Doctor 'negligent' - specialist
2005-07-29 22:24
George - Rhoda Isabel Muller of Albertinia probably died as a result of massive haemorrhaging during a laparoscopy to repair a hiatus hernia.
This was among evidence given in Mossel Bay regional court this week by Professor Philippus Christoffel Bornman.
Bornman is head of surgical gastro-enterology in the surgical department at the University of Cape Town.
He was giving evidence for the prosecution in the hearing of Dr Hugo Prins, who has been charged with manslaughter after the death of Mrs Muller on April 22, 2002.
Prins performed the "routine operation" on Muller in Bayview Hospital in Mossel Bay on that day.
Exhibits
Bornman said that in the light of exhibits made available to him, and the evidence that had been heard already, it was his firm opinion that Muller died because of "catastrophic haemorrhaging of an injured main blood vessel which, in all probability, was the vena cava inferior".
He said the injury probably had been caused by the placing of either the Veress needle, through which carbon dioxide was placed in the abdomen, or, more probably, the placing of the first trocar, the sharp instrument through which the laparoscopy is performed.
Bornman explained the laparoscopy procedure in detail to the court, as well as the risks involved.
He pointed out that surgeons who used the "closed" method had to be aware of the fact that this was equal to "a controlled stab wound" and was a risky procedure.
The injury to the major blood vessel resulted in massive retroperitoneal haemorrhaging, which also resulted in a progressive and irreversible condition of shock.
This resulted in Muller dying within three hours of the injury to the blood vessel.
Unacceptable
Bornman said that, in his opinion, there had been an unacceptable delay in the diagnosis of the haemorrhage and to establish the cause thereof.
The result was that the action to stop the haemorrhaging was not started soon enough to save Muller's life.
He did not think Prins had acted in a manner that could have been expected of a reasonable surgeon in his position.
Bornman said this lack of action could be regarded as negligent.
The drop in the patient's blood pressure, haemoglobin count, pulse rate and absorption of oxygen in the blood would have been a sure sign that there was a massive haemorrhage.
Prins should have known that he should have opened the patient's abdomen immediately to find the cause of the haemorrhage and try to rectify it.
The stitches he placed in the peritoneum "in the vicinity of the blood vessel" had had no effect.
Aggravating
An aggravating factor was that Prins continued with the operation while being aware of Muller's unstable condition.
There was also a strong suspicion that there was haemorrhaging, but the source of the bleeding had not been established.
He said Prins' priority should have been with Muller.
He asserted that Prins' negligence resulted in Muller's death.
The hearing was postponed to January 23 2006.