Patient Awarded $3.8m in Claim Against Anaesthetist, but Surgeon Not Negligent

07 May 2018

sara bird

by Dr Sara Bird

Doctors confer in surgical masks

In March 2018, the Court of Appeal found an anaesthetist was negligent for failing to inform an orthopaedic surgeon to stop surgery sooner.  

At the initial Supreme Court hearing, the conduct of both the anaesthetist and the surgeon was found to be negligent, but the surgeon was successful in overturning the decision against him. This left the anaesthetist liable for the full damages of $3,828,075 plus legal costs.

The claim involved a 24 year old patient with Noonan syndrome and associated lordoscoliosis. The patient suffered worsening restrictive lung disease as a result of his scoliosis. The surgeon recommended a two-stage procedure to correct the patient's spinal deformity.

The initial procedure was successfully performed on 13 November 2009. The second stage was planned to be performed 10 days later, but the surgery was brought forward to the evening of 17 November 2009 because of increasing problems ventilating the patient in ICU. The opinion of the treating team was that the second stage needed to be performed as soon as possible, or the patient might die from his worsening respiratory problems.

The operation was expected to take four hours, commencing at 7pm, but the anaesthetist asked the surgeon to terminate the procedure at 9.25pm when the patient suffered an episode of profound cardiovascular collapse. The surgeon quickly closed the wound. The patient was turned from the prone position and his condition markedly improved. Unfortunately, the patient suffered paraplegia as a result of an ischaemic injury to his spinal cord.

The basis of the finding against the anaesthetist was that the operation should have been terminated earlier than occurred in light of deteriorating blood gas results which revealed high carbon dioxide levels.

The Court found that if the operation had been terminated earlier, the patient would not have suffered the significant cardiovascular collapse at 9.25pm which was the cause of his paraplegia. The anaesthetist had called for advice from an anaesthetic colleague and also a cardiothoracic surgeon when the patient's carbon dioxide levels continued to increase between 8pm and 9pm but it was not until the cardiovascular collapse at 9.25pm that he informed the surgeon of the need to stop the procedure. The Court found that the anaesthetist’s decision to allow the surgery to continue for 30 minutes after seeking advice from two experienced colleagues, with no success in improving the patient’s condition, was a breach of his duty of care.

The Court of Appeal upheld the surgeon's appeal because:

“[Dr G] as principal orthopaedic surgeon was entitled to rely on [Dr S] as principal anaesthetist for advice as to the anaesthetic condition of [the patient] and it was [the patient’s] anaesthetic condition that dictated the cessation of the surgery”.

Read more about this case in Defence UpdateAnaesthetist’s Negligence Leads to Costly Consequences

This blog contains general information only. We recommend you contact your medical defence organisation or insurer when you require specific advice in relation to medico-legal matters.



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