Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
Dr Lucas’ explanation
8.15 Dr Lucas remembered quite a lot about the fentanyl incident:
“I did not inform the patient that I was going to give her fentanyl. She
arrived in the theatre being described by the nurses and technicians as
being terrified before I had said a word to her.”
8.16 Dr Lucas took a careful history of the events of the patient’s last anaesthetic,
and concluded that whatever misadventure caused the crisis it was not a drug
allergy. Dr Lucas advised me:
“When I met her on the morning of surgery … I took a careful history of
the events of that anaesthetic, as would be expected of a consultant
anaesthetist, and concluded that whatever misadventure had caused the
crisis, it was not a drug allergy.”
8.17 Dr Lucas felt that the patient had been mislabelled or misdiagnosed. Dr Lucas
stated that while there are other narcotic alternatives to fentanyl, it is an
excellent, widely used narcotic and he believed that it was not in the patient’s
best interests to spend the rest of her life not having fentanyl available to her.
Dr Lucas had discussed the issue with the patient prior to the procedure.
During the anaesthetic and thus in a very controlled clinical environment, with
her airway intubated and ventilated, and with all the resuscitative drugs for
anaphylaxis close at hand, Dr Lucas first administered a tiny test dose of
fentanyl. When the patient’s condition remained absolutely stable, Dr Lucas
continued to use fentanyl as the intra-operative narcotic. The patient was alert
when Dr Lucas took her to the recovery room. When Dr Lucas reported the
events to the recovery room nurse she seemed appalled. When Dr Lucas
explained to the patient what he had done, it was his impression that she
thanked him very sincerely.
8.18 When asked specifically whether the patient gave her consent for him to test
and trial fentanyl on her when she was asleep, Dr Lucas responded that no, the
patient did not give her consent, but she did not forbid him to use fentanyl.
The patient was terrified of the prospect of fentanyl anaesthesia because of
what had previously happened to her. Dr Lucas did not think it was true to say
that the whole debate about fentanyl terrified her. Dr Lucas believes that he
did not push the issue about asking her for permission to use fentanyl. In his
response to my provisional opinion Dr Lucas summed up his position as
follows:
“I did not give an anaesthetic without consent. I had the patient’s
consent to give an anaesthetic and from my discussions with her I
believed that she did not forbid me to give her fentanyl.”
8.19 Dr Lucas advised that he thought it was relevant that the patient was a nurse.
He felt betrayed by her because he thought she had thanked him.
8.20 Dr Lucas’ view before the operation was that the patient was not allergic to
fentanyl. She did not give a history in any way consistent with anaphylactic
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