Family questions time delays over man?s treatment

It was cold comfort for family and friends of 22 year old Blair Langdon, who sat at a three and a half hour coroner's inquest, hearing about improved medical procedures at Masterton Hospital, put into place following Mr Langdon's death.
Mr Langdon died on Sunday, November 23, 2003 at Wellington Hospital while being operated on for internal injuries sustained in a motorcycle event on a rural property 40 minutes east of Masterton.
In an emotionally charged setting, Coroner Jock Kershaw heard evidence from police and Masterton surgeon and Medical Advisor to the Wairarapa District Health Board, Alan Shirley.
Also attending the inquest were Mr Langdon's parents, John and Glenys Langdon and his partner, Kristy Forbes.
In his opening address, Mr Kershaw described the coroner's inquest as a "court of bereavement as well as a court of justice".
In a two hour questioning of Mr Shirley by his lawyer, the timeline from the accident at 10.20am until Mr Langdon's death just before midnight, and Masterton Hospital procedures, went under great scrutiny.
Mr Langdon had stalled his motorcycle and when attempting to restart it, he had fallen to the ground with his right side of his body taking the full force. As a result he suffered a lacerated liver, fractured ribs, broken shoulder and a severed artery to one of his kidneys. Much of this not apparent until a CT scan at Masterton Hospital some six and a half hours later.
In a statement from the family they wished it known that they were not engaged in a witch-hunt to lay blame on any person.
"Having said that, it has to be recognised that with an injury of the sort suffered by Blair, time is the enemy, and it must be questioned whether the time available was spent in the best way".
The family questioned not only the perceived time delays but also if intervention surgery, perhaps at Masterton Hospital, could not have been done earlier.
Mr Langdon's death prompted not only a case review by an independent medical officer but also a Handbook for Locum Consultants being written.
Mr Shirley told the inquest that this episode of care had resulted in a lot of discussion and had brought to light a lot of instances applicable in other areas.
He said that the clinical diagnosis of Mr Langdon would hold up to scrutiny but there were always areas where they might do better.
"We have been through a very difficult time and process and hope that some of the measures will help".
He said the handbook was not simply a piece of paper, but one of status where all employees must follow the protocol.
All clinicians would have a copy and it would be prominent in Accident and Emergency and in the High Dependency Unit. He said communication had been improved between teams if there was likelihood of transfer between hospitals, but most importantly the decision to transfer would come at a lower threshold.
"Awareness to do this has to be an outcome of this case review".
A surgeon, anaesthetist, radiographer and laboratory technician would automatically be called prior to the trauma victim arriving.
This has happened in the past, but in a less formal way. Mr Shirley said the response may be unnecessary but it is better to turn away the medial personnel, than to wish in retrospect that there was more help.
The issue of transferring trauma patients is one that is riddled with a detailed process especially in sourcing the qualified personnel. Masterton Hospital has an arrangement with Wellington Hospital to use the Westpac Trust LifeFlight retrieval team. There is a fixed wing aircraft also available but this also involves transfers from Hood Aerodrome and Wellington airport causing more delay.
"There are always financial restraints but if a clinician believes the helicopter should be called, it will be," said Mr Shirley.
He was adamant that Mr Langdon had not received conservative treatment and that the time spent at Masterton Hospital was necessary to adequately diagnose his condition.
Mr Langdon arrived at Masterton Hospital in the ambulance at 12.40pm and was able to give staff full details of what had happened to him. His clinical diagnosis was liver injury and fractured right hand ribs. He had x-rays and a blood transfusion and a CT scan was requested.
He was transferred to the High Dependancy Unit at 3.30pm and given some oral contrast, which Mr Shirley explained needed an hour to work. His CT scan was performed at 5pm.
The results of this were discussed between the on-call surgeon at Masterton and the radiologist in Wellington. As well as confirming the liver laceration it also revealed extensive internal bleeding.
It was at this point that a helicopter and retrieval team was requested from Wellington. This team arrived in Masterton at 8pm and left with Mr Langdon at 9.35pm. It is reported that Mr Langdon's condition was unstable during transfer and he was transferred directly into theatre at Wellington Hospital. He died of cardiac arrest in theatre at 11.45pm.
When being questioned by the Langdon family's lawyer, Ed Cooke, Mr Shirley said Mr Langdon would have had to transferred to Wellington Hospital whether Masterton had tried to operate locally or not.
He described it as unfair to speculate on this issue pointing out there was a lot more to operating than purely the operation. There is the inevitable complications and the aftercare. It would have been inappropriate for Blair to have stayed".
Mr Cooke asked that when Masterton Hospital has its new hospital and facilities, could major trauma be dealt with in Masterton. Mr Shirley said major trauma cases are always better dealt with in main hospitals but there will always be challenges to that practise.
In the statement from the Langdon family it was said it is accepted that the case review has resulted in some recommended actions but the question must be asked whether in a similar situation they are sufficient to prevent another person dying.
If Blair's death is to have some meaning, there has to be changes in place that would result in a better outcome".
Towards the end of the inquest, Mr Langdon's father, John, asked to speak and gave an impassioned account of the accident and experience at Masterton Hospital.
Coroner, Jock Kershaw suppressed further details and has reserved his decision until a later date.