An A&E doctor told a medical hearing he is not culpable for failing to stop a psychotic woman leaving hospital just hours before she killed her two-year-old son.
Dr Clement Agbatar claims he did not know Melanie Ruddell was suffering from acute psychosis when he examined her at University Hospital of Hartlepool, and could not force her to stay.
Mrs Ruddell discharged herself and later that night strangled and stabbed her son Christy at her brother’s home in West Rainton.
She then drove to Peterlee Police Station and walked in carrying the toddler’s lifeless body.
Mrs Ruddell, formerly of Castle Eden, pleaded guilty to manslaughter on the grounds of diminished responsibility in February 2011 and was detained under the Mental Health Act.
A 2012 inquest ruled Christy had been unlawfully killed by his mother, but Sunderland Coroner Derek Winter questioned how she was ever allowed to discharge herself from hospital on August 8, 2010.
Dr Agbatar is now facing allegations of misconduct at a fitness to practise hearing at the Medical Practitioners Tribunal Service in Manchester, where he is representing himself.
The General Medical Council, represented by Nigel Grundy, say Dr Agbatar - who has since retired from North Tees and Hartlepool NHS Trust - should have ensured Mrs Ruddell was examined by the crisis team and sectioned.
But making submissions over the telephone at yesterday’s hearing the medic denied any wrongdoing.
Dr Agbatar said: “I had made up my mind, gauging the note and the answers she gave to my questioning, that she was absolutely medically correct at the time I was examining her and therefore, based on that I could not possibly force her to stay.
“She may have been psychotic after she left the hospital, but at that moment I was talking to her she was not and I could not possibly force her to stay against her will.
“It would have constituted an assault.”
But the GMC say he did make a diagnosis of psychosis and had referred Mrs Ruddell to the crisis team.
Mr Grundy said he is now trying “to row back as far as he can” from a diagnosis or a recognition of psychotic symptoms.
He added: “The reason why he is doing this is because he knows what he should have done as a response to that.
“He knows that he should not have let her go, which is the key to this case.”
It is alleged that the doctor failed to take into account the information available from police or the ambulance record, failed to properly assess the patient and failed to record a diagnosis.
The GMC say that he should have ensured Mrs Ruddell - referred to during the hearing as Patient M - was assessed by the crisis team and sectioned after she presented at A&E suffering from delusions and hallucinations.
The panel heard that an expert report commissioned by the GMC concluded that Dr Agbatar’s conduct ‘fell seriously below that expected of a reasonably competent associate specialist in accident and emergency medicine’.
Dr Agbatar denies all of the charges against him.
He is also facing allegations relating to another woman, known only as Patient A, who he treated at the Hartlepool hospital in September 2010 after she was assaulted by her ex-partner.
It is said that the doctor failed to recognise the abnormality of her low blood sugar and tachycardia, seek a medical opinion or refer her to the physicians - he denies the charges.
The panel, chaired by Dr Susan O’Connor, retired yesterday to determine the facts of the case.
If they find any of the allegations found proved they will then go on to consider if the doctor’s fitness to practise is impaired by reason of misconduct.
If they find against the doctor he could face being struck off the medical register.
The hearing, which is expected to last until April 4, continues.