An anaesthetist accused of doing too little to control the pain a woman felt during caesarean surgery has been cleared of misconduct.

But he should have been more "situationally aware" -- such as when the woman kicked the surgeon when the incision into her uterus began and had to have her legs held down by nursing assistants.

"These are matters which the tribunal considers Dr N should have been aware of," the Health Practitioners Disciplinary Tribunal said in its verdict, made public today.

This fell short of the expected standard, but not far enough to warrant a finding of misconduct. Others in the theatre could have alerted the anaesthetist if they were concerned by the woman's pain and discomfort.


The prosecutor -- the Health and Disability Commissioner's director of proceedings -- has appealed against the dismissal of the charge. The tribunal suppressed the anaesthetist's name.

The woman, "Mrs S", now a mother of two, was giving birth to her first child, a healthy son, in February 2013. A normal delivery was planned but it progressed to a medical induction, a non-reassuring fetal heart trace and then caesarean done with epidural anaesthesia.

Mrs S said she told the anaesthetist the surgery was hurting but he assured her she was feeling pressure, not pain. She heard questions about pain relief, to which the anaesthetist replied, "it would be over soon anyway".

Her husband, Mr S, said she repeatedly told him she was hurting. He asked the anaesthetist if she could have something for her pain, but Dr N told the woman he had given her enough pain relief.

Under questioning, however, Mr S said that although he caught Dr N's eye, he could not fully recall if he had verbalised the request for more pain relief as a whole sentence.

"The tribunal understands that Mrs S may have been experiencing pain; but the critical question is how this was verbalised or communicated. That pain may have been communicated by her to Mr S, her husband, or to [surgeon] Dr A or to ... [midwife Rosemary] Johnson or to ... [then-student midwife Birgit] Mitchell."

The question was how much of this was communicated to or understood by Dr N as the anaesthetist, the decision said.

"The tribunal accepts Dr N's evidence that, had there been communicated to him significant concerns about pain, he would have remembered these and he would have done something about them."

" ... there is insufficient evidence that any of the other persons in the surgery who may have heard Mrs S complain of pain conveyed this to Dr N in a sufficiently compelling way for him to have considered conferring with Mrs S to agree on a change to the analgesic plan."