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Surgeon Convicted of Manslaughter for Delaying Operation

Author Information (click to view)

Skeptical Scalpel

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.

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Skeptical Scalpel (click to view)

Skeptical Scalpel

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.

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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?

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.

 

32 Comments

  1. This conviction was quashed by the court of appeal the n 15/11/2016. Hooray !

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    • Yes. Thanks.

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  2. Thanks for your comment. I have acknowledged in the post itself and in comments that one person is rarely responsible for a bad outcome of this sort. I hope someone can give us more details about this case. I agree that what we have from the media and the judge is insufficient.

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  3. You ask some very good questions. It is likely we will not get the answers. It’s true that it takes more than one person to create such a bad outcome.

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  4. Thanks for the information. Sounds like the prosecutors are over-zealous.

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  5. Despite some of the responses above there is nothing especially unusual or unprecedented about this case, unfortunately. Many British doctors have been prosecuted for manslaughter since the policy was changed by the Director of Public Prosecutions in 1990. The number of prosecutions since that date is well over fifty now, with as many as six in a single year. The sentencing tariff was increased in 2003 and longer sentences are being imposed.

    Manslaughter prosecutions are not unknown for US doctors either. Everybody has heard of Conrad Murray, but he is not alone. My knowledge of the US system is limited so I have no idea how common it is for doctors to be prosecuted there, or how the circumstances compare with UK cases. Germany and Australia certainly prosecute as well, though in Germany the punishment may be limited to a fine (based on only one case, but certainly well below the minimum likely sentence in the UK).

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    • It would be interesting to know what the offenses were for those 50 or so prosecutions. Has anyone written about them and if so, where could the story be found?

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  6. Skeptic scalpel more to this one than meets the eye. Commenting on the case when you don’t really know what happened is not going to get the truth. Criminalising an unblemished career will not improve patient safety. British surgery reeling from this judgement. Check out this website and ask who is right and would you smell a rat here after 40 years of unblemished career. Tragedy patient died but all is not as it seems.

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    • Jenny, thanks for commenting. In my defense, I discussed the fact that many people contributed to the demise of the patient. I could only base my post on what was available publicly. Discussing the case is a way of helping to uncover the truth.
      ***
      Your website link did not come through in the comment, but here it is http://davidsellu.org.uk/supporters/. There are many testimonials to Dr. Sellu, and they also refer to the part that others may have had in the patient’s death. But I didn’t see too many facts there. Did he delay obtaining the CT scan or not? Did he delay seeking a reading of it? Did he delay taking the patient to the OR?
      ***
      Why didn’t Dr. Sellu’s lawyer do a better job of educating the court? It will be hard to introduce any new information since the verdict is already in. As I said, “‘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?” I can see why British surgery may be reeling.

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  7. There obviously has been a system failure . Yes where we’re the nurses who were supposed to be looking after this patient ? A friend of mine had major surgery at this hospital (who was a nurse herself) she complained to me about the standard of care at this hospital by the nurses as I myself was a senior nurse in the NHS and also in the private sector. This poor surgeon has been made a scape goat for a very obvious failing in this hospital . There has been other cases similar to this at this hospital. As for the surgeon’s delay in giving the appropriate treatment, we do not know the details and the circumstances surrounding the case.

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    • I agree that we don’t have all the details. It is certainly possible that the surgeon has been made the fall guy for all those who participated in the situation. However, we do know that he was the one who was convicted. One would hope that the court had at least most of the facts. It is a shame for the poor patient and his family.

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  8. I read the comments of the judge. Of course, I agree entirely that this surgeon’s conduct fell well short of the standard of care and did contribute to the patients death. That is malpractice, and rightly deserving of judgement and discipline by the medical authorities.
    However, it should NOT be considered manslaughter. I’m no legal expert on manslaughter, but it is entirely beyond precedent and reasonable punishment to imprison a man for 2 years due to poor medical care. The unfortunate fact that the patient died does not mean the punishment has to be equal to that outcome. Probably every experienced doctor has provided occasional poor care that contributed to a patients death. If every doctor who contributed to a bad outcome went to prison, there would be much worse overall health for everyone. This surgeon is not a criminal; he’s just a doctor who had a really bad day with horrible results. Reprimand, discipline, financial penalty, losing his license, sure. Prison, no.

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    • You make some good points. As others have pointed out, we don’t have all the facts here. Even the judge’s sentencing remarks left a lot of unanswered questions. There may have been something that pushed this into the realm of criminal behavior.

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  9. A good RN would have stayed with this until the patient was seen for the bowel perf. .A nurse is an advocate for their patient. I have been in similar situations in the past, and got the patient transferred to ICU to be seen by an ICU doc. I almost got in trouble, but the patient lived and the resident was fired. After that I had a lot of respect from the MD,s.

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    • That is what I was talking about in the post and in some of the comments. The patient comes first.

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  10. Not the criminal results. But the conditions sound like the future of medicine in the US

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    • I hope you are wrong, but you may be right.

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  11. No one deserves such appalling mistreatment, I don’t care what kind of band-aid station he finds himself in. The sentence is no where near harsh enough (this may be why I never get to serve on a jury?) and others had to be complicit in the negligence. S.S., as you know, a perforated bowel does not present benignly. A nurse should have been raising holy hell, even in the most polite and reserved English manner. (I, on the other hand, always raise holy hell in the most direct Midwestern manner – first the surgeon in question, then the Chief – no messing around.) I know this could happen anywhere, I’ve dealt with clueless or over-confident residents and nurses on the brink of killing someone but this sounds like a broken system, to me.

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    • It seems that the nurses in this private hospital in London either failed to recognize the severity of the problem or did not feel empowered to go up the chain of command. As I said, I would have fully expected a call from either the floor nurse or her boss bringing the case to my attention.

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  12. In the U. S. the family would have received policy limits from the surgeon (at least $1,000,000) and likely a larger amount from the hospital but the doc would not have gone to jail. We did not hear what compensation the family got but I suspect they would have been happier in the U. S. Having the doc in jail does not help replace Dad’s income.

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    • I agree that there would have been a big settlement in the US. I’m not sure if the family in this case received any money.

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  13. Does this English surgeon also lose his license to practice medicine as a result of the conviction and sentence?

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    • I am not certain but apparently he did lose his license to practice medicine. One report said that the judge ordered him to prison even though he was not ever going to practice medicine again.

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  14. Well said, Skeptical Scalpel. If this doctor has been a bully, then the nurses and “baby doctors” may have been afraid of him. It is important that bully doctors be disciplined so nurses and underlings will catch mistakes and try to rectify.

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    • In fairness, we don’t really know of he was a bully. Judging from some of the other comments, care in private hospitals in the UK seems a bit lax. They aren’t used to seeing really sick patients.

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  15. To address your comment about what the residents were doing, well there were likely none at all. UK private hospitals are different from American ones in the fact that they only do elective surgeries (think TKR or hysterectomy). They are also different in that there are NO junior doctors (ie, non-consultant grade surgeons/anaesthetists/radiologists) apart from one person called an RMO (resident medical officer). These are generally recently migrated foreign doctors who have yet to get a job at a proper hospital. They aren’t paid particularly well and do very little (generally the like of just taking bloods and reading chemistry results from patients as they are admitted for their surgery) and are required to live in the hospital for 2 weeks at a time, hence it doesn’t tend to attract anyone but the desperate.

    This also leaves the issue of who actually takes care of the recovering patient, and that tends to fall down to the nurses, who alert the RMO if they see a problem, who can then speak to the consultants when an issue arises. This basically means that unless the surgeon is there checking on the patient as a follow-up (which tends to be few and far between considering they’ll be doing lots of operations to earn them money) there are no surgeons doing ward rounds on the patients to notice acute issues. Not to mention the nursing staff, whilst experienced, tend to have been in the hospital for a while and thus only really deal with the recovering surgical patients and not acute cases.

    I have also had run-ins with surgeons in such private hospitals and I can tell you that they can get away with shit there that the NHS admin staff wouldn’t even dream of tolerating, most likely because they are making the hospital money and if nothing extreme then they’re inclined to let it slide than lose a surgeon bringing in patients.

    That’s not trying to rag on any of the consultants or any other staff in private hospitals, but I do think it highlights a big difference between the kind of care you’d receive in private vs NHS hospitals in the UK.

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    • Thank you for clarifying what a Resident Medical Officer is and what he does, which sounds like not much. It also sounds like you had better not get sick in a private hospital in the UK. I am curious as to what you thought about the fact that this was tried as a criminal case and what the verdict was?

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      • Sadly you’re probably not far off the mark suggesting you ought to not get sick in a private hospital. Indeed it’s not rare for an ambulance to be called to transfer an acutely ill patient to the local NHS hospital (or one in a HDU/ITU that is too unwell to be kept there).

        As for my view on the verdict, I don’t think I know enough to begin to comment on it. The High Court Judge’s report lacks many details surrounding the case, I feel, and I will eagerly be awaiting the outcome of Mr Sellu’s Fitness to Practice Hearing (which occurs either through GMC-initiated investigations, or as a result of a criminal conviction) as these are made public, to be able to find out more about the case.

        It is especially confusing when even the editorial in the BMJ (http://www.bmj.com/content/347/bmj.f6722) is glaringly thin on details. Indeed it doesn’t even address the question how this surgeon came to be alerted to this patient. If the patient was indeed recovering from a knee operation (in the remit of a trauma and orthopaedics surgeon) how and why did he end up under the care of a colorectal surgeon? I suspect perhaps the RMO may have noticed an issue and consulted an appropriate consultant, but still why wasn’t the original T&O surgeon involved if it was his patient?

        Whilst it does seem like Mr Sellu was negligent, whether that should have result in imprisonment is another matter. We know nothing about any of this so I find it difficult to be able to comment on the appropriateness of the decision as a result.

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        • I will grant you that there are some missing details. My understanding is that the patient had a knee replacement, which is usually elective surgery. He developed abdominal pain, and Sellu was consulted. If orthopedic surgeons in the UK are anything like they are here in the US, getting one involved in a patient with abdominal pain would simply have wasted even more time. They very likely would have declined to see the patient anyway. There was a trial and Sellu’s attorney had an opportunity to present his side of the story. The judge’s sentencing remarks were pretty specific. I hope you read them as I did provide a link.

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  16. As a nurse I would most DEFINITELY have gone to my supervisor and questioned the surgeons actions,or delay of, if I felt than the patient was in danger as I have a few times before. Unfortunately, I am often told to call the Doc myself and ask, or a simple shrug and “the doctor is aware, what more can you do?” Well, questioning a doctor doesn’t usually go over very well and in most cases we trust that the doctor does, in fact, know what they are doing. Although there are others involved, we can only do what the doctor orders. If the doctor doesn’t give orders, what more can we do?

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    • Each hospital has its own culture and chain of command. I think that you have an obligation to your patient to pursue a situation like this until it is satisfactorily resolved.

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    • Each hospital has its own culture and chain of command. I think that you have an obligation to your patient to pursue a situation like this until it is satisfactorily resolved.

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