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  • November 16, 2017

‘Relatively Easily’ Brain Surgery Has Tragic Results

‘Relatively Easily’ Brain Surgery Has Tragic Results

PANAGOULIAS -v- THE EAST METROPOLITAN HEALTH SERVICE [No.4] [2017] WADC 118

Prior to his injuries the plaintiff was a very social person. He enjoyed a range of leisure activities like, fishing and cooking, home handy work including renovating and tinkering with cars, and enjoyed his work as well.

In December 2005, the plaintiff was diagnosed with a brain tumour. He had been experiencing headaches for some time, he was referred to a neurosurgeon.

The tumour was determined to be benign but needed to be removed. The plaintiff and his wife were advised that this kind of tumour was ‘relatively easily’ managed. The phrase ‘relatively easily’ must of course be understood in the particular context of brain surgery, with all its significant inherent risk.

On 23 January 2006, the neurosurgeon performed the required surgery and about 90% of the tumour mass was removed.

The headaches began to return however, along with some vision problems. Once again, the neurosurgeon was consulted. He advised that it would be necessary to deal with the part of the tumour that remained.

The plaintiff was admitted to hospital for the surgery. The surgery was performed the next day. It was not a success. In the course of the surgery the neurosurgeon nicked the plaintiff’s carotid artery causing worrying bleeding. The attempt to remove the tumour was abandoned.

When the plaintiff left hospital, his condition was stable, except perhaps for a fairly constant and consistent mucous discharge from his nose. The plaintiff had been advised not to blow his nose, but this discharge meant that he was constantly wiping it.

Over the course of the next few weeks the plaintiff and his wife consulted with the neurosurgeon many times over the phone seeking medical advice, including for a severe sneeze suffered by the plaintiff.

In the early hours of one morning, the plaintiff’s wife woke up to find him complaining about having ‘quite a severe headache’.

The following morning, the plaintiff’s wife called the neurosurgeon and told him that her husband had a very uncomfortable night, that he was in a lot of pain, and that he had a really bad headache. She said that he responded by saying to her something to the effect of ‘well you need to take him into the emergency department. There could be something going on with his aneurysm thing and he just needs to be in the hospital over the weekend so that they can observe him’.

After presenting to the hospital, the plaintiff was admitted to a ward, an observation made suggested that the plaintiff was ‘OK‘. Just eight minutes later he was ‘found to be unresponsive’ and experiencing ‘hemiplegia‘ (That is, one side of his body was paralysed). Shortly after this he lost consciousness, an emergency team was called, and the plaintiff was intubated and ventilated. By this time a bacterial meningitis had caused the plaintiff severe and irreversible brain damage.

The plaintiff continued to have multiple medical episodes, being the result of neurological problems caused by the brain injury.

Breaches

The breach alleged against the neurosurgeon by both the plaintiff and the hospital was that he neurosurgeon failed to provide the plaintiff with an appropriate warning or advice after the plaintiff had sneezed out a piece of what appeared to be fatty material. The neurosurgeon should have told him to immediately go to hospital if he developed ‘other symptoms including a more severe headache, stiff neck, high temperature or photophobia‘. That obligation is said to arise from a number of facts and circumstances, sometimes summarised by the notion that the plaintiff was a ‘complicated case’.

The plaintiff’s allegation of breach as against the hospital is that, given the plaintiff’s history and his symptoms on presentation at the ED and throughout the course of the day, the staff at RPH failed to act in a timely way to treat the plaintiff’s bacterial meningitis.

Findings

The judge stated that “the plaintiff’s former life has been taken from him. He is left not only with significant physical disabilities, but with the cognitive and emotional problems that have been described, there is no prospect whatever of recovery” and had no hesitation in finding that the failure to commence intravenous antibiotics and corticosteroids by a certain time breached the duty of care owed by the hospital to the plaintiff. In that regard, the evidence presented was that if the plaintiff had been treated with intravenous antibiotics and corticosteroids earlier, then, on the balance of probabilities, the plaintiff would not have suffered an adverse outcome from the bacterial meningitis infection.

Order

The judge ordered that the plaintiff should have judgment against the hospital for a substantial amount but dismissed the action against the neurosurgeon.

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