Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
shock. He considered that she had had a reaction. He believed that he would
help her if he could prove to her that she was not allergic to fentanyl. He said
he was motivated by the prospect of restoring to this patient “the availability
of a very useful narcotic and at the same time dispelling a delusion about
allergy that was terrifying her”.
The surgeon’s view
8.21 The patient’s surgeon, Dr Ian Burton, thought that it had been explained to the
patient outside the theatre that fentanyl would be used. “She may have been
so frightened that she would suffer a significant reaction that it was difficult to
determine whether consent was informed.” Dr Burton stated that if he had
honestly thought that the patient would suffer an anaphylactic reaction, then he
would have cautioned Dr Lucas against using fentanyl. Dr Lucas said he does
not know how Dr Burton could have known he was going to use fentanyl. He
had discussed it with the patient, and no one else, until afterwards.
8.22 The surgeon said that he admired Dr Lucas for taking such a courageous step
and testing the patient’s response to the drug. The surgeon carefully reviewed
the notes and listened to the anaesthetist. He was satisfied that Dr Lucas was
not taking an unnecessary risk.
8.23 The surgeon described being almost able to “feel the antagonism of the
nursing staff present at the operation”.
The records and pre-anaesthetic checks
8.24 The undated pre-anaesthetic record for this patient is described in para 8.5. It
recorded the fentanyl allergy and adds under the heading “Other” “description
of allergy that of simple overdose in patient without IV fluids’”, and notes
under the “Plan” “Give fentanyl under controlled conditions to R/O [rule out]
allergy …”. The handwriting on this form appears to be that of Dr Lucas.
8.25 While at THL, Dr Lucas stated that he did “quite a bit of the pre-anaesthetic
clinic work”. He continued:
“Consent was not an issue at the pre-anaesthetic clinic because I was
assessing people and checking out their health pre-anaesthetic. I was not
determining or doing informed consent at a pre-anaesthetic clinic. I
pointed out to patients at pre-anaesthetic clinic that I would not
necessarily be the one who was going to give them their anaesthetic
before their surgery.”
8.26 A colleague made the following observations about the pre-anaesthetic clinic
Dr Lucas worked in every Monday:
“He dealt with the difficult and complex cases and gave a detailed
excellent report on each patient and was extremely helpful. I am sorry
that this is not continued anymore .… For every consultation done by
Dr Lucas there was usually at least one page of history, examination and
105