DOCTORS involved in the emergency treatment of a Corowa man who suffered a catastrophic bleed during surgery at Wodonga hospital did not know a second vital artery had been cut, a court has heard.
That discovery was made the next day, when Robert Hawkins, 55, had a CT scan after his condition in Albury hospital’s intensive care unit had worsened.
Mr Hawkins died in February 2010 following complications when Albury urologist Jonathan Lewin cut the wrong artery during laparoscopic surgery to remove his left kidney and the tumour attached to it at Wodonga Regional Health Service (now Albury Wodonga Health).
Giving evidence to the inquest at Wodonga Coroner’s Court yesterday, Mr Lewin said the straightforward surgery was complicated in part by the size of Mr Hawkins’ tumour, which had pushed his kidney into a position difficult to access — factors that only became clear during surgery.
Immediately realising he had cut the blood supply to the small bowel and not the kidney, Mr Lewin switched to open surgery, stopped the bleeding with clamps and called for a senior surgeon with vascular experience.
General surgeon Neil Geddes “took control of the situation”, tying off the cut artery.
No attempt was made to rejoin the artery — Mr Lewin told the court that after three hours of emergency surgery, the small bowel was “pink and moving”, indicating it was healthy.
Mr Lewin said Mr Geddes was satisfied with the blood flow reaching it and so he “deferred to his experience and expertise”.
Mr Lewin said he specifically asked if another artery, the coeliac axis — the main blood supply to the abdominal organs — was intact and Mr Geddes had said it was.
But a CT scan the next morning, prompted by Mr Hawkins’ condition, showed it was severed.
Asked by coroner Jacinta Heffey whether this was something that should have been seen earlier, Mr Lewin said no, because it was located “quite deep” and was difficult to see.
The court previously heard if a cut artery to the small bowel was not re-attached within three to four hours, death is almost certain.
Mr Lewin said he was not aware of that time period until after this incident.
Ms Heffey asked if there was any discussion about transferring Mr Hawkins for vascular surgery, but Mr Lewin said he could not recall: “My view at the time was to stabalise and transfer him to the local ICU as quickly as possible.”
ICU doctors told the court Mr Hawkins was too unstable to transfer to Melbourne any earlier than the next day.
Mr Lewin said he “remained deeply affected by the death of Mr Hawkins”, but after advice from senior surgeons and a review of research, “I am satisfied it was an error that arose from the unusual anatomical circumstances ... rather than a lack of competence.”
The inquest will continue in Melbourne at a later date, with the coroner still to hear from Mr Geddes.