2006-11-13Staff Report 2 "By Wezi Tjaronda WINDHOEK Dr Franz Stellmacher, a senior medical practitioner from Rehoboth, was last week found guilty on one count of using the wrong method to stop bleeding on a pregnant woman whose foetus was still alive. Stellmacher was charged on two counts of performing a termination of pregnancy and using the wrong method - dilation and curettage (D&C)) - on which Willie Rousseau, the pro forma complainant, asked the committee to convict the doctor on both counts. A medical Professional Conduct Committee held an inquiry after the complainant, a Rehoboth resident Catherine Fidalgo, on whom the D&C was done, lodged a complaint of unprofessional conduct against the doctor. Fidalgo fell pregnant with an intra-uterine device (IUD) in situ. Curretage of the uterus is the scraping of the lining of the uterus. The committee headed by Advocate Richard Metcalfe found the doctor guilty of treating the patient by terminating the pregnancy instead of exploring other means such as induction. But in terms of Section 43 of the Medical and Dental Act of 2004, the committee postponed the imposition of sentence for 12 months during which Stellmacher should undergo professional development in obstetrics and gynaecology. After 12 months, the committee will meet again to review the case. Metcalfe said the committee arrived at the verdict having taken a number of factors into account, such as putting the patient at a significant risk and also significantly traumatizing her. He said the sentence was arrived at considering that Stellmacher had 40 years' experience during which period no complaints were lodged against him. Metcalfe also said Stellmacher was one of the most senior medical practitioners in the country. Expert evidence presented during the inquiry stated that performing the procedure on a patient who is 15 weeks' pregnant puts the patient at risk of more bleeding. Although evidence presented by Dr Egaria Olivier, an anaesthetist, said the patient was in an emergency condition because she was in a Class 3 blood loss, meaning she was closer to becoming terminal and could lose her life, others had it that it was not advisable to proceed with the procedure on a patient whose condition was already compromised. Experts said rather than perform a D&C, the doctor could have tried other means to stop the patient from bleeding, such as inducing labour. Stellmacher said in his testimony he opted for a D&C as the easiest way out for a patient. And although experts said the procedure was a major cause of haemorrhage, it was a common way of arresting uterine bleeding. ""The procedure was done under general anaesthetic and if I opted for other means, like induction of labour, it would have been more painful. In this case, to induce a woman who knew that she would lose her baby would have had psychological effects on her,"" he said. He also argued that had the patient not had the procedure, there was a possibility the uterus was going to explode with haemorrhage. ""I removed that which was the threat to the woman's life which was bleeding from the placenta which could have cost her life,"" he added. The doctor said he was proud of what he had done to protect the woman's life and was shocked when the council became involved. ""I was accused of killing her (Figaldo's) baby and/or being an abortionist,"" Stellmacher said, adding that as far as he was concerned, he wanted to preserve the life of the mother, who has a husband and two children. ""I practised foresight and intervened as soon as possible as prevention is better than cure,"" he added. Rousseau said in his concluding remarks the defendant would have been concerned about the life of the foetus and should not have performed a D&C without exhausting all other means such as conservative treatment of bed rest or induction of labour. Even if the patient had presented placenta praevia, which Dr Michael Roberts, an obstetrician and gynaecologist disputed as unlikely before a gestation period of 28 weeks, Rousseau said there was the possibility the patient could have carried the full term of the pregnancy, which means that her condition did not pose any emergency. Fidalgo consulted two doctors before she saw Dr Stellmacher, who diagnosed placenta praevia and performed a D&C on May 7, 2004. Although Stellmacher observed that the procedure had stopped the bleeding, which Fidalgo presented in her pregnancy, the bleeding persisted and Fidalgo underwent another D&C at Katutura Hospital later in September that year. A pathology report said the patient had products of conception in her uterus, which could have come from an incomplete abortion." 2006-11-13Staff Report 2
