DENTAL SURGERY DEATH Coroner Comments On Procedures

Press, Volume CIX, Issue 31987, 14 May 1969, Page 32

DENTAL SURGERY DEATH Coroner Comments On Procedures

(Xew Zealand Press Association?

WELLINGTON, May 13.

Two standard dental procedures were commented on by the Wellington Coroner (Mr J. Meltzer) at an inquest today on a woman who died in a Porirua dental surgery in January from heart failure while under anaesthetic.

The Coroner raised two issues before delivering his finding on the death of Colleen Ann Chinnery, aged 29, a Porirua housewife. These were the practice of dentists relying merely on the word of the patient as to previous medical history—a matter of concern in deciding the safety of administering an anaesthetic—and the practice of administering intravenous injections in a dentist’s chair to a patient in a sitting position.

The Coroner said he felt justified in making his comments so that the New Zealand Dental Association which was represented by an observer at the inquest, could take such steps as it considered proper in the public in-1 terest

“Nothing 1 say is intended to be a reflection on the dentist or the anaesthetist immediately concerned,” he said

“Nor do I trust anything 1 say will alarm the public or shake their confidence in a profession that is respected and admired by our society. “My comments arise from the addendum to the evidence given by Dr Alexander, a fully qualified and experienced pathologist. First I' stress Dr Alexander’s state-! ment that he was reassured; after his inquiries that the: anaesthetic used was proper \ for the purpose and was ad-; ministered in a correct man-i ner and dosage. i Medical History “He refers, however, to two : points that are of consider-; able importance. Stated! briefly, they raise two issues.! First, the existing practice! of dentists, who are about to make extractions, relying: merely on the word of the patient as to their previous! medical history, and thei second, the administration of intravenous anaesthetics by’ dentists to patients while in a sitting position. “On the first point it is clear that the deceased did; not disclose the truth of her medical history to the dentist.! Had she done so it is presumed the present tradgedy may not have occurred. "The underlying influence I take from Dr Alexander's ; evidence is that the Dental: Association may feel that a| further look is desirable at: existing practice in this connection.

“While 1 appreciate the difficulties from a practical point of view of requiring a doctor’s certificate in every case before intravenous anaesthetic is administered, I feel I have discharged my duty by drawing attention to this matter.”'

On the question of intravenous injections to a patient in a sitting position, the Coroner said Dr Alexander had stated that it was entirely in accord with standard practice in the dental profession. Dr Alexander had pointed out that many medically qualified anaesthetists regarded the administration of an

intravenous anaesthetic agent to a seated patient as undesirable practice.

Cardiac Arrest

“I am certainly not compeitent to express any views on this statement,” the Coroner I said. “It may be that there 'is some authority that would dispute this contention. That ' such a statement has been made is, however, surely justification for my bringing it to the notice of the Dental Association for examination.” The Coroner's finding was that the deceased died on January 23 at the dental surgery of Hall and Easterbrook, Porirua, from cardiac arrest ! during anaesthesia administered for the extraction of •teeth.

Raymond Oliver Brown, a dental surgeon, of Porirua, isaid that on October 18, 1968, IMrs Chinnery called for a ! dental examination and requested extraction of all her teeth.

I He had not treated her before.

She also mentioned that, she ;wanted the teeth to .be ex- ! tracted under a general ! anaesthetic.

: “As a matter of course, I questioned her about her general health, and she told me that she suffered from a bad ! heart and that she had at'tended the hypertension clinic of the Wellington Hospital,” Mr Brown said. “I therefore considered that she was a bad risk for treatment under general anaesthetic, and I decided not to do the extractions myself but to refer her to the dental department of the Wellington Public Hospital.” - No Illness j David Roger Cain, a dentist with Hall and Easteri brook, said in his deposition, .which was read in his absence, that Mrs Chinnery came to the clinic on January 16 and spoke of having 'her teeth extracted. “She told me at that time that she had no previous serious illness, nor was she being treated by a doctor, nor was she taking any drugs.” The appointment was made I for 1 p.m. on January 23. ! “On January 23 Mrs Chinnery arrived and I could see that she appeared to be very nervous,” Mr Cain said.

The anaesthetic, sodium brietai, was administered by Mr Hall. It took five to seven minutes to remove the teeth. The extraction was normal

as was the recovery. Mr Hall left the surgery. “All of a sudden, and for no apparent reason, she started to turn blue and at the same time she seemed to stop breathing,” Mr Cain said.

Measures were undertaken to alleviate this. Mr Hall administered a cardiac stimulant. Mouth-to-mouth resuscitation was attempted. I Highly Nervous William Emil Hall, dental surgeon, said Mrs Chinnery was highly nervous but she went smoothly to sleep. He said he administered 60mg of the anaesthetic initially and during the operation three increments of 20mg. Mrs Chinnery had never been given an anesthetic at his surgery before. William Stewart Alexander, pathologist at Lower Hutt, said in his post-mortem report that he found the deceased had suffered from a bad heart condition. Dr Alexander said he ascertained that the agent used for the anaesthetic was proper for the purpose and was administered in a correct manner and dosage. “Inquiries prior to administration as to her general health were of a routine and superficial character, but I am informed that Mrs Chinnery, when asked, denied any present treatment or disability and the matter was not more extensively pursued,” he said.

Dr Alexander said he had found that the deceased had earlier been to Mr Brown and Dr Cable, director of the hospital dental service. “I am told that Dr Cable advised that the teeth should be removed but that full inpatient conditions should be observed,” he said. “Mrs Chinnery left to think it over, and apparently presented herself to Mr Hall’s rooms within a day or so. “It would appear that she may have been tempted to conceal her medical history in order to avoid the necessity of the elaborate precautions advised.

“I have investigated the circumstances of administration of intravenous anaesthetics by dental surgeons, and I find in the present case the dental surgeon, of aboveaverage training and experience in this procedure, administered an anaesthetic in a manner entirely in accord with standard practice in the dental profession.

“It should be pointed out, however, that many medically qualified anaesthetists regard the administration of an intravenous anaesthetic agent to a seated patient as undesirable practice. “The absence of a medical examination, including both history and physical examination, before a general anaesthetic is also an undesirable feature of these dental administrations.

“It must be conceded that the woman would have really needed an electro-cardiogram to show the true state of affairs.”

Remanded Again.— Patrick Joseph Byrne, aged 74, retired seaman, of the Home of Compassion, Silverstream, was further remanded until May 27 when he appeared in the Upper Hutt Magistrate's Court yesterday. He is charged with the murder of John Fergus Fahey on April 25 at Silverstream.—(P.A.)