Court doubts postmortem 2

There was no evidence whatsoever. 

What you need to know:

  • The judge stated that on the evidence of the defense pathologist, court exercised its discretion not to believe the postmortem report because of the missing gaps highlighted.

It is not uncommon that patients die while undergoing surgical interventions and some of these deaths have been directly attributed to the procedure of the anaesthesia or even the effects of the drug administered.

 Anaesthetic deaths
These deaths are what are known as anaesthetic deaths. It is, however, not true that for a death to qualify as an anesthetic death the patient must have died while on the operating table.

Not all deaths that occur during or after a surgical operation are anaesthetic deaths. Some of the deaths may inevitably result from the injury or complications of the condition for which the patient is undergoing the surgical procedure especially during emergency surgery.  

And it came to be that when a student who was in his Senior Four vacation died in the ward in Kabarole Hospital three hours after undergoing a surgical operation for a hernia, the onus was on the court to determine if indeed the death of the student was an anaesthetic or not and accordingly apportion liability. 

Postmortem
The postmortem report classified the patient’s death as an anaesthetic dead and squarely put the blamed on the surgeon and the anaesthetist.

The circumstances and cause of death were rather obvious; the patient walked to the hospital on January 14, 2015, not to have an operation on, but to confirm that his surgery would be performed the following day, on January 15. However, the medical doctor talked the patient into having the surgical operation that day.

A local anesthetic was initially administered at the commencement of the surgery. In a turn of events a general anesthetic agent was later administered as the patient reportedly complained of a lot of pain. Shortly after the administration of general anaesthesia the patient vomited and suffered a cardiac arrest. The surgical team that operated on the patient urgently called an anaesthetist who rushed and helped resuscitate the patient. 

The operation was then completed and the patient transferred to the ward from where he died shortly after. At the postmortem examination the patient was found to have died as a result of severe lung damage attributed to the stomach contents he choked on when he vomited. 

Pathologist’s verdict 
The pathologist who carried out the postmortem examination provided expert evidence and told court that the patient should never have been given general anaesthesia for such an operation. 

The defense called in another pathologist to review the postmortem report. The pathologist told court that the postmortem report did not also describe the findings in each individual organ and that the opinion expressed in the report that that the body organs were normal was inconsistent with evidence of aspiration which is an abnormality. However in the postmortem report the weights of the lungs were recorded as 610 grammes for the right lung and 620 grammes for the left lung that the defense pathologist conceded were abnormal. 

Inconsistency 
The defense pathologist further told court that the histology findings, which was part of the postmortem report,  was inconsistent with the internal examination for one to make a conclusion of aspiration and that there were other possible explanations for the histology recorded other than hypoxia. The other explanation for the histology found in the lung included diarrhea, vomiting and bleeding.

The pathologist did not however tell court whether the histology, as found in the lung, was consistent with aspiration of the stomach contents. And much as the injury to the lungs could have been caused by diarrhea and vomiting and bleeding, it was not documented anywhere that the patient had any of these conditions.

The purpose of a postmortem examination is primarily to establish the cause of death and link it to the circumstances thereof as obtained by history. Court observed that the duty of an expert witness is to furnish the judge with the necessary scientific criteria for testing the accuracy of their conclusions so as to enable the judge or jury to form their own independent judgment by the application of these criteria to the facts proved in evidence. To court, therefore, the evidence of the pathologist who reviewed the postmortem report clearly showed there was a lot lacking in the postmortem report and that there was no scientific basis to conclude that the death was an anesthetic death.  

Court also concluded that there was no evidence whatsoever that the death was a result of the negligence of the medical team that worked in the theatre that day.
Regarding expert opinions, court has the discretion to believe or not to believe their reports.

The judge stated that on the evidence of the defense pathologist, court exercised its discretion not to believe the postmortem report because of the missing gaps highlighted.

To be continued ...
 

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