Surgery decision taken far too late, expert tells inquiry

THE TREATMENT of a Dublin woman who was admitted to hospital with a bowel obstruction and died five days later amounted to a “serious falling short” in standards, it has been claimed.

Colette Donohoe (54), from Crumlin, died four years ago from multiple organ failure, sepsis and severe infectious colitis in St James’ Hospital. The family claims there was neglect in her treatment.

The locum consultant surgeon in charge of her care, Dr Javaid Ahmad Butt, is now the subject of a fitness to practise inquiry by the Medical Council.

He faces five allegations of professional misconduct including failing to arrange adequate treatment for the patient’s bowel obstruction, failing to arrange adequate monitoring of her, failing to arrange timely surgical intervention and failing to keep adequate medical records. He denies the allegations.

Giving evidence on the second day of the hearing, expert witness Dr Anthony Peel said the decision to operate on Ms Donohoe, which was taken on the day she died, was “far too late” and the chance of a successful outcome was “severely marginalised”.

Had surgery occurred two days previously, she would have been in a much better physiological state to withstand surgery and it would also have dealt with the infection in the small bowel which contributed to her death, he explained.

Ms Donohoe was admitted to St James’ Hospital on Thursday, August 17th and died on Tuesday, August 22nd, 2006.

Counsel for the Medical Council JP McDowell asked Dr Peel if the decision not to carry out surgery until the afternoon of the 22nd was a “marginal falling short or a serious falling short”.

Dr Peel responded: “It was a serious falling short because the aim of conservative treatment in hospital is to pre-empt complications and resolve the small bowel obstruction.” Dr Peel, a consultant surgeon in St Bart’s Hospital, London, said the conservative treatment of small bowel obstruction, which was treatment short of surgery, was “hard work” and the patients involved needed constant monitoring.

He said the failure to monitor her urine levels to see if the small bowel obstruction was resolving itself rendered the initial tests as meaningless. He also criticised the absence of any notes from Saturday morning August 19th until 4pm on the day before she died as entirely unacceptable. He said Ms Donohoe’s symptoms, which included vomiting green bile and tenderness in the abdominal area on the day before she died, should have resulted in an immediate CT scan and surgery afterwards.

Dr Peel said it was the responsibility of the consultant in charge to ensure his team or the on-call team provided him with up-to-date information that progress was being made and if progress was not being made “he does the appropriate investigation”.

Registrar Dr Devesh Singh, who was on call on the weekend before Ms Donohoe died, said he could not recall her as a patient and would only have done so had her case being unusual which he said it wasn’t. The inquiry continues.