WOMAN'S DEATH

Evening Post, Volume CXXXII, Issue 41, 16 August 1941, Page 7

WOMAN'S DEATH

UNDER ANAESTHESIA

CORONER HOLDS INQUIRY

AUCKLAND HOSPITAL

(P.A.) AUCKLAND, August 14. Questions concerning the manner in which an anaesthetic was administered *.o a woman were asked by the City Coroner, Miv Hunt, when an inquest was held into the death in the Auckland Hospital on July 19 of Lucy. Mary Pryer, aged 77, widow. She was admitted to the hospital on July 13 with a fractured thighbone and died under an anaesthetic. Sub-Inspector Calwell represented the police and Mr. Spence the relatives of Mrs. Pryer. Dr. Walter Gilmour, acting medical superintendent and pathologist at the hospital, said that after making a postmortem examination his opinion was that death was due to respiratory failure during anaesthesia. Dr. Donald Bartlett Gash, house surgeon, said that the deceased was taken to the operating theatre at 8.15 a.m. on July 19. Dr. Horsle'y, who was acting as anaesthetist, left while Xray "plates were being taken and shortly after 9 a.m. Mr. Garlick, a sixth-year student who had replaced her, drew his attention to the patient's condition. He ordered the necessary steps to be taken but it was not possible to resuscitate the deceased. DR. HORSLEY'S ABSENCE. Dr. Alice Horsley said she had been an honorary' anaesthetist at the hospital since 1915. After a surgeon, Dr. Selwyn Morris, had manipulated the pattent's limb, she adjusted the machine, giving the patient oxygen equivalent to atmospheric air, which was normally perfectly safe for an indefinite period. , The Coroner: Do you not think that having observed the way the patient took the anaesthetic, it would have been better for you to have remained till the operation was finished? Witness: I am sure I should have remained. My action was against the ordinary custom and rules of the hospital. • The Coroner: From what I have learned from Dr. GiJmour, it probably would not have made any difference, but I do not think it is right. . Witness stated she had hoped to be back for the major part of the operation, but when she had finished a case at the Mater Hospital a second serious case delayed her. COMPARATIVELY SMALL DOSE. Clive Garlick said he was a finalyear medical student completing his studies at the public hospital. Part of his studies included the administration of anaesthetic under the supervision of the honorary anaesthetist. The deceased's condition was gooa when Dr. Horsley left and she was being given a comparatively small anaesthetic dose. Her condition was satisfactory till about 9.15 a.m.; when suddenly her breathing changed. In spite of all efforts at resuscitation she was not revived and was pronounced dead about 9.25 a.m. Witness was fully conversant with the type of machine used and had previously administered three or four gas and oxygen anaesthesias under supervision. , "I should like to.: make it clear that while I said the cause of death was the anaesthetic, it had nothing to do -with the administration of it," stated Dr. Gilmour. "I am perfectly satisfied of that and Mr. Garlick knew how to work the machine, and had enough experience to enable him to carry on." "I felt when I heard the facts that the matter should be inquired into," said the Coroner, "and this inquiry will have its effect in the future. The cause of death was respiratory failure during anaesthesia and there is no evidence to show that the anaesthetic was improperly administered or that the woman was not under proper care." The Coroner added a rider that the attention of the Hospital Board should be drawn to the fact that the deceased, when under anaesthesia, was not under the care of an anaesthetist for the whole of the period.