Questions remained unanswered over operation—detective

Press, 9 October 1987, Page 9

Questions remained unanswered over operation—detective

Questions remained unanswered over a minor surgical operation at Ashburton Hospital which led to a woman’s death, the Christchurch coroner, Mr Neil Mac Lean, was told yesterday. Detective . Senior-Ser-geant Mike Muddiman was giving evidence on the opening day of an inquest into the death of a Rangiora woman, Nancy Ruth Hendrie, on July 13 — four days after the surgery.

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He said the anaesthetist, Mr John Louw, who is also the superintendent of Ashburton Hospital, told him he did not know why Mrs Hendrie suffered a cardiac arrest during the surgery. Mr Louw declined to give further details once the Christchurch C. 1.8. began the investigation, Detective Senior-Sergeant Muddiman said. The coroner heard evidence that Mrs Hendrie, aged 53, had suffered breathing problems during surgery on her hand and for tennis elbow. Detective Senior-Ser-geant Muddiman said that during the inquiry it became apparent a number of issues relating to the operation needed to be answered. Mr Louw’s report of the surgery did not disclose for how long the patient was ventilated, although it was obvious she was having respiratory difficulties, he said. He said he questioned the level of Halothane, which is mixed with oxygen and nitrous gas to keep a patient asleep, being given to Mrs Hendrie. He said the investigation showed the Halothane was turned down 15 minutes into the surgery when recommended medical practice indicated a reduction after five minutes. A blood pressure cuff, used as a safety device when a patient was having problems, was not used, and there appeared to be no evidence of continual physical monitoring of the patient by touching the arteries, he said. There was also no evidence whether the alarm systems on the automatic anaesthetic machine were switched on or off, he said. Mr Louw also left the operating theatre during the surgery to get a music tape to play on the theatre tape recorder, he said. Detective Senior-Ser-geant Muddiman said Mrs Hendrie had gone to Ashburton Hospital because of a long waiting list at Christchurch Hospital. She was admitted to Ashburton Hospital on July 8 and was to have surgery the next morning performed by an Ashbur-

ton surgeon, Mr John Macdonald. On the morning of the operation Mrs Hendrie was relaxed and happy. She was given pre-op medication at 8.45 a.m. and taken to a room adjacent to the operating theatre at 8.55 a.m. Her blood pressure was recorded as normal. She was taken into the operating theatre at 9 a.m., where the anaesthetic nurse, Hildegard O’Brien, had checked the equipment and prepared the machinery for the anaesthetist. Mr Louw then rechecked the equipment and administered suxamethonium, a paralysing drug, thiopentone, a sleeping drug and atropine, a heart stimulant. After the anaesthetic was applied Mrs Hendrie was slow to respond to breathing by herself. Detective Senior-Ser-geant Muddiman said there was a lack of detail surrounding the time, although it was believed Mrs Hendrie had to be assisted to breath by either an automatic or hand ventilator for 20 to 25 minutes. At 9.20 a.m. the operation began, and at 9.30 a.m. Mr Louw left the theatre to get a music tape to play on the theatre tape recorder from a locker about 30 to 60 seconds from the theatre. Detective Senior-Ser-geant Muddiman said it was believed Mr Louw was away from the theatre for one minute or less. Staff Nurse O’Brien said she advised Mr Louw before he left that the ventilation bag was shallow and Mrs Hendrie was not responding, he said. At 9.35 a.m. Nurse O’Brien left the theatre to blow her nose. She was absent for about two minutes. During this time, Mr Louw noticed the patient was in difficulty and at 9.40 a.m. he alerted the surgeon that something was wrong. The cover was removed from the patient’s head and it was noticed she was hypoxic, a grey-blue colour. Emergency treatment was begun immediately, but the patient had no

pulse from 9.40 a.m. to 10 a.m., when there was some response and a return of pink to the face. t The operation was completed and Mrs Hendrie was taken to intensive care. Mrs Hendrie was transferred to Christchurch Hospital intensive-care unit the next day. She failed to respond to treatment and on July 13 a life support system was removed and Mrs Hendrie died.

Dr Trevor Cook, an anaesthetist at Ashburton Hospital, said he was asked by Mr Louw to care for Mrs Hendrie when she reached intensive care. He thought Mr Louw told him the patient had had a cardiac arrest. Dr Cook said that from Mr Louw’s notes the premedication given to Mrs Hendrie was standard and the drugs administered were not of abnormal doses. Dr Cook said he would not have given the patient Atropine, because he did not believe Mrs Hendrie’s age or the dose of suxmethonium would induce slowing of the heart. Dr Cook said the dose of the vapour Halothane, of 2 per cent,, would have been all right if she had been breathing normally. “However, if she was being mechanically ventilated, 2 per cent is excessive. Half a per cent to a maximum of 1 per cent would have been sufficent,” he said. Dr Cook said he had had difficulty interpreting Mr Louw’s notes relating to the administration of gases and vapour. Under cross-examina-tion by Mr Brian McCleß land Q.C., counsel for the family, Dr Cook said it was not his practise to leave the operating theatre while a patient was anaesthetised although there was no hard or fast rule. If he did have to leave it was his duty to ensure that the patient was properly cared for, he said. Dr Cook said he always monitored his patients while they were under anaesthetic. He said he did not know why Mrs Hendrie had had a cardiac arrest during surgery. Dr Cook agreed that the

equipment used was in perfect working order and could not be’ responsible for Mrs Hendrie’s death if it was properly used. He also agreed that her death could not have been caused by an. allergy to the medication used, otherwise she would have had an adverse reaction a lot earlier. When Mr McClelland suggested her death had

been caused by an overdose of Halothane, Dr Cook replied that was only one possibility. Appearing for the Crown is Mr Tim Gresson, assisted by Miss Rosie Carruthers. Mr John Walker and Mr Peter Bashier appear for Mr Louw and Mr Macdonald. Mr John Brandts-Gieson appears for the Ashburton Hospital Board.