Baby wrongly injected during scan at Nepean Hospital

Channel 9 news has reported that baby Declan was injected with the wrong medication whilst undergoing a routine CT scan at Sydney’s Nepean Hospital.

An emergency department doctor accidentally administered 12mg of intravenous Suxamethonium instead of administering 12mg of Ketamine to the baby.

Declan stopped breathing for 90 seconds and turned blue. The Director of the Emergency Department met with the parents that day and apologised.

Suxamethonium is a short acting depolarising neuromuscular blocking agent (NMB). It essentially causes short-term paralysis and is used as sedation/relaxation in anaesthesia.

    • Endotracheal intubation.
    • Endoscopic examination.
    • Orthopaedic manipulations.
    • Short surgical procedures.

There are numerous guidelines regarding the administration of this drug in hospitals in Australia. Equipment for intubation and ventilation must be available. It should only be given when a person experienced in endotracheal intubation is present. It should not be administered to a conscious patient.

Dr William Mooney ENT and Cosmetic Surgeon under investigation

It has been reported in the media, that celebrity nose job doctor William Mooney is under investigation by the coroner in relation to the deaths of 2 patients.

Dr Mooney boasts on his website that not only is he “Australia’s leading ENT, specialising in Facial Plastic Surgery” but also  “Sydney’s Premiere Rhinoplasty Surgeon.” He has clinics in Bondi Junction and Bankstown, and founded Face Plus Medispa, on Bondi Beach, a day spa offering beauty treatments.

Patient Death: East Sydney Private Hospital

The Sydney Morning Herald reported on 2 March 2018, that Alex “Little Al” Taouil, a feared standover man and a close associate of bikies and Melbourne identity Mick Gatto, died after undergoing nasal surgery by Dr William Mooney at East Sydney Private. Dr Mooney says Mr Taouil had a post operative stroke that was not directly related to any trauma from the surgery. This case has  however been referred to the coroner.

Second Patient Death: Strathfield Private Hospital

On 15 February  2018, Pouya Pouladian underwent surgery by Dr William Mooney ENT for sinus problems/sleep apnoea at Strathfield Private Hospital. Dr Mooney allegedly nicked an artery during the surgery.

Nurses told the family that Dr Mooney would come to see them after the surgery. That night they waited until 8pm only to be told Dr Mooney had gone home. “He never came,” Mrs Pouladian said. The family said that, in the two days Pouya was in Strathfield Private, Dr Mooney did not see or speak to him or his family.

Pouya was discharged from hospital on 17 February, and within hours began vomiting. He collapsed and was taken to Canterbury Hospital by ambulance. He was then transferred to Concord hospital, where he subsequently went into cardiac arrest and died.

Dr William Mooney and drug testing

Medical sources have confirmed that further restrictions have been placed on Dr William Mooney’s registration on top of the current conditions which require him to undergo random drug testing.

A search of AHPRAs database revealed that Dr William Mooney currently (22/03/18) has the following conditions imposed on his registration:

1. Not to perform the following frontal and ethmoidal sinus procedures:•

  • External fronto-nasal ethmoidectomy (MBS 41731)
  • Radical fronto-ethmoidectomy (MBS41734)
  • Intranasal operation on the frontal sinus or ethmoidal sinuses (MBS 41737)
  • Catheterisation of frontal sinus (MBS 41740)
  • Trephine of frontal sinus (MBS 41743)
  • Radical obliteration of frontal sinus (MBS 41746)
  • External operation on the ethmoidal sinuses (MBS 41749)
  • Transorbital ligation of the ethmoidal artery or arteries (MBS 41725)
  • Removal of nasal polyp or polypi (MBS 41662, 41665 and 41668)

2. To nominate an experienced ENT surgeon to act as his professional mentor for approval by Medical Council of NSW in accordance with the Medical Council of NSW’s Compliance Policy – Mentoring (as varied from time to time) and as subsequently determined by the appropriate review body.

(a) The first mentoring meeting is to occur within a week of being advised that his mentor is approved and thereafter at a frequency to be determined by the mentor.

At each mentoring meeting the practitioner is to include discussion of the following:

i) the personal and professional effect that the issues which brought the practitioner to the attention of the Council have had on the practitioner

ii) possible clinical concerns raised by the Council, such as his current heavy workload, patient and procedure selection, and time management of procedures including concerns regarding the speed of those procedures

iii) how the practitioner has reflected on his practice, and whether changes to his practice are required.

(b) To authorise the mentor to report, in an approved format, to the Council within one month of being advised that his mentor is approved and every three months thereafter about the fact of contact, and to inform the Council if there is any concern about his professional conduct, health or personal wellbeing.

(c) To authorise the Medical Council of NSW to provide proposed and approved mentors with a copy of the decision which imposed this condition.

3. To submit to an audit of his medical practice, by a random selection of his medical records by a person or persons nominated by the Medical Council of NSW and:

a) The audit is to be held within 3 months from 21 March 2018 and subsequently required by the Council.

b) The auditor(s) is to examine and assess the following aspects of his practice including:

i) a general medical records audit of his ENT practice

ii) an audit of operative procedure records, including the indications, compliance with conditions, and where possible, duration of such procedures against complexity and reasonably expected duration

c) To authorise the auditor(s) to provide the Council with a report on their findings.

d) To meet all costs associated with the audit and any subsequent audits and reports.

4. To authorise and consent to any exchange of information between the Medical Council of NSW and Medicare Australia for the purpose of monitoring compliance with these conditions.

This registration is also subject to other conditions. These conditions are not publicly available due to privacy considerations.

 

Sources:

 

Macquarie University Hospital Death of Patient Paul Lau

A coroner’s inquest has found that Mr Paul Lau died on 19 June 2015 as a result of prescribing error by an anaesthetist, which led to Mr Lau receiving medication intended for another patient whilst he was recovering from ACL reconstruction surgery. The error was not detected by Hospital staff before his death.

Dr Kim opened Paul’s TrakCare record to prescribe a small amount of fluids, which he had forgotten to prescribe during Paul’s surgery. Dr Kim then failed to close Paul’s TrakCare record and opened GS’s (another patient’s) TrakCare record before prescribing post-operative medications for GS at 1:55pm.

Mr Lau was prescribed a Fentanyl Patch and a Fentanyl PCA. He died of fentanyl toxicity.

According to the inquest findings:

It is clear that Dr Kim failed to exercise proper care, diligence and caution whilst prescribing medication erroneously in Paul’s TrakCare record from 1:55pm to 2:00pm. Dr Kim accepted that a patient’s name is displayed on screen in TrakCare at all times and that he overrode 22 alerts presented in three batches whilst prescribing, selecting “consultant’s decision” and entering his password each time. Dr Kim accepted that he bears primary responsibility for the error.

Criticism was made of the hospital’s pharmacist:

In the Pharmacy, Ms Bui, the dispensing pharmacist, failed to adequately assess the appropriateness of the Fentanyl patch for Paul, particularly having regard to the fact that an opioid naïve patient had been prescribed the strongest dose and the fact that Fentanyl patches were not regularly prescribed for postoperative pain.

Criticism was also made of the nursing staff:

A similar absence of critical thinking was displayed by the nursing staff. The Recovery nurses did not question the order for the Fentanyl PCA, despite the Fentanyl PCA not being discussed during handover. The Ward 1 nurses did not assess whether the Fentanyl patch was appropriate medication for a patient in Paul’s circumstances and did not adjust their practices to reflect the risks posed once the Fentanyl patch was administered.

Dr Gregory Robinson – drug addicted surgeon Shoalhaven Hospital banned

The HCCC prosecuted general surgeon Dr Gregory Robinson before the NSW Civil and Administrative Tribunal (‘the Tribunal’), in relation to his management of 4 patients at Shoalhaven District Memorial Hospital.

Allegations were found proven as follows:

  • On 17 February 2015, a patient was admitted under Dr Robinson with symptoms of vomiting and suspicion of an incarcerated abdominal wall hernia. Dr Robinson performed a laparotomy and bowel resection on the patient later that day.  Dr Robinson delayed his review of the patient and he inappropriately conducted major surgery on the patient contrary to his agreement with the anaesthetist to limit the surgery, given the patient’s clinical condition.
  • On 10 December 2013, a 10 year old boy, was admitted under Dr Robinson to the hospital complaining of abdominal pain. Dr Robinson failed to examine or assess the boy until the morning of 13 December 2013 and he inappropriately relied on a first year surgical trainee and resident to examine the patient in his absence.
  • On 24 November 2010, a patient was on the operating table, anaesthetised and intubated with Dr Robinson ready to perform repair of a left inguinal hernia. Dr Robinson left the patient on the operating table intubated without allowing the operation to proceed for some time, and threatened to stop operating on the patient until another of his patients was admitted into hospital.

Dr Robinson had a history of depression and narcotics abuse from 2000, which lead to the him being on the New South Wales Medical Council and Board’s impairment program from 2002.

The doctor explained that he had voluntarily ceased practising in 2015 because he felt that he needed time to heal after the incidents which gave rise to these proceedings.  The Tribunal noted that during the last 12 months he had undertaken reading, meditation, engaged in Buddhism and developed strategies for dealing with stress.

The Tribunal found that Dr Robinson was impaired and imposed a 2 year ban from practice from 26 February 2018.

Sydney doctor misdiagnoses tuberculosis

A man went to his GP in Chippendale, Sydney with symptoms of persistent cough, shortness of breath, on multiple occasions and was initially told that he had asthma. He was subsequently told by the GP that he had lung cancer and was referred to Royal Prince Alfred Hospital, Camperdown.

The hospital conducted various tests which showed that he had tuberculosis and X-rays later found the man had a 6cm hole in his lung. The patient was kept in isolation in RPA for 3 weeks and treated accordingly.

During the period of alleged misdiagnosis, members of the patient’s family became infected with tuberculosis. There are fears that members of the wider community may have also been infected. There are media reports that at least 10 people have been infected and are receiving treatment.

Tuberculosis is a contagious disease caused by a bacterial infection of the lungs. The disease can spread to other parts of the body and can be spread to other people by coughing or sneezing.

Symptoms include:

  • Persistent cough
  • Coughing up mucous and/or blood
  • Fatigue
  • Fever
  • Loss of appetite
  • Weight loss
  • Chills

Making a diagnosis of tuberculosis involves taking a thorough medical history, including symptoms, physical examination of the patient, ordering specific blood tests, testing samples of phlegm. A chest x-ray may also be ordered. Treatment includes various medications. A misdiagnosis can occur because the symptoms of TB can resemble other illnesses.

Robert Starkenburg, Bondi Dentist Deregistered

Dr Robert Starkenburg, a Bondi Junction dentist was found to have engaged in professional misconduct. The New South Wales Civil and Administrative Tribunal found that the dentist’s surgery had inadequate infection control and he was de-registered from the profession of dentistry.

This was a dentist with a history of hygiene issues, stemming back to inspection in 1998. Further complaints arose in 2014 and 2016. In 2016, the inspector found that he was “now mostly compliant with infection control requirements” but there were on-going concerns with hand hygiene, out of date stock and inadequate health records. The tribunals concern was that despite the dentist’s extensive experience, “the breaches that occurred have been gross, repeated, and occurred over a considerable period.”

Whilst this is not a medical negligence action for compensation, it is a disciplinary case, and it is however quite possible for a civil suit to arise where failing to observe proper standards of cleaning of instruments and hygiene results in a patient being infected with HIV and other blood-borne viruses. Establishing causation in these cases can be problematic however.

Dr Jonathan Stern, GP misdiagnosed heart attack

The HCCC recently prosecuted a complaint involving an alleged failure by Dr Jonathan Stern, General Practitioner to make a diagnosis of a heart attack and administer Aspirin.

The patient in question attended the GP’s St Ives’ medical practice complaining of chest pains. He was briefly seen by Dr Stern and was advised by the doctor to go to the hospital. The doctor did not call an ambulance nor phone the hospital ahead, and his referral letter was deemed to be inadequate. There was no provision of aspirin however Dr Stern did afford the patient some treatment by administering a Nitrolingual spray.

The patient’s work colleague who turned up to the practice drove the patient to the hospital. Unfortunately the patient collapsed and died at the reception desk at the hospital. The cause of death was ischemic heart disease and coronary atherosclerosis.

Expert evidence suggested that in situations like this a GP should-

  • Give aspirin
  • Perhaps give nitrolingual spray.
  • Call an ambulance
  • Monitor the patient whilst waiting for the ambulance to arrive
  • Be ready to administer CPR

The Professional Standards Committee imposed restrictions on Dr Stern’s registration, the main one being that he be mentored for a minimum period of 12 months.

Whilst this case is a disciplinary case, and not a tort action for medical negligence, it is important that medical practitioners take appropriate and timely action when a patient presents with symptoms of a heart attack.

In civil law suits for medical negligence however, medical evidence will need to be adduced to show that taking appropriate action would have made a material difference to the patient’s outcome in order for damages to be awarded. This legal issue is known as “causation”, and is not often addressed in disciplinary cases.