Surgeon should have checked X-rays, hearing told

THE SURGEON who removed a healthy kidney from an eight-year-old boy should have checked the X-rays when he saw the kidney was not diseased, an expert witness told a fitness-to-practise hearing yesterday.

Robert Wheeler, a consultant paediatric surgeon and expert witness for the Irish Medical Council, also said when the boy’s parents raised their concerns about which kidney was to be removed it should have been “a red flag” to the surgeon.

The boy was being treated at Our Lady’s Hospital for Sick Children in Crumlin, Dublin in March 2008 when the operation took place. He was under the care of consultant paediatric surgeon Prof Martin Corbally. A junior doctor then on his team, Sri Paran, carried out the surgery.

Prof Corbally made an erroneous note on the child’s file stating that his left kidney should be removed, when it was the right kidney that was diseased.

Moments before their son went into theatre, Jennifer Stewart and Oliver Conroy told Mr Paran they were worried there had been a mistake. Mr Paran checked the boy’s file, read that the left kidney was to be removed, and proceeded on that basis.

Once surgery had begun, he saw that the left kidney looked healthy, checked the notes again, and removed it. He did not check the X-rays, which were under the trolley in the theatre.

Mr Wheeler told the fitness-to-practise committee that when a doubt was raised by anybody about an organ being removed, it should lead to a “pause for thought”. “I think the parents’ concern is a real red flag,” he said.

When Mr Paran saw the healthy kidney he should have stopped and looked at the images, Mr Wheeler said. Surgeons were trained to deal with the unexpected.

“Just because you start something doesn’t mean you have to finish it,” he said.

Eileen Brannigan, counsel for Prof Corbally, said her client would say he could not fully explain the error he made in the boy’s notes. It was possible he was given incorrect information by a nurse who he asked to check a computer for the boy’s records, or he may have made a transcript error himself. There was “human error” in the process, Ms Brannigan said.

She said the professor had “delegated” the operation to Mr Paran, and assumed he would look at the X-rays before operating.

But Charles Meenan, counsel for Mr Paran, said his client did not know he was going to perform the operation until five minutes before the event. Mr Wheeler conceded that if this was the case, it was “undesirable” and “too short a time”.

Mr Meenan asked Mr Wheeler whether, as a consultant, he would delegate the removal of a kidney to a junior doctor. Mr Wheeler said he would not. “I would be at the operating table,” he said.

Mr Meenan said on the day in question, Mr Paran had been working in theatre seven, and had gone to theatre five where the boy was because he had “10 minutes to spare”. The anaesthetist had asked him to catheterise the patient, and he did so. He also positioned him on his side.

Prof Corbally had then asked him: “Are you happy to get on with it?” Mr Meenan said, and then pointed to where Mr Paran was to make the incision.

Mr Wheeler agreed this was not “a fulsome delegation” of responsibility for the operation.

He also conceded it could be difficult for a doctor in training in some hospitals “to speak out”, though, he clarified, he was not referring to Crumlin hospital when he said that.

The medical council made 15 allegations of misconduct against Prof Corbally and 13 against Mr Paran. But following an application by Ms Barrington, seven charges against Prof Corbally were dropped.

One charge against Mr Paran was dropped.

The case continues today.