Expert witness critical of Cape Breton gynecologist

An expert hired by the College of Physicians and Surgeons of Nova Scotia says a Cape Breton gynecologist gave incomplete and overly negative information to a woman who was in the midst of delivering her first child.

The expert, Dr. Joshua Pulsky, testified this week that Dr. Manivasan Moodley kept "borderline illegible" notes on his actions and did not meet the standard of patient-centric care.

Moodley, who practises in Cape Breton, is facing three complaints of professional misconduct from three different women. The college began a hearing into the complaints in August, when all three women told their version of events. 

The hearing resumed Wednesday in Bedford, N.S., to hear expert opinion evidence from Pulsky, a gynecologist from Windsor, Ont., who was asked to review the evidence in the cases.

The issue in the first complaint was an episiotomy, a medical procedure that involves making an incision to provide more space for the baby's head during delivery. A woman testified in the summer that she expressly told Moodley she did not want an episiotomy unless her baby was in danger. Pulsky said it was his opinion, based on a review of the evidence, that the baby was not in danger during delivery.

Pulsky testified that the procedure should only be performed if the patient consents and said Moodley appears to have relied on inaccurate statistics to defend his decision to perform the procedure.

Pulsky said by using figures that greatly exaggerated the risk of complications without the episiotomy, Moodley showed a lack of knowledge.

"The patient could get the idea there was more of a risk than there was," Pulsky testified.

He noted that Moodley only started making notes after he learned the patient had complained about the care she received during childbirth.

The second case involved a Cape Breton woman in a high-risk pregnancy. She was admitted to hospital complaining of abdominal and back pain that persisted over several hours. The woman and her partner testified that they felt she was in labour and that Moodley wouldn't listen to them. Their son was born prematurely with health difficulties.

Pulsky's assessment of Moodley's handling of this case was more nuanced. He said it's hard to judge whether Moodley missed earlier signs of labour. But he said when the pain persisted as long as it did, Moodley should have considered the possibility it was in fact labour pains.

Pulsky was subjected to a tough cross-examination Thursday by Moodley's lawyer, Muneeza Sheikh, over the third case. It involved a 21-year-old woman who had gone to Moodley to ask about a tubal ligation, a permanent form of birth control. Moodley discouraged the woman from getting the procedure, a position that Pulsky said violated the woman's right to autonomy in making her decision.

But under Sheikh's cross-examination, Pulsky admitted he took at face value the complaints from the three women. He said he was following instructions in a letter from the college that retained him for his analysis.

"How is your report objective, neutral and unbiased?" Sheikh asked.

"I see the issue," Pulsky replied.

Sheikh referred Pulsky to the transcript of an interview the woman gave to the college as it conducted its investigation into the complaints against Moodley. In the transcript, the woman said Moodley discussed alternative methods of birth control, but she said she wasn't interested in any of them.

Pulsky said he had not seen that transcript before Sheikh pointed it out to him. He said it shows Moodley did provide options to the woman.

Scheduling has proven to be a considerable challenge for this hearing. The sessions this week were held only to hear from Pulsky. Testimony from Moodley and closing arguments from the lawyers isn't expected to happen for months.