KZN Health challenges Smith claim

2016-06-22 12:30
Isabella Smith (84) describes the burning pain she experienced after being given a drink of Formalin in Grey’s Hospital after an operation.

Isabella Smith (84) describes the burning pain she experienced after being given a drink of Formalin in Grey’s Hospital after an operation. (Ian Carbutt, The Witness)

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Pietermaritzburg - There is no evidence that former Grey’s Hospital patient Isabella Smith (84) was injured as a result of swallowing formalin in 2010.

That’s according to a senior doctor in the KZN health services who told a high court judge this based on medical and nursing reports.

Dr Douglas Wilson, head of the medicine department for Grey’s and Edendale hospitals, gave evidence yesterday before Judge Graham Lopes in the case in which Smith is suing the KZN Health Department for just over R1 million for medical negligence.

She alleges that her life was “ruined” when she was accidentally given formalin instead of water to drink by anaesthetist Christella Alphonsus after undergoing a knee replacement operation at Grey’s Hospital on May 5, 2010.

Alphonsus admitted in her evidence last week that she did give Smith formalin to drink by mistake, but said Smith only took a “sip”.

Smith’s evidence was that she “gulped” the liquid and started screaming due to the pain and burning in her nose, mouth, throat and stomach immediately afterwards. She suffered from nausea, vomiting and ongoing pain. She has not been able to eat solid food ever since and is suffering from depression.

A clinical psychologist who testified on her behalf said she is suffering from chronic Post Traumatic Stress Disorder.

Wilson, who testified yesterday on behalf of the department, prepared various reports after being asked for information regarding the incident.

He told the judge that he did not personally examine Smith but based his findings on the various medical and nursing records at his disposal.

He testified that formalin ingestion is extremely rare. In fact, Smith’s case was the first and only one he had ever come across and so little is known about it.

Formalin is an aqueous solution of 30% to 50% formaldehyde which typically contains 15% of methanol as a stabiliser, he said. It is widely used in industry but medically is used to preserve tissue specimens.

Wilson said, based on what he has read, that ingesting formalin could cause injury to the “gastrointestinal mucosa, nausea, vomiting, pain, bleeding and perforation”.

Ingestion could result in “metabolic acidosis” (or high acidity), central nervous system depression and coma, respiratory distress and renal failure.

However, in his evidence he said he believed the effects would depend on the concentration of the formalin ingested. The formalin used in hospitals is a “10% buffered solution”.

Under cross examination by advocate Rocky Ramdass (for Smith), he admitted he is not an expert and did not know precisely what that meant but said he believed it meant the concentration of the active ingredient, formaldehyde, was “less”.

“Mrs Smith experienced nausea and vomiting in the immediate post-operative period, which may have been caused by formalin ingestion or fentanyl given with the epidural anaesthetic,” he said in his report.

According to his report “blood gas” tests carried out in the wake of the incident showed that her blood was “normal”.

He also said it had been noted on the medical and nursing records that Smith was “tolerating well orally” after the incident. No pain was noted when she swallowed and her ability to eat did not appear to be compromised, he stated.

No central nervous system depression or coma had developed and Smith was able to respond throughout her hospital stay to nurses.

Wilson testified that he had found all of this to be “reassuring” and confirmed his view that there was no evidence in the records that she was injured by formalin ingestion.

Smith was discharged from Grey’s on June 9, 2010.

Asked why she spent some five weeks in hospital instead of three days, Wilson put this down to various other medical conditions she suffered from which required extensive tests, including problems with her heart.

He also testified that immediately after she swallowed the formalin, Smith was appropriately treated by being given milk and activated charcoal to drink. “There is no antidote for formalin ingestion … These are the recommended immediate measures when formalin is ingested,” he said. A drug was prescribed for nausea and as no further features of formalin toxicity developed subsequently further treatment was not required.

The case will continue tomorrow.

Read more on:    pietermaritzburg  |  health  |  court

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