SURGEON’S VIEW OF YOUTH’S TREATMENT

Press, Volume CIV, Issue 30762, 28 May 1965, Page 3

SURGEON’S VIEW OF YOUTH’S TREATMENT

(New Zealand Press Association)

AUCKLAND, May 27.

The question of whether all persons with head injuries should be seen by members of the staff of the neuro-surgical unit at Auckland Hospital was a matter which could be referred to the board with the possibility that it might institute some system, said the Coroner (Mr A. D. Copeland) at Otahuhu today.

Mr Copeland was concluding an inquest into the death of Kenneth Roy Alach, aged 17. The youth was injured when he fell front his motorcycle at New Lynn on February 16. He died in Middlemore Hospital three days later.

Mr G. D. Speight and Mr E. W. Henderson appeared for the Auckland Hospital Board. Mr L. P. Leary Q.C., with him Mr P. D. Ellis, represented the mother, Mrs Joan Alach. Senior-Sergeant R. Austin appeared for the police. David Robertson Goodfellow, acting-superintendent-dn-chief of the Auckland Hospital Board, said that in his opinion Kenneth Alach did not suffer any harm by virtue of having been transferred from Auckland to Middlemore Hospital.

Neither, in his opinion, was the patient subjected to any clinical risk by the transfer, as his condition on arrival at Middlemore did not cause the receiving medical officer any serious concern, and it was not materially different from what it had been while he was under observation at Auckland Hospital. OBSERVATION PERIOD Every patient suffering from concussion was admitted to hospital for a period of close observation, said Goodfellow.

The Auckland Hospital Board had recently approved a special new ward for the reception of head-injury patients to be established in the Auckland Hospital. The board was awaiting Health Department approval for this to be built.

Asked if it would have been better for a neuro-surgeon to have seen the youth on arrival at hospital, Goodfellow said the decision must rest with the judgment of the medical officer who first examined the patient.. “One cannot help being aware of the fact that it is very easy to be wise after the event,” said Goodfellow. With these complications he agreed it would have been wise to call a neuro-surgeon. He told Mr Speight that on the information available the house surgeon was justified, he thought, in sending the patient to Middlemore. OPERATION TIME

Donald Dixon McKenzie, a

neuro-surgeon, said he had been asked by Mrs Alach to investigate the death of her son. He had had access to hospital records and had heard the evidence.

The patient had been seen by relatively inexperienced persons all through, and the operation was performed only when he was already collapsed and irreversible changes were present. McKenzie said he believed the patient would have recovered if he had been in hands of an experienced neuro-surgeon and the operation would have taken place much earlier.

He suggested that, in the future, all head injuries in Auckland Hospital should be seen by members of the staff of the neuro-surgical units. He said he had suggested in 1953 that all head-injury cases should be seen by members of the neuro-surgical unit.

His views were known to the board.

Mr Leary said that all the case amounted to was that, in future, it would be desirable to retain such patients where

there was a neuro-surgical unit.

Mr Lean’ said he was not in Court to blame any medical man. As far as they could see everyone had done what they thought best at the time. MATTER OF JUDGMENT Mr Speight said that this was a case where the whole question was clinical judgment.

If McKenzie’s views were adopted, then neuro-surgeons at Auckland would see four cases a day. The same witness had said that there was a world-wide shortage of neurosurgeons. The hospital authorities were well aware of their responsibilities. The coroner said he appreciated that the basis on which Mrs Alach had come to the Court was to prevent this happening again. He had been pleased to hear Mr Leary say there was no reflection on the medical profession. There were 1500 concussion cases in Auckland every year. Of these only four developed acute extra-dural haemorrhage. “Is it practical to have all these 1500 cases all confined to the neuro-surgical unit at Auckland Hospital?” the Coroner asked.

The Coroner said he appreciated McKenzie's views and. as stated in the acting super-intendent-in-chief's report, that would be the ideal situation. But it was a question of whether it was practicable. It was a matter which must be left to the competent men on the Hospital Board. BUILDING DELAYS The present position had also been aggravated by the building programme at Auckland Hospital. The question of whether all head-injury cases should be seen by neuro-surgeons was a matter which could be referred to the board by Mr Speight with the possibility of instituting some system. The Coroner found that the youth died at Middlemore Hospital on March 1 from extradural haemorrhage after head injuries received when he fell off a motor-cycle.