Tricky pregnancy termination case ends with a double judgement

AFTER three days of scrutiny in front of a panel appointed to decide whether or not his termination of a pregnancy two years ago was appropriate, Rehoboth doctor Franz Stellmacher was yesterday found guilty on one of two charges.

Stellmacher has acknowledged that on May 7 2004, he performed a dilation and curettage (D&C) procedure on then 27-year-old Catherine Fidalgo, terminating a 15-week pregnancy. Fidalgo subsequently laid a complaint of unprofessional conduct against Stellmacher with the Medical Board of Namibia.She alleged that he had not performed the operation properly, as four months after the procedure, remains of the foetus were allegedly still found inside her.During the inquiry, questions were raised as to whether specimens provided by the woman were in fact “retained products of conception”, and whether Dr Stellmacher had been too hasty to proceed with a D&C procedure.Speaking in his own defence yesterday, Stellmacher said he was proud of what he had done on that day, and that he still believed it was the correct procedure.Fidalgo had become pregnant in January 2004, despite an intra-uterine device she had inserted earlier as a contraceptive.Not long after, she consulted her family doctor, William De Klerk, as she was experiencing pain and vaginal bleeding.De Klerk testified on Wednesday that he had booked Fidalgo off work and later admitted her to hospital, but was unable to determine the cause of the bleeding.She subsequently went to see a gynaecologist in Windhoek, but still the cause of her bleeding remained a mystery.Fidalgo said on Tuesday that she then decided to consult Stellmacher, who had a reputation at the town as a veteran medical practitioner “who knows what he is doing”.Stellmacher has practised medicine at Rehoboth for 40 years.He was able to make a positive diagnosis, he says, that she had a condition known as “placenta praevia”, which is a leading cause of vaginal bleeding in pregnant women.This, Stellmacher said, could have led to excessive bleeding later on, and he decided to do a D&C in order to save the mother’s life.The operation, he says, was a success.He said yesterday that following the operation Fidalgo stopped bleeding, and he confirmed this by staying with her for 10 minutes after the operation.He also maintained that he had completely cleared the woman’s womb and that repeated checks were done to make sure of this.The biggest contention to Stellmacher’s chosen procedure came from gynaecologist Dr Michael Roberts, who on Wednesday said a D&C should not be done after the 12th week of pregnancy, as happened in this case.Roberts argued that the condition “placenta praevia” was not likely to be diagnosed until the 28th week.He felt that the amount of bleeding in Fidalgo’s case was not life threatening.He suggested that Stellmacher should have waited until a natural miscarriage was imminent, and that he should then have induced labour by chemical means.On Tuesday, Fidalgo testified that soon after she was discharged from hospital, she found small pieces of “bone” while urinating.After going back to Stellmacher, he allegedly told her that what she had experienced was normal after this type of operation, and gave her antibiotics.In September that year, however, she says she was bleeding profusely, and again noticed the same “bone-like” tissue.A piece of this tissue was handed in at the inquiry as evidence, and up to yesterday Stellmacher had disputed that this could have been “retained products of conception”.The six-member panel, consisting of members of the public, medical and legal practitioners, yesterday found Stellmacher guilty of treating his patient improperly, and contended that during the operation he exposed Fidalgo to excessive bleeding that could have been avoided.He had placed her at significant risk, the panel argued.Counting in Stellmacher’s favour, however, was the fact that he has never before in his 40-year career been found guilty of malpractice, and is considered one of the most senior doctors in his area, panellist Richard Metcalfe said.The panel thus postponed the imposition of a penalty or suspension for a period of 12 months, within which time Stellmacher will have to undergo 20 hours of obstetrics training.The panel’s decision is however not final, and will have to be ratified by the Medical Council before being accepted.Fidalgo subsequently laid a complaint of unprofessional conduct against Stellmacher with the Medical Board of Namibia.She alleged that he had not performed the operation properly, as four months after the procedure, remains of the foetus were allegedly still found inside her.During the inquiry, questions were raised as to whether specimens provided by the woman were in fact “retained products of conception”, and whether Dr Stellmacher had been too hasty to proceed with a D&C procedure.Speaking in his own defence yesterday, Stellmacher said he was proud of what he had done on that day, and that he still believed it was the correct procedure.Fidalgo had become pregnant in January 2004, despite an intra-uterine device she had inserted earlier as a contraceptive.Not long after, she consulted her family doctor, William De Klerk, as she was experiencing pain and vaginal bleeding.De Klerk testified on Wednesday that he had booked Fidalgo off work and later admitted her to hospital, but was unable to determine the cause of the bleeding.She subsequently went to see a gynaecologist in Windhoek, but still the cause of her bleeding remained a mystery.Fidalgo said on Tuesday that she then decided to consult Stellmacher, who had a reputation at the town as a veteran medical practitioner “who knows what he is doing”.Stellmacher has practised medicine at Rehoboth for 40 years.He was able to make a positive diagnosis, he says, that she had a condition known as “placenta praevia”, which is a leading cause of vaginal bleeding in pregnant women.This, Stellmacher said, could have led to excessive bleeding later on, and he decided to do a D&C in order to save the mother’s life.The operation, he says, was a success.He said yesterday that following the operation Fidalgo stopped bleeding, and he confirmed this by staying with her for 10 minutes after the operation.He also maintained that he had completely cleared the woman’s womb and that repeated checks were done to make sure of this.The biggest contention to Stellmacher’s chosen procedure came from gynaecologist Dr Michael Roberts, who on Wednesday said a D&C should not be done after the 12th week of pregnancy, as happened in this case.Roberts argued that the condition “placenta praevia” was not likely to be diagnosed until the 28th week.He felt that the amount of bleeding in Fidalgo’s case was not life threatening.He suggested that Stellmacher should have waited until a natural miscarriage was imminent, and that he should then have induced labour by chemical means.On Tuesday, Fidalgo testified that soon after she was discharged from hospital, she found small pieces of “bone” while urinating.After going back to Stellmacher, he allegedly told her that what she had experienced was normal after this type of operation, and gave her antibiotics.In September that year, however, she says she was bleeding profusely, and again noticed the same “bone-like” tissue.A piece of this tissue was handed in at the inquiry as evidence, and up to yesterday Stellmacher had disputed that this could have been “retained products of conception”.The six-member panel, consisting of members of the public, medical and legal practitioners, yesterday found Stellmacher guilty of treating his patient improperly, and contended that during the operation he exposed Fidalgo to excessive bleeding that could have been avoided.He had placed her at significant risk, the panel argued.Counting in Stellmacher’s favour, however, was the fact that he has never before in his 40-year career been found guilty of malpractice, and is considered one of the most senior doctors in his area, panellist Richard Metcalfe said.The panel thus postponed the imposition of a penalty or suspension for a period of 12 months, within which time Stellmacher will have to undergo 20 hours of obstetrics training.The panel’s decision is however not final, and will have to be ratified by the Medical Council before being accepted.