I’m a pretty staunch defender of surgeons. I tend to take their (our) side on most issues, but a recent case from England raised some conflicting thoughts for me.

David Sellu, a consultant (attending) colorectal surgeon at a private hospital in London, was convicted of manslaughter by a jury and sentenced to 2 and a half years in prison, of which he must serve at least half, for delaying surgery for man with a perforated intestine.

The patient was recovering from a knee replacement when he developed abdominal pain. Dr. Sellu took over management of the case and failed to treat the patient in a timely way. After seeing the patient, he waited 24 hours before operating.

According to the judge, whose sentencing remarks are available in full, the surgeon had  several lapses.

Although he suspected a bowel perforation when he first saw the patient, he did not have a CT scan done until the next morning and did not pursue findings of what proved to be free intra-abdominal air on that CT scan. He thought the scan showed signs of bowel perforation, but he did not request a reading from a radiologist.

He did not tell the resident to give antibiotics although they would certainly not have helped that much.

He made no record of seeing the patient on the morning of surgery and was preoccupied with a scheduled elective case. He did not speak to the nurses or the resident taking care of the patient.

He also changed his account of the story.

One wonders what the nurses and the resident were doing while all this was going on. In my experience, nurses, residents, or other physicians involved with the patient’s care would have gone up the chain of command to demand action. Perhaps this is not a part of the culture in a private hospital in England, but as this case illustrates, it should be. In my many years as a surgical chairman, I received many such phone calls or visits from concerned staff.

Yes, others must have been involved and will have to live with their silence, but Sellu was in charge of the case.

The conflicting part for me is that at first I thought, “What sort of precedent does this set?” Where does this fit on the continuum of an honest mistake, malpractice, and an out-and-out crime?

Well guess what? Conflict over. If a doctor feels that a patient has a bowel perforation, the diagnosis must be ruled in or out in a timely way. Waiting 12 hours to get a CT scan and 24 hours to operate is unacceptable.

If you think that a year or so in jail is a harsh penalty for the surgeon, put yourself in the shoes of the patient’s wife and six children. And don’t forget about the patient himself, who is dead.

Thanks to Tom Lewis (@thomasllewis) for alerting me to this story.

Skeptical Scalpel is a recently retired surgeon and was a surgical department chairman and residency program director for many years. He is board-certified in general surgery and a surgical sub-specialty and has re-certified in both several times. For the last three years, he has been blogging at SkepticalScalpel.blogspot.com and tweeting as @SkepticScalpel. His blog averages over 1200 page views per day, and he has over 7400 followers on Twitter.