Husband accuses doctor

By JO-MARIE BROWN

More than five years after Patricia Ross' death, her husband Ken cannot believe the Matata woman died after an operation to repair her broken arms and legs.

"I was talking to her in the hospital and she was okay. I never thought that she would die from some broken limbs."

Yesterday Mr Ross told a Medical Practitioners Disciplinary Tribunal that he wanted his wife's anaesthetist, Dr Thirunavukarasu Rajasingham, held accountable.

Dr Rajasingham is accused of professional misconduct for not adequately monitoring Mrs Ross' urine, blood pressure and temperature.

He also is accused of failing to ascertain whether a central venous line was correctly inserted and functioning appropriately, and of not telling the surgeons about his concerns for the patient.

Mrs Ross was airlifted to Rotorua Hospital on December 11, 1996, after a car accident. She had 13 separate arm and leg fractures that took 6 1/2 hours to repair.

A coroner's inquest in 1997 found that Mrs Ross died shortly after surgery from a severe internal haemorrhage in her right chest cavity. An artery had been accidentally punctured during the insertion of a central line by Dr Rajasingham.

The 64-year-old anaesthetist had worked 16 hours before starting on Mrs Ross' lengthy operation and the coroner urged the profession to examine the issue of fatigue, although it was not proven to have contributed to Mrs Ross' death.

The Australian and New Zealand College of Anaesthetists drew up policy guidelines on fatigue.

A Health and Disability Commission inquiry later found that Dr Rajasingham failed to monitor his patient in line with professional standards.

Yesterday, Dr Malcolm Futter, an Auckland anaesthetist with more than 25 years' experience, said Dr Rajasingham had not taken basic steps such as inserting a urinary catheter that would have helped assess Mrs Ross' condition.

"Given the extent of Mrs Ross' injuries, there should have been concern for her blood loss and appropriate fluid replacement from the time of her arrival in hospital, and this should have become Dr Rajasingham's concern when she arrived in the operating theatre."

A central line was inserted about 1am and Mrs Ross' condition began to appear unstable - her heart rate rising and blood pressure dropping.

By 4:30am, Dr Rajasingham was worried about the position of the central line. Dr Futter said he should have then undertaken an urgent re-evaluation of Mrs Ross.

After the operation, a chest x-ray showed fluid in Mrs Ross' chest cavity. She died three hours later.

Dr Futter admitted under cross-examination that it was not uncommon for arteries to be punctured when central lines were inserted. Any punctures usually self-sealed, but for some reason this did not occur in Mrs Ross' case.

Defence lawyer Chris Hodson said Mrs Ross' blood pressure was monitored. Dr Rajasingham would explain in his evidence why her urine and temperature were not checked.

Mr Hodson said it was "more likely than not" that Dr Rajasingham had placed the central line in correctly and by the time he became concerned about Mrs Ross' condition a major part of the operation was in progress, and "there was little alternative but to allow the surgeons to continue".

The two-day hearing continues today. If found guilty, Dr Rajasingham faces possible suspension, censure, conditions on his employment or a fine of up to $20,000.