Anaesthetist’s responsibilities detailed in fatality hearing

Press, 14 July 1982, Page 5

Anaesthetist’s responsibilities detailed in fatality hearing

A senior specialist anaesthetist in Christchurch gave evidence in the District Court yesterday, in relation to a charge of manslaughter against an Australian doctor, that the anaesthetist, during an operation, was entirely responsible to ensure that the appropriate gas mixture was administered to the patient. The evidence was heard on the second day of the preliminary hearing of a charge against lan Haban McDonald, aged 56. of Brisbane. of killing Carl Lewis Gomulski. aged 11. on March 16 last year while acting as an anaesthetist, and by omitting without lawful excuse to perform a legal duty towards the boy. thereby committing manslaughter. ;

The defendant has elected trial by jury. Evidence of a further four witnesses washeard yesterday before Judge Fraser adjourned the hearing to today. The Crown alleges that the defendant caused the boy's death by a series of errors in which the boy deprived of oxygen because a carbon dioxide tap had been turned on inadvertently instead of oxygen, on the anaesthetic machine.

The boy died in Christchurch Hospital, on March 23 after having been transferred by air from Greymouth after an operation at Grey Hospital on March 16.

Mr N. W. Williamson appears with Mr P. A. Boyce for the Crown and Mr R. G. Collins, with Mr C. W. James, both of Wellington, for the defendant.

Hugh Russell Bodie, a specialist surgeon at Grey Hospital, said that before the planned appendix operation on Gomulski the defendant connected him . to the anaesthetic machine. It was the defendant's responsibility to maintain the patient in an anaesthetised state.

Dr Bodie said that upon making the incision he noticed the blood was blue, a result of being de-oxy-genated.

His initial reaction was that it was due to some abnormality of the defendant.

He stepped aside to allow the defendant to check his equipment. He could not see what the defendant did. The only thing he recalled clearly was the defendant disconnecting the mechanical ventilator and start ventilating the patient by hand. Dr Bodie asked that the end-trachael tube be checked to make sure it was in the trachea.

There was a short interval between the time the defendant began making the checks, until it became obvious to Dr J. R. West and him that corrective measures were not having the desired effect. That was when they noticed the patient was cyanosed. His skin was a d'ustv blue colour.

It’appeared that the problem related to either the tube being in the wrong place, or the patient's lungs were collapsed. Dr West was asked to again check that air was entering the chest.

Dr Bodie said he then recalled the defendant saying he thought the boy's pulse was diminishing. As Dr Bodie checked the pulse, it stopped. He then began external cardiac massage, but there was no immediate improvement.

An alarm was sounded and other nurses arrived and a

trolley with emergencyequipment brought in. A cardiac monitor confirmed what they knew, that the boy's heart was not working. Dr Bodie said. The defendant continued to ventilate the patient byhand.

Dr Bodie said he was not able to tell why the cardiopulmonary resuscitation that he and the defendant were doing was making no difference to the boy's condition. "It was obvious we were in desperate straits." Dr Bodie said. A consulting physician at the hospital was then called.

A nurse, Mrs Edith Forrest. who was assisting the anaesthetic nurse, noticed that the carbon dioxide on the anaesthetic machine was turned on. The "correction" was made and within a fewseconds the boy's colour improved and after about 30 seconds a cardiac action could be felt. His pulse also resumed functioning. It was decided to continue removing the appendix. Dr Bodie said subsequent examinations indicated that the patient had suffered brain injury, but it was not possible to ascertain the severity.

It was decided to continue with ventilation of the patient, and the acting medical superintendent was notified that a misadventure had occurred in the operating theatre.

Dr Bodie said he heard the defendant tell the anaesthetic nurse that it was as though the child had been

ventilated with non-respir-able gas.

Douglas lan Chisholm, a specialist anaesthetist, in charge of the department of anaesthetics for the North Canterbury Hospital Board, detailed differences in Brit-ish-manufactured and Australian - -manufactured anaesthetic machines. He said an Australian Medishield major machine had minor differences in attachments to the Britishmade Boyle model. He said he considered the variations in the machines (depicted in photographs) in Toowoomba Hospital. Queensland, were no greater than the variations in those at Grey Hospital. The variations should present no problems to an experienced anaesthetist. It w-as part of day-to-day duties to cope with machines in different operating theatres.

Dr Chisholm said the positioning of gas meters on machines was not to any standard, but this was under review at present because of a body of opinion which considered that it would be a safety feature to have the oxygen tap on the right.

This had not yet been done, he said. Dr Chisholm said variations occurred between various countries and manufacturers. but the general basic idea was the same and could be followed by anybody with experience. Dr Chisholm said carbon dioxide was attached to some anaesthetic machines, it was not used continuously throughout an operation, but was most commonly used to

assist in the re-establishment of spontaneous respiration in a patient. Dr Chisholm said it was entirely the sponsibility during an operation to ensure that the appropriate gas mixture was administered to the patient. He considered techniques and responsibilities for anaesthetists would be the same in Australia and NewZealand.

He had not experienced anaesthetists setting the knobs for gas supply bytouch rather than by looking at them.

Dr Chisholm said that if the wrong gas control knob was inadvertently turned on he would expect the anaesthetist to discover this with checks during the operation, because of the frequency of checks of the gas flows. Dr Chisholm said that in cases of cardiac arrest, unless measures were taken no oxygen reached the blood. The brain must not be without oxygen for more than a minute, but life could continue "without intellectual capacity" if oxygen was restored after being deprived for up to about five minutes.

He said it appeared to him that the outcome of the present incident was that the patient was deprived of oxygen for a sufficient time to cause irreversible brain damage. Dr Chisholm said that upon seeing that the blood of a patient was blue, an anaesthetist should adopt instant alertness and a scheme of orderly activities to find the cause.

He then traversed the checks which he would expect to be done.