By JR on Thursday, March 31, 2011
A COMPETENT surgeon should have known the reason for Heidi Clarke-Lewis' massive blood loss and been able to do something about it, an inquest into her death was told yesterday.
Professor Andrew Korda told the inquest a sharp medical tool known as a trocar had struck the 29-year-old's spine during an operation to remove an ectopic pregnancy, causing the fit, healthy patient to bleed to death.
Giving expert evidence yesterday, Professor Korda said it would have been "like hitting a nail into a wooden table" and should have alerted surgeon Dr Samy Nassief to the possibility of damage to major vessels.
Professor Korda agreed with assisting counsel Peggy Dwyer that he would have expected a "competent general surgeon" to identify the source of the bleeding, clamp major arteries and call for assistance if needed. "Most general surgeons should have enough rudimentary knowledge to repair a vascular injury," Professor Korda said.
Ms Clarke-Lewis died during the surgery for the ectopic pregnancy at Wagga Wagga Base Hospital on April 30, 2009.
A post-mortem examination found she died from an intra-abdominal haemorrhage, after injuries to her right common iliac artery and vein. Professor Korda said the trocar caused the damage to the artery, after entering her body about 2-3cm off target, and resulted in Ms Clarke-Lewis losing more than four litres of blood.
Dr Nassief should have made a larger incision to look for the site of the bleeding about 10-15 minutes into the surgery, he said.
"The appropriate response would have been to extend the incision and try and find out where the bleeding was coming from," Professor Korda said.
A second doctor called in to assist Dr Nassief made that larger incision after arriving in theatre about 90 minutes later but was not able to find the direct source of the bleeding in the time.
Nurse Cherie Anderson has previously told the inquest that she believed the trocar's safety mechanism failed, meaning that a sharp blade had been exposed within the stomach of Ms Clarke-Lewis.
Professor Korda said: "If a trocar is inserted in a manner in which it hits the fifth lumbar vertebra, no safety mechanism will protect the patient."
But he was not critical of Dr Nassief's decision to operate on Ms Clarke-Lewis because he said ectopic pregnancies were unpredictable.