Surgeon and anaesthetist negligent for failure to abandon operation

by | May 21, 2017 | Health Blog

A recent decision of the Supreme Court of NSW highlights the shared responsibility of the surgeon and the anaesthetist in deciding whether to proceed with surgery or abandon it when the patient’s condition deteriorates during surgery.

The patient, Mr Hobson, was born with Noonan Syndrome, a genetic disorder which manifested in a severe lordoscoliosis and idiosyncratic shape of his chest as a result of which he had developed difficulties breathing. Mr Hobson’s condition had deteriorated to the point where he required operations to remedy this defect. The first surgery was performed on 13 November 2009 and was carried out uneventfully. The second surgery occurred on 17 November 2009 and it was in the course of this surgery that Mr Hobson sustained a hypotensive insult to his spinal cord that rendered him a paraplegic.

In general terms, Mr Hobson alleged that the surgery on 17 November 2009 ought to have been aborted when it became apparent that his intraoperative condition was critical and quickly deteriorating. He alleged he would not have sustained any injury at all if that course had been taken in a timely way. On the contrary, Mr Hobson complained that that the defendants negligently persisted with the surgery to the point where irreparable damage to his spine occurred.

During the first hour of surgery, Mr Hobson suffered acute reduction in oxygen saturation and a drop in blood pressure. After about 1.5 hours, vecuronium was administered in an attempt to improve Mr Hobson’s worsening ventilation. This neutralised the spinal cord monitoring, however it was decided to proceed with the operation. Approximately 2 hours into the procedure, due to a number of anaesthetic difficulties being encountered and problems with ventilating, the anaesthetist urged the surgeon to hurry up as Mr Hobson’s condition was deteriorating. Minutes later, Mr Hobson was hypoxic and hypotensive and it became clearly necessary to abandon the surgery.

The allegations were the subject of a significant amount of evidence from the defendants and the experts which is summarised in detail in the decision.

In the end, the Court concluded that the surgeon and anaesthetist were both negligent in persisting with the operation when it should have been abandoned earlier. The anaesthetist was alive to Mr Hobson’s deterioration which would have caused a reasonably competent anaesthetist to call a stop to the surgery. The surgeon was being alerted to the problems encountered by the anaesthetist and had the ultimate say in whether to continue or not. A reasonably competent orthopaedic surgeon would have called a stop to the surgery. The Court found that had the surgery been paused or halted earlier, Mr Hobson would not have suffered spinal cord damage.

A peer opinion defence under s5O of the Civil Liability Act 2002 was rejected by the Court.

Judgment was entered against the defendants for over $3.8 million in damages, plus costs.

To read the decision in Hobson v Northern Sydney Local Health District [2017] NSWSC 589, click here.

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