More testimony on Patel trial

By Dr. Ananya Mandal, MDApr 21 2010

In the ongoing trial of Dr. Jayant Patel for manslaughter of three men and grievous injury to the fourth during his tenure as Director of surgery at Bundaberg base hospital new testimony has surfaced. Patel had pleaded not guilty.

The Supreme Court heard that Patel had inadvertently torn a patient’s oesophagus or food pipe and also nicked a vital jugular vein in the neck. This was related to the court by Dr Emma Igras who said that she had found in one of the victim Mr. Phillips’ chart that his oesophagus was "inadvertently torn" during the procedure in May 2003. The injury to the jugular vein was told to the court this Tuesday by an attending anesthsiologist at the operation.

Dr. Igras, a trainee surgeon, was assisting Patel when the oesophagus got torn open and she said, this was “not part of the planned operation.” Mr. Phillips was undergoing a surgery for removal of the oesophagus for throat cancer. She did not say whether this accidental tearing of the oesophagus could have led to the death of the victim.

She was cross examined by Patel’s lawyer Michael Byrne, QC, where she confessed that oesophagus is a delicate organ and because of her “extremely limited” experience with such surgeries she could not comment on whether such accidents happened commonly.

In yesterday’s testimony it was ascertained that the accidental nick in the jugular vein led to lot of bleeding and four bags of intravenous fluids had to be transfused. Mr. Phillips was said to be suffering from a chronic kidney disease and the potassium overload from these fluids could have lead to a heart attack that caused death of the patients two days after surgery.

Today further light was shed on this. Marie Goatham, a theatre nurse was cross examined. According to her, Mr. Phillips had been given Hartmann's solution (a fluid replacement which contains potassium) during the operation. This could have led to the potassium overload and eventual death. She said, that the operation staff had been warned after the operation that care should be taken before giving Hartmann's solution to patients with renal problems. But she could not recall when and how the directive for administration of Hartmann’s to Mr. Phillips was given. She said Mr. Phillips was in recovery unit for 50 minutes which was longer than usual.