Death following anaesthesia: Court passes its judgment

One ground for the acquittal was that the patient’s primary doctor, the doctor who examined the patient and planned for the operation, was not physically present in the operating room when the surgery was being carried out. He had called a foreign doctor to carry out the operation and the foreign doctor left the country immediately after the death of the patient.
The professional body that investigated this death held the patient’s primary doctor responsible for her death. Not so, stated court. The court’s reasoning was that none of the members of the investigating team was a laparoscopic surgeon and that the team had failed to co-opt one during the investigations.
Court, however, refused to see that this was not a death due to the process of laparoscopy but a death following anaesthesia, about which there was no dispute. The professional body was in total agreement with the fact that the patient died due to the improper administration of anaesthesia.

The other reason was that to court the cause of death of the patient was not clear. To the two pathologists who carried out the post-mortem, the death of the patient was due to the insertion of the endo-tracheal tube into the oesophagus of the patient instead of the trachea. The evidence of this was the considerable amount of blood found in the patient’s stomach.
Court again refused to address its mind to this crucial piece of forensic evidence. There was simply no other explanation for this finding. Another important piece of forensic evidence was found on the request for the post-mortem that the doctors who operated on the patient sent to the pathologists; the patient’s heart had gradually slowed down before she died. This usually occurs when the anaesthesia given to a patient is inadequate. And this is the case when the tube is wrongly inserted.

The pathologist told court that the patient’s death was consistent with intra-operative neurogenic cardiac arrest and associated gastritis. The professional body’s representative told court that the patient’s death was an anesthetic accident. To court these were two very different causes of death and therefore raised doubt as to what the true cause of death was. In reality these were one and the same thing said in different words.
Court apparently chose to believe the anaesthetist when he testified that in his entire career he had successfully administered anaesthesia to many patients and that the patient could not have been alive on the operating table for 20 minutes.
There was, however, no independent proof that the patient was indeed alive on the operating table for 20 minutes. The only proof was that a small incision was made into the abdomen and that there was only time enough to touch the inner lining of the abdomen. These could not have taken 20 minutes.

Standard procedure
Doctors usually take history as part of their work. This is not to bias them but rather guide them. They then compare their findings with the history given to them and make the appropriate conclusions. In this particular case, the foreign doctor had pointed out to the wrong insertion of the tube into the oesophagus of the patient. Court, however, ruled that this was hearsay evidence.
The reason the surgeons gave for carrying out the operation was that the patient was infertile. Infertility is only medically diagnosed in a couple that have been having unprotected sex at least three times in a week for one year. There was no proof that the patient was married and had a regular sexual partner.

And furthermore before fibroids are removed from a woman’s uterus with the aim of managing infertility, the doctor must make sure that the woman is ovulating well and that her fallopian tubes are not blocked. None of these tests were carried out on the patient.
Laparoscopic surgery to remove fibroids can only be performed when the fibroid is less than eight centimetres in size. At post-mortem, the pathologists found that the fibroid was 15 centimetres in size, double the recommended size for this operation.

Possible error
Laparoscopic surgery to remove fibroids can only be performed when the fibroid is less than eight centimetres in size. At post-mortem, the pathologists found that the fibroid was 15 centimetres in size, double the recommended size for this operation.