Doctor ‘Gave 23 Times The Normal Dose Of Drug To Dying Babies’

A Scottish consultant was yesterday accused of giving a massive dose of a paralysing drug to two terminally-ill babies to hasten their deaths in an act that was “tantamount to euthanasia”.

A hearing of the General Medical Council (GMC) in Manchester was told that Dr Michael Munro, who worked in the neonatal unit at Aberdeen’s Maternity Hospital, gave 23 times the normal dose of a muscle relaxant drug to the two premature babies before they died.

The consultant neonatologist was also accused of failing to record his actions in the medical notes of either child and concealing his use of the drug during an investigation after colleagues raised concerns with health authorities.

Dr Munro, 41, is appearing before the fitness to practise panel of the GMC following an investigation into the deaths of two babies at the maternity hospital in 2005. If found guilty, he could be struck off the medical register.

The first child, identified only as “Baby Y”, died in the summer of 2005. The second, “Baby X” – previously named as Lewis Anderson, whose parents Neil and Susan live in Aberdeen – died in December of the same year. He was more than three months premature when he died.

Dr Munro is alleged to have hastened the deaths of the two infants by administering pancuronium, a drug which is used with general anaesthesia in surgery. The drug is also a component of the lethal injection used in some US states to execute death row prisoners.

Outlining the case for the GMC, Andrew Long told the hearing: “Dr Munro administered a muscle relaxant drug called pancuronium to both babies, which stopped them breathing and hastened their death.

“These primary facts are admitted and indeed Dr Munro admits his conduct was outside accepted professional practice; but Dr Munro does not accept that it was inappropriate, contrary to guidelines or below the standard expected of a medical practitioner. The GMC asserts that it was all of these things and tantamount to a form of euthanasia, even though death was inevitable.”

The hearing was told that Baby X had suffered a brain haemorrhage and the decision was taken to withdraw treatment after his condition worsened.

Shortly after 11:30am on 20 December, the baby’s breathing tube was removed and doctors began a course of morphine to ease the child’s suffering.

As Baby X became weak, he began to struggle to breathe – a normal consequence of treatment withdrawal and a condition known as agonal gasping.

Dr Munro told Baby X’s parents he could give the child a drug, but “it was on the verge of what society finds acceptable”, the hearing was told. He then injected the child with 2,000mg of the drug which, he admits, hastened the death of Baby X.

Colleagues raised doubts about the treatment and an investigation was launched into the doctor’s actions.

Despite telling investigators he had never before administered pancuronium, the inquiry discovered he had injected a second child with the muscle relaxant six months earlier.

Mr Long explained that Baby Y had been born two weeks premature on 20 June, 2005, suffering from pulmonary hypoplasia and pulmonary hypotension. The child needed help breathing and again, following consultation with the family, the decision was made to withdraw care.

Mr Long said: “At about 8:30pm, care was discontinued and the child was started on a morphine injection and was then given to his parents to nurse while his life ebbed away. In the terminal phase of life the child began gasping. This can be painful and distressing for both parents and staff to see.”

Dr Munro instructed a nurse to get a phial of pancuronium and he administered a dose to the child. The doctor admitted he failed to note in the child’s medical records that he had administered the drug. Mr Long, however, stressed that neither set of parents was unhappy with the doctor’s treatment of their children.

Expert witness Professor Neil Marlow said he believed Dr Munro had been acting from the “highest possible motives”. He added part of the medical guidelines regarding treatment of children in circumstances similar to these was contradictory.

Dr Munro’s decision to administer the drug also allowed the children to die with peace and calm, said Prof Marlow.

Dr Munro, who has not been suspended from his post by NHS Grampian, denies that his conduct was below standard, dishonest or inappropriate.

The hearing, which is expected to last several days, continues.

NHS Grampian launched a four-month investigation into the deaths after concerns were raised, in consultation with the procurator-fiscal, but no legal action was taken.

Pain and suffering place medics in a serious dilemma

THE Munro case sheds new light on the difficult line doctors have to tread when dealing with terminally ill patients.

On the face of it, the laws concerning euthanasia are straight forward: it is illegal to help anyone to die, no matter how much they ask or the degree of pain they are in.

However, within the medical world, the concept of “double effect” brings doctors, as is shown by the Munro case, perilously close to breaking the law.

This occurs where, faced with a patient who is in terrible suffering with no prospect of recovery, a doctor can choose to act in a way which primarily eases that person’s pain, but with the knowledge that a likely outcome is that the patient will die.

Thus, as in the current case of Dr Munro, a physician could increase the amount of pain-killer in the full knowledge that while it will relieve suffering, it will also interfere with the patient’s ability to breath and may bring about death.

While the distinction between causing somebody to die and having them die as a result of other treatment has strength as a defence in law, it has been viewed by some as a “distinction without a difference”.

According to Glasgow University professor Sheila McLean, the law on ending life has to be clarified. Prof McLean said: “The law seems to be upholding the sanctity of life and yet at the same time can turn a blind eye to helping people to die.

If we are going to say that we must keep people alive no matter what, it would outlaw so many practices.”

Stressing that she was not advocating the legalisation of euthanasia, Prof McLean said that doctors were being left to work in a “terrible situation” because of the lack of clarity.

“I would not be surprised if there were a lot of GPs who are upset that this case has come to court, and who say that this is something that happens and it has to be managed”, she said.

The General Medical Council (GMC) offers guidance on the “withholding and withdrawing life-prolonging treatments”.

The GMC acknowledges that while doctors have a “responsibility to make the care of their patients their first concern” there were some cases where they faced a situation in which treatment “may simply prolong the dying process and cause unnecessary distress to the patient”.