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Postoperative care of deteriorating patient in private hospital following abdominal surgery (06HDC13334)
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(06HDC13334, 30 April
2008)
Surgeon ~ Senior house officer ~ Private hospital ~
Laparoscopic surgery ~ Responsibility of private hospital ~
Postoperative care ~ Pain relief ~ Deteriorating patient ~
Communication ~ Competence review ~ Credentialling ~ Rights 4(1),
4(5)
A man complained about the postoperative care provided by a
private hospital to his wife, who had had abdominal problems in the
past. The woman consulted a surgeon, to whom she had been referred
on previous occasions, with abdominal pain, nausea and anorexia. In
the absence of a definite diagnosis, the surgeon discussed the need
for a diagnostic laparoscopy. Accordingly, an exploratory
laparoscopy was organised to include a probable appendicectomy and
a cholecystectomy.
After the surgery, the woman's condition deteriorated. Nursing
staff caring for her were concerned about her condition and on
several occasions notified the surgeon. Despite emergency surgery
and aggressive management from intensive care units in two
hospitals, the woman died a few days after the initial surgery.
The private hospital stated that concerns expressed about the
surgeon's practice prior to the woman's operation had not reached a
level where it was appropriate to take action to restrict his
practice.
It was held that the surgeon breached Rights 4(1) and 4(5), as
he failed to provide services with reasonable care and skill, and
failed to co-operate with the nursing staff to ensure quality and
continuity of care. The senior house officer on duty on the night
the woman's condition worsened was held to have failed to assess
the woman in person when called, and failed to provide services
with reasonable care and skill, consequently breaching Right
4(1).
It was held that the private hospital took reasonable actions in
the circumstances to credential the surgeon and ensure that he was
competent to practise - noting, however, that the Medical Council's
competence review process is no substitute for a rigorous
credentialling process. Accordingly, the private hospital did not
breach the Code.
The surgeon was referred to the Director of Proceedings, who
decided not to issue proceedings.