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THE Albury surgeon whose mistake with the scalpel led to the death of a patient had “unlimited privileges” to operate without supervision at Wodonga hospital, an inquest has heard.
Wodonga Coroner’s Court was yesterday told urologist Jonathan Lewin had successfully performed the surgery in question more than 20 times before the death of Corowa man Robert Hawkins.
Mr Hawkins died in February 2010 following a catastrophic bleed when Mr Lewin cut the wrong artery during laparoscopic surgery to remove his left kidney, at Wodonga Regional Health Service (now Albury Wodonga Health).
Deputy director of medical services at Albury Wodonga Health Glenn Davies yesterday said the hospital had gone above and beyond to ensure Mr Lewin was competent to perform the surgery — generally considered standard treatment for small kidney tumours — as no other doctors were performing it locally at the time.
Mr Davies said Mr Lewin was credentialled to perform all urologic surgery when appointed senior urologist in May 2009.
He had been a senior registrar for eight months when he had been directly supervised while operating.
His appointment was endorsed by the Royal Australasian College of Surgeons and his own supervisors had deemed him competent to perform the keyhole surgery without supervision.
Mr Davies said AWH’s committee had two extra supervision requirements of its own — both of which were met.
It had also relied on references from Mr Lewin’s mentors.
“My understanding is surgeons don’t provide references lightly — they’re one of the few ways for hospitals to gauge competency,” Mr Davies said.
Mr Lewin successfully performed seven surgeries at Wodonga before Mr Hawkins’ death, in addition to the 17 he did during his training.
The court had previously heard from Royal Melbourne Hospital’s head of urology Professor Anthony Costello, who had questioned Mr Lewin’s experience.
Professor Costello believed 17 surgeries was not enough to perform what he considered a “risky procedure” unsupervised, saying 40-plus was a more appropriate figure, and that only experienced surgeons in larger metropolitan centres should perform it.
There are no guidelines detailing how urologists should be credentialled for certain surgeries, leaving it to hospitals’ discretion.
Mr Davies said following Mr Hawkins’ death, all laparascopic surgeries were done at Albury hospital because it had a better equipped intensive-care unit.
AWH also conducted an audit of all prior nephrectomies, with nothing to report.
After his mistake, Mr Lewin had immediately switched to open surgery and had called general surgeon Neil Geddes to help, during which time a second artery — the main blood supply to the abdominal organs — was also cut.
The severed arteries were not revasculated and Mr Hawkins returned to intensive care at Albury hospital, but was flown to St Vincent’s Hospital in Melbourne 24 hours later, where he died two days later.
The court had previously heard from specialist urologist Shomik Sengupta, who believed Mr Lewin had acted appropriately and promptly throughout Mr Hawkins’ surgery and treatment.
The inquest before Coroner Jacinta Heffey continues today.