The cause of death of Whanganui pensioner Carmen Walker after an isolated limb infusion at Waikato Hospital in 2010 is the subject of a coronial inquest. Photo / Stuart Munro
The cause of death of Whanganui pensioner Carmen Walker after an isolated limb infusion at Waikato Hospital in 2010 is the subject of a coronial inquest. Photo / Stuart Munro
Two buckets that contained the volume of blood drained out of Carmen Walker in a hospital procedure that ended her life were disposed of the day she died.
It prevented any chance of measuring the amount of blood in the buckets and pinpointing the exact cause of Walker’s death, which is now - 13 years later - being probed by a coroner.
According to a nurse involved in Walker’s August 2010 isolated limb infusion at Waikato Hospital, it was hospital policy that waste from a procedure or surgery was only kept if the patient died in theatre.
In Walker’s case, the 78-year-old great-grandmother from Whanganui was barely alive when she left the procedure room and was not expected to survive the night after the melanoma treatment that was supposed to extend her life went wrong.
The nurse, who has interim name suppression, told an inquest into Walker’s death she had never experienced such a serious incident in theatre and she was unsure what to do following the patient’s transfer to the intensive care unit.
Walker suffered a cardiac arrest after the deflation of tourniquets isolating her leg to allow infusion of the concentrated chemotherapy drug melphalan to treat the cancer that had spread from her right ankle.
Resuscitation ensued to stabilise Walker but by then her brain had been deprived of oxygen for too long after the left ventricle of her heart was found empty, meaning there was no blood for the heart to pump.
The nurse said she and others cleaned up the room so Walker’s husband Bob and son Craig could sit with her after they were delivered the unexpected and devastating news she was not likely to survive.
There were two buckets - or containers - in use in the Harris Suite of the Radiology Department that afternoon, the nurse told the inquest before Coroner Alexander Ho at the Hamilton District Court yesterday.
A white container placed inside a purple bucket collected the saline after it “washed out” the leg, as well as Walker’s tainted blood which was exsanguinated before the tourniquets were released.
This bucket was at the foot of the bed next to the nurse. The second container collected the perfusionist’s equipment waste as well as the melphalan mixed with blood.
After Walker suffered a cardiac arrest and was resuscitated the two buckets were moved to another room as part of the clean-up.
The nurse said the lead surgeon, who also has interim name suppression, and observing surgeon Dr Adam Greenbaum, entered the annex room and went to the perfusionist’s bucket to see how much blood was in it because it was not measured.
However, the nurse had to warn the surgeon not to put his hands in the bucket because it contained cytotoxic waste.
She said the pair left before she had a chance to tell them the other bucket had been sealed ready for disposal and was sitting on a nearby shelf.
It was suggested the combined volume of blood in both buckets could have been as much as five litres - the amount circulating in the body - but there was no way to be sure because of the other waste also in the buckets.
Coroner Alexander Ho is presiding over the inquest into the death of Carmen Elizabeth Walker at Waikato Hospital in 2010. Photo / Mike Scott
The nurse later called the hospital’s theatre coordinator for direction about whether to keep the waste because of Walker’s bleak prognosis but was told the buckets could be disposed of as usual because the policy dictated that waste only be kept when a patient died in theatre.
She said the same policy was still in place today.
One theory on the cause of Walker’s massive blood loss suggested by the surgeon in the first coronial inquiry in 2011, was that the tourniquets were not sufficiently compressing the arterial blood supply to the limb, allowing blood to leak into the limb as the venous system was washed out.
The nurse said she checked the two tourniquets during the procedure and they were not leaking.
On Tuesday the inquest heard the perfusionist, who was in charge of the limb and the fluid going in and out, and the anaesthetist both believed Greenbaum exsanguinated Walker - a necessary part of the procedure to drain all the blood from her leg tainted with melphalan.
But the nurse said it was definitely the lead surgeon who did this. She also confirmed a crash call was made by the Harris Suite staff though the anaesthetist later testified this was likely a mistake because only an emergency anaesthetist was needed.
The nurse also described how she was so concerned there was no debrief of the event she rang a colleague the next day and dictated a detailed note describing what happened.
However, the nurse said she did not fill out a serious incident report of the procedure despite it being hospital policy.
This was in part because she injured her back during the procedure and took several days off work to recover.
The injury was also the reason she rang her colleague and dictated the note because she didn’t know if she would be able to be involved in any debrief.
The nurse finished by expressing her sympathy to the Walker family for their loss.
The inquest also heard from intensive care nurse Analea Cruz who said she had no memory of Walker but referred to her notes that Walker oozed blood from where the catheters had earlier been inserted.
Her notes also described Walker as having melena, a black stool indicative of upper gastrointestinal tract bleeding, pointing to Walker having internal bleeding.
When it was put to Cruz that evidence from two pathologists stated this was “not supportable” she said that was their medical opinion while her note was a nursing observation.
The anaesthetist, who has interim name suppression, began testimony yesterday and will continue today.
Natalie Akoorie is the Open Justice deputy editor, based in Waikato and covering crime and justice nationally. Natalie first joined the Herald in 2011 and has been a journalist in New Zealand and overseas for 27 years recently covering health, social issues, local government, and the regions.
