Evidence on patient with broken leg

Press, Volume CXIV, Issue 33534, 15 May 1974, Page 14

Evidence on patient with broken leg

(New Zealand Press Association)

AUCKLAND, May 14.

An associate of Dr Milan Brych told the cancer inquiry today that she thought Dr Brych was joking when he telephoned and threatened to call the police to a woman cancer patient who had been lying for two days with a broken leg and was not attended to by an orthopaedic surgeon.

Dr Helen Wood said that although the patient did not receive orthopaedic attention until four days after her admission, she was being well looked after during that period and was being given painkilling drugs.

Dr Wood said that after being told of Dr Brych’s telephone call by a ward sister, she did not summon an orthopaedic surgeon because the woman was Dr Brych’s patient and she was under the impression he had already been in touch with a surgeon. Evidence about the incident was put before the inquiry this afternoon at the request of the authority conducting the inquiry. Professor R. D. Wright, of Melbourne. FILE DIFFERENCE Mr K. Ryan, representing Dr Brych, drew Professor Wright’s attention to a difference between photocopies of the patient’s medical file produced as evidence, and the original file which was subsequently produced on Mr Ryan’s insistence. The file contained notes <iade by the nursing sister at the time the patient was admitted. Mr Ryan pointed out that the bottom line of the document did not appear on the photocopy. Part of the line omitted read; “Please notify orthopaedic surgeon in the morning.” Earlier, Dr R. Burton, head of the radiotherapy department, to which the woman was admitted on Sun-

day, April 28, gave evidence that the patient had been treated by Dr Brych a week earlier with the cancer drug cyclophosphamide. NURSING CARE The woman’s broken leg was an “inevitable” result of her cancer, and her immediate need was nursing care. “Most people like this never had any orthopaedic attention because they are regarded as beyond it,” Dr Burton said. “It is common for them to have only nursing care for the last few weeks of their life.” Dr Burton said he offered to give the woman radiotherapy treatment, but she declined.

The patient was operated on by an orthopaedic surgeon only on Monday (May 13) Dr Burton said, but this interval of a fortnight since her admission did not surprise him because it would have given the patient more time to recover from the effects of her chemotherapy. Questioned by Mr Ryan, Dr Burton said he was quite unaware that on Tuesday after the woman was admitted, Dr Brych had made out a written requisition for an orthopaedic surgeon. TIME FACTOR Requisitions of this sort tended to be pigeonholed for some time and it was inevitable they would take about 36 hours to be delivered to the orthopaedic department, even if, as in this case, they were marked “urgent.” Professor Wright asked Dr Brych why, after the patient had been admitted on April 28, he had not telephoned the orthopaedic surgeon himself.

Dr Brych replied that he had not been on duty at the time. He had in fact been taking “five minutes escape” while accompanying Professor Wright on a visit to Auckland Hospital in relation to the inquiry.

The woman’s case was classed as "urgent.” Dr Brych said, and this meant that a requisition form was in order. For "immediate” cases he would personally seek the orthopaedic surgeon, and attention was usually given without delay. Earlier, Professor J. G. Buchanan, associate professor of haematology at Auckland Medical School, told the inquiry that he personally

would have suspended Dr Brych’s treatment programme in December, 1972 —- the time when it was approved for expansion by the hospital board and the .DirectorGeneral of Health (Dr H. J. H. Hiddlestone).

Professor Buchanan was asked by ,Mr C. R. Pidgeon, representing the hospital board, whether, in view of the active animosity that in Dr Burton’s view existed between the radiotherapy department and the haematology department, it would not have been extremely unwise to have appointed a haematologist to take part in the survey. Professor Buchanan said he disagreed. OWN CASES Answering another question, Professor Buchanan said he could recall only one patient being referred from his department for chemotherapy treatment in the radiotherapy department during the last two years. The haematology department usually treated the patients itself.

Cross-examined by Mr Ryan, Professor Buchanan said the haematology department had stopped referring patients to the . radiotherapy department because of uncertainties about the treatment being used there, and because the haematology department’s treatment was better.