FATAL TONSIL OPERATION

Evening Star, Issue 22681, 22 June 1937, Page 3

FATAL TONSIL OPERATION

CORONER REFERS PAPERS TO MEDICAL BOARD DISSATISFIED WITH PRECAUTIONS TAKEN [X’ek United Phess Association.] AUCKLAND, June 21. Dissatisfaction with the precautions taken by a medical practitioner in performing an operation for the removal of tonsils was expressed by the city coroner (Mr F. K. Hunt, S.M.) at the inquest touching the death on June 2 of Doreen Lily Baton, aged 17£ years, under an anaesthetic at the surgery of Dr Albert Arthur Huso. The coroner stated that in his opinion another qualified medical" man should have been in attendance, and he proposed to bring the matter under the notice of the Medical Board. Dr Gilmour, who performed a post mortem examination, stated that, apart from unhealthy tonsils and adenoids, the organs of the girl’s body were healthy. Death in his opinion was due to asphyxia caused by the action of the aiuesthctic on the respiratory centre of the brain. In reply to the coroner he said that the removal of tonsils from an adult was considered to be a major operation, and the person performing the operation should have a properly qualified assistant. He thought it was usual to put a case of that kind into hospital He was of the opinion that the patient in this case died from anaesthesia. The need for the presence of a second medical man arose out of the possibility of an emergency, such as haemorrhage. He bad known of patients succumbing as in this case even when there were two duly qualified medical men in attendance. t Dr Hnse, a duly/qualified and registered medical practitioner, stated that on June 1 he had been called to a patient in Mauukau road. Her tonsils were much swollen and she had great difficulty in breathing. He arranged for her to visit his surgery the following morning to have her tonsils removed. The Coroner: Why didn’t you send her to hospital ? Witness: I am a duly qualified man and I usually leave it to the patient whether the operation should be performed in a hospital or in my surgery. You agree that this is a major operation P—Yes. Why didn’t you call in another medical man?—T think there was no work for two medical men, as the administering of the ether and the operation wore separate, and two men could not work at one time. Witness said there were present at the operation his nurse (who was not registered). himself, and a Air Aleuli (an endocrinologist). Witness administered the anaesthetic, and the patient started struggling violently, and had to bo hold by Air Aleuli and the nurse. Immediately the patient quietened down she became cyanoscd, and the pulse and breathing stopped. The anaesthetic had been stopped before the pulse and breathing ceased. She had been swallowing pus from the tonsils, and witness felt that the severe exertion in struggling had caused her heart to give out. He did not believe the patient died of anaesthesia. He felt that in the method used in this case the patient got such an abundance of air that death from anaesthesia could only result from an overdose of the anaesthetic; but in the open method, in which the patient got free air, it was practically impossible to give an overdose. Dr Gilmour (recalled) stated that all the appearances of the body were those caused by death from asphyxia, and not by death from heart failure. There was no obstruction to the air passages to, account for asphyxia. It was not usual for such operations to be performed without the assistance of a qualified medical man, except in cases of emergency. Catherine Wilkins (the nurse in Dr Huse’s rurgerv) and Percy Aleuli (endocrinologist) also gave evidence. “ I have held many inquests on people who have died under anaesthetics, and it is quite possible this was a pure accident,” stated the coroner, “ but 1 am not at ail satisfied that this girl was properly treated. I think Dr Huso should not have attempted such an operation without the assistance of a properly qualified man. He had no such assistance, just an unregistered nurse and a man who had no medical experience whatever, exe,ept through a correspondence school. I find that the cause of death was asphyxia caused by the action of ether on the respiratory centre of the brain. After hearing the evidence I am not satisfied it was a justifiable thing for Dr Huse to perform such an operation as tonsilectomy on an adult without a properly qualified assistant being available. This is a. major operation, and an emergency such as haemorrhage might occur, requiring the assistance of .another qualified man. This should have been known to Dr Huso, and I therefore propose to scud to the Afedical Council these depositions so that it can take such action as it thinks is called for.”