Hospital could not take a patient’s pulse, a Medical Council fitness to practise inquiry has heard.

The inquiry heard that a consultant at the hospital believed it was not safe to have 31-year-old Dr Asia Ndaga, working in the hospital and that there were concerns about her competency from the moment she joined the hospital on July 1st, 2010.

There were concerns that her medical knowledge was “weak” for a senior house officer, at the slow speed of her assessment and diagnosis of patients and about her ability to calculate drug dosages.

A clinical incident had been noted formally whereby a nurse had to show her how to certify the death of a patient and how to write up medical notes in relation to a patient transferred from Dublin.

Dr Ken Mulpeter, a consultant geriatrician at the hospital, undertook an assessment of her competency on August 18th after concerns had been raised. He took her to see a patient with chronic obstructive pulmonary disease and an irregular heartbeat and asked her to take the patient’s pulse. She tried to do this by putting her fingers “on top of the patient’s wrist” rather than underneath it and said the patient was in normal rhythm.

“I obviously got a bit of a shock with that, so I asked her to take the patient’s pulse in his feet,” said Dr Mulpeter. “She put her two fingers on areas of the foot where you would not feel a pulse.”

He said how to take a patient’s pulse was something learned in first or second year in college.

He said Dr Ndaga was unable to say how much oxygen the patient was on, something which could be read from the patient’s oxygen mask and a device on the wall.

She also did not know why the man had a barrel-shaped chest. It was an indication of lung disease but she suggested rickets.

In addition, she failed to take an adequate patient history, partly due to some language difficulties. Dr Mulpeter felt she was not competent to continue working in the hospital as a senior house officer and her contract was terminated.

Dr Ndaga, who did not turn up for the inquiry, was found guilty of poor professional performance. The fitness to practise committee will report to the full council and recommend an appropriate sanction, which was not disclosed.

The inquiry heard Dr Ndaga had not been interviewed by the hospital and the hospital did not check her references. Pat Murray, human resources manager at the hospital, said this was because she was interviewed by the Royal College of Physicians of Ireland as part of a central recruitment process and allocated to the hospital as part of the college’s training scheme. He understood she did not get a post in the initial round of offers from the college but was on “a reserve list” used when all training posts had not been filled.

Dr Ndaga qualified in Romania in 2008 and was registered by the council in March 2009. Solicitor JP McDowell, for the council, told the inquiry it was not clear whether she had worked in Ireland before getting the Letterkenny job. However, Mr Murray said when he spoke to her about her performance, she indicated this was her first job in Ireland.

Dr Mulpeter said in evidence that “at the time we had some difficulty in recruiting doctors, so there was an expectation that the doctors might not be as strong as in previous years”. Staff were therefore prepared to supervise them more closely. He said it might be expected she would need time to get up to speed on the Irish hospital system but his major concern was her competency. He did not consider it safe to have her working in the hospital.

Mr McDowell said initially a firm of solicitors had engaged with the council on her behalf, claiming the assessment of her skills by Dr Mulpeter lasted only five minutes and that he looked down on foreign doctors, an accusation denied by Dr Mulpeter and Mr Murray.