Doctor faces formal review over preterm birth

A Wollongong Hospital obstetrician has been referred to the Health Care Complaints Commission for failing to discuss the resuscitation of an extremely premature baby with his parents, leaving the child to die 30 minutes after birth, an inquest heard.

Senior obstetrics registrar Dr Robert Wanat now faces investigation over the birth of baby Ty Lacey, after a coroner found he had overridden the parents' right to determine the fate of their child.

Ty was born to couple Myliss and Philip Lacey on February 15, 2010 after just 24 weeks gestation.

Ty's twin brother Cruz had died in utero.

Unaware of what to expect with a stillborn child, Mrs Lacey delivered Cruz and quickly became highly distressed at his appearance.

She was then forced to give birth to Ty, holding the tiny child for just 30 minutes before he died.

A four-day inquest found the parents had been robbed of the opportunity to discuss resuscitation, despite clearly expressing their wish for everything possible to be done to save their son's life.

Deputy State Coroner Ian Guy said Dr Wanat had not consulted the parents about resuscitation - with devastating results.

"The inquest has emphatically shown, contrary to an apparent hospital investigation, that on the day Ty was born, there was no [discussion or] agreement with the parents that there would be no resuscitation," he said.

"There was a significant risk Ty would not survive and if he did, a very significant risk of severe disability, but neither outcome was inevitable.

"By the treating doctor not supporting the parents' wishes, Mr and Mrs Lacey were denied, in the most tragic of circumstances, the chance for Ty they so desperately wanted."

During Mrs Lacey's labour, Dr Wanat phoned another doctor from Sydney's Royal Hospital for Women, who advised that Ty had a poor prognosis but made it clear the doctor needed to discuss all the options with the family.

According to Mr Lacey, when Dr Wanat returned, he simply said: "I am so sorry ... we are not going to do a C-section and I have been told not to help ... he is just not going to make it ..."

Mrs Lacey asked Dr Wanat to help Ty after the birth, to which he merely replied: "I'm sorry."

"What was to come was the most horrific and heartbreaking experience I have ever had to endure," Mr Lacey said. "To watch my son try to breathe and hold on to life while he slowly turned blue in the face; it was devastating."

Mr Guy yesterday slammed Dr Wanat's conduct in failing to explain the available options, describing his decision to ignore the Laceys' wishes as a "major and fundamental failing [of] care".

The inquest was told Dr Wanat had since shown a concerning lack of insight into his actions, with the coroner noting the distinct lack of candour in his evidence.

Mrs Lacey discovered she was pregnant with twin boys in October 2009 but soon became concerned about the growth discrepancy between the babies.

On January 27, 2010, the parents learned the babies had developed twin-to-twin transfer syndrome, a condition resulting in an abnormal exchange of blood, and were referred to the Royal Hospital for Women.

Surgery was planned but soon abandoned when doctors discovered baby Cruz had died in utero.

The couple then had extensive discussions about the risks for the surviving twin and whether there should be resuscitation if Ty was born at less than 26 weeks' gestation.

Mr Guy said a management plan, indicating the couple did not want resuscitation, was not intended to be binding and was always open to discussion and change.

Delivering his findings, Mr Guy recommended the health minister consider creating a guideline for treatment of premature babies, including an informed plan and advice about parents' rights regarding resuscitation. He also recommended educating parents about what to expect if a baby is stillborn or not given resuscitation.