Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
13.4 A nurse reported seeing Dr Lucas wake patients before their operations were
finished. She remembered the case of a patient with a hernia who woke
before the operation was finished and coughed. The nurse commented that
“you could almost hear the stitches going”.
13.5 One anaesthetic technician saw Dr Lucas’ patients coming out of anaesthetic
early but not regularly. The technician commented that waking patients is
not an exact science:
“A couple of times, when Dr Lucas had been riled by the nurses in
theatre, patients had woken early but it was hard to say whether the two
were connected (ie, Dr Lucas being riled and the patients waking early).
It was not for me to comment on this aspect of anaesthetic practice. Dr
Lucas knew patients were waking up.”
Dr Lucas described any suggestion that he woke patients up early in response
to being angry with nurses as “hideous”. He stated that “my measure of
excellence is to have the patient respond to (not be conscious of) the last skin
stitch”.
13.6 A member of the nursing staff noted that in one instance Dr Lucas asked for
a patient to be put into the lithotomy position (legs up in stirrups) before the
patient was under anaesthetic. Dr Lucas said of that situation, “when they
got to the stage in the procedure where the patient’s legs could be put in the
lithotomy position, [the patient] said I’d like to go to sleep”. This incident
was the subject of an incident report described below (see paras 13.7 – 13.9).
In addition, the patient wrote to me about her treatment (see para 6.12).
Incident report
13.7 The Theatre Manager described an incident involving a patient who
requested a general anaesthetic but was told by Dr Lucas that she was to have
a spinal. “The patient cried. The patient’s legs were in the lithotomy
[position] .... When the surgery started the patient could feel the procedure.
Dr Lucas then had to administer a general anaesthetic and he was very rough
and jerked her head back. [The nurse] was very upset so she went to Dan
Madden and insisted he come down.”
13.8 The nurse recorded in a handwritten incident report that was never registered
by THL that Dr Lucas instructed two nurses to position the patient (who
preferred a general to an epidural) into the lithotomy position while she was
still awake. The nurse “spoke to Dr Lucas and stated that the patient did not
want to be awake when the operation was being done or when her legs were
in lithotomy and he then proceeded to forcefully administer the general
anaesthetic”.
13.9 An anaesthetic technician recalled that Dr Lucas woke this same patient
while she was still in the lithotomy position. The patient had specifically
requested to be asleep during her operation. Dr Lucas told her she was to
have a spinal. After considerable debate Dr Lucas gave her a general. “As a
result Dr Lucas was obnoxious toward everyone, but more so to the patient.”
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