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Surgeon Convicted of Manslaughter Wins Right to Appeal

Surgeon Convicted of Manslaughter Wins Right to Appeal
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Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

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"Should this conviction be overturned, it will be another blow to the "Captain of the Ship" doctrine, which assumes that a surgeon is responsible for everything that happens to his patient."
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Last month, a three-judge panel granted English surgeon David Sellu the right to appeal his conviction. He has already served 15 months in prison.

In this space 2 years ago, I blogged about Sellu, who was charged with manslaughter in the death of a patient at a private hospital in London.

If you do not want to read that entire post, here’s a brief summary:

While recovering from a total knee replacement, a man died from sepsis secondary to an intestinal perforation. Sellu had been asked to consult on the patient.

Although I pointed out that many other caregivers must have contributed to this tragic outcome, no one else was blamed. According to the judge’s sentencing remarks, Sellu did not aggressively investigate and treat the cause of the patient’s abdominal pain and his accounts of the events surrounding the patient’s death were inconsistent.

Accounts of the case were not detailed, but I assumed Sellu was at fault.

“…even if Sellu wins the appeal, his reputation has been ruined, and he will probably never practice again.” – Skeptical Scalpel

 

Some commenters from the UK pointed out that not all of the facts were known. A website in support of the doctor, whose career had previously been exemplary, was created. Many friends and colleagues said that he had been railroaded and called for the case to be reopened.

Last summer, the Daily Mail [a newspaper and website which has been scorned by journalists and readers alike, but shined this time] ran a story revealing the results of a root cause analysis done by hospital staff that found multiple system failures regarding the performance of emergency surgery. The corporation that owns the involved hospital had withheld this information before the trial.

Some of the problems were as follows: an x-ray and CT scan ordered by the doctor were not done in a timely way; staff did not adequately monitor the patient; the surgery was delayed because no anesthesiologist was available. Apparently, the hospital had no emergency call roster for anesthesia at the time and still does not.

There’s more.

A house physician diagnosed the problem as a muscle spasm and gave the patient a muscle relaxant several hours before Sellu was asked to see the patient.

The patient had been on dabigatran, an anticoagulant drug, which at the time of this incident in 2010, had no antidote. The prosecution had told the court that the patient’s chances of survival from a bowel perforation with sepsis was 2.6%—overly optimistic for a 66-year-old man requiring surgery.

The hospital’s medical advisory committee also investigated the incident and found Sellu was not culpable for anything that happened and that the hospital should not be doing emergency surgery. Minutes of this meeting were also not divulged at the doctor’s trial.

Should this conviction be overturned, it will be another blow to the “Captain of the Ship” doctrine, which assumes that a surgeon is responsible for everything that happens to his patient.

However, even if Sellu wins the appeal, his reputation has been ruined, and he will probably never practice again.

 

 

Skeptical Scalpel is a retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and critical care and has re-certified in both several times. He blogs at SkepticalScalpel.blogspot.com and tweets as @SkepticScalpel.

6 Comments

  1. It’s widely known that you don’t want to get really sick in our local hospital, right here in the middle of the good ol’ US of A. There are no residents, much like the private UK hospitals. Only recently have they hired Hospitalists and considering the local MD they chose as chief, I am not hopeful.

    The problems are multifocal. What I have observed is the physicians expect to be obeyed by the nursing staff without any questions or comments and don’t want any after hours disturbance. The nursing staff is not challenged to be at the top of their game by the nursing management and chief, and are actively discouraged from calling physicians. There is more fear of being reprimanded or fired for real and imagined slights and issues than there is concern for providing poor care. I could not work in that environment.

    This is not to say that being a patient in a teaching hospital is without its perils. A patient can still be at risk of poor care in the most esteemed institutions. There’s always a physician with that lethal mix of stupidity and hubris lurking in the wings or a nurse who’s afraid of showing (s)he doesn’t know everything and either doesn’t recognize the problem or tries to fix it without help. The difference is there are a lot more eyes on an individual patient to hopefully avert disaster.

    Disasters still happen and patients die unnecessarily. I have never seen a physician or other staff member more than fired and in most cases, the whole thing just goes away. I know there are well publicized instances when physicians and nurses lose their license to practice, but I don’t think that’s the norm.

    I had a really bad experience with speaking up, but I won’t go into that in a public forum.

    Reply
    • Thanks for the comments. I certainly didn’t mean to suggest that something like the Sellu couldn’t happen here. I’m sure it has and probably will again. Your examples illustrate why hospitals and medicine are unlikely to become like the airline industry, where personnel are encouraged to report near misses and people who speak up are not punished. Three years ago, I wrote about the so-called “just culture” that does not exist in medicine. http://skepticalscalpel.blogspot.com/2012/02/quest-for-medical-error-transparency.html

      Reply
  2. I’m a bit confused was the infection brought on by the Knee surgery? Seems that there was plenty of faults involved , however it seems that the person most responsible would be ” the Captain of the Ship” how would you characterize the quality of care here.?

    Reply
    • Some details of the case were missing. I assume that the perforated intestine was a separate event that may have resulted from a medication the patient was receiving or possible even from stress. Based on what I know about the case, the quality of care wasn’t great. But it was certainly a team effort. The surgeon was not without fault, but I don’t think it rose to the level of prison, and others should not have gotten away with their misdeeds. Colleagues from the UK have advised me that it’s not a good idea to get sick in a private hospital over there.

      Reply
  3. This is a very interesting story. Whilst I agree that a Doctor is 100% in charge of his patient, and should always take full responsibility, you must question the team. Working in healthcare requires the full collective work of your staff, we are all a team. Effective care means each individual must participate in the ultimate goal; “Patient Wellbeing”. Clearly the latter was lacking in this story, and other healthcare staff involved should be taking some of the blame.

    Reply
    • I agree. See my response to Vince on this date.

      Reply

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