Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
9.5 The Theatre Manager described these two rapid sequence inductions as
follows:
“One weekend, there were two children in a row who had limbs to be
manipulated. A nurse asked Dr Lucas if he would gas induce the
children. This request made Dr Lucas quite irate. He would take out his
annoyance on patients, by being rough and aggressive. Dr Lucas left a
child on the table in the operating theatre (the mother was present in
theatre) and disappeared for about 45 minutes. Dr Lucas apparently did
not want to work with [the technician] in theatre. He was trying to find
another technician to come to theatre and work with him.”
Dr Lucas’ explanation
9.6 Dr Lucas advised me:
“Several months before this event my doing intravenous inductions in
children had become an issue and had not yet been resolved. I can
remember receiving a memo in which [the Group Manager (Hospital)]
asked the Department of Anaesthesia to develop some guidelines about
intravenous induction of anaesthesia in children but to my knowledge
nothing was done. In this case, while I was in the theatre getting ready
before the patient arrived [the] Nurse entered and started her
preparations. That I intended to do an intravenous induction came up in
the conversation and she said something to the effect, ‘I wouldn’t let you
give an anaesthetic to my child’. This made me feel quite unsupported
by the nursing staff. I wanted to have the induction to go smoothly and
so, before we got started, I asked the technician to come out into the
quiet and privacy of the pre-anaesthetic room where I could go over the
steps necessary for helping me. I thought asking her to come out there
would save her face if that was an issue. Her response was to get quite
angry and exclaim something to the effect of ‘Oh Brian, just get on with
it’ implying that I was being insufferable. She stormed back into the
theatre leaving me alone. Under these circumstances, I was not prepared
to anaesthetise the child. I went to the theatre office and first called [the
Head of the Department of Anaesthesia] for advice. He advised that I
call [the] chief anaesthetic technician who said she herself could not
come in. I explained to [the surgeon] what my problem was and he
seemed understanding. Finally, the nurse and technician arrived in the
office, I told them that the prerequisite for my doing the case with that
technician was that she listen to the way I wanted it done. She listened
and we did the case. I did not tell anyone that she refused to do the case
with me; I told them that I was afraid to start the case with her because I
did not trust her to help me in the manner that I wished.
I might add that this was the technician who seemed always to want to
help me in the way she had learned to help some other anaesthetist. For
example I can’t remember a single time that she inflated the cuff of an
endotracheal tube in the way that I had, repeatedly, requested. She
seemed more concerned than most nurses I have met about the
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