Gisborne Hospital Report - Health and Disability Commissioner

Gisborne Hospital 1999 – 2000
Operating Theatre Protocols
Opinion
not been a result of ignorance or cavalier pursuit of cost containment.
As much in response to changed attitudes as to a careful analysis of risk
it is now considered unacceptable to re-use syringes except, possibly,
under circumstances where there have been precautions taken to
eliminate any conceivable risk.
As your investigators’ research has shown, Dr Lucas came from a
culture that within the last ten years had accepted syringe re-use. It was
certainly accepted in New Zealand until a few years ago. It has to be
considered that the way the syringe is used will contribute enormously to
the risk that re-use poses. The two extremes are the re-use of a syringe
which has been in continuity with a system containing blood and re-use
when the syringe has been attached at a site remote from the patient, as
part of a system which contains valves to prevent backflow.
…
In reviewing Dr Lucas’ use of syringes it has to be admitted that it did
not conform to current standard practice and that when told that his
practice was unacceptable he may not have consistently modified it.
Whether this latter failure was intentional or a result of thoughtless habit
is not clear.”
3.36 At the core of this issue of re-use of syringes is the fact that though the risk of
transmission may be very small, no one can guarantee that it is non-existent.
In this situation there are two principles to be kept in mind. The first principle
is the prudent avoidance principle, which says that wherever possible risks
should be minimised, when it does not cost too much to do so. In the case of
re-use of syringes, there is very little convincing evidence offered that the cost
of new syringes was a major factor in the practice. It would therefore be in
keeping with this principle not to re-use. The second principle is the
precautionary one, which provides that when an activity raises threats of harm
to the environment or human health, precautionary measures should be taken
even if some cause and effect relationships are not established scientifically.
Again, according to this principle, there is no defence for re-using syringes.
(Editorial. Caution with the precautionary principle. Lancet, 2000;356
(9226):265)
3.37 In my opinion, although Dr Lucas’ re-use of syringes did not conform with
standard anaesthetic practice current in New Zealand from October 1999 to
March 2000, it appears that technically he did not breach professional
standards. The Australian and New Zealand College of Anaesthetists
introduced more stringent standards in May 2000. However, Dr Lucas
complied with anaesthetic standards in New Zealand at the relevant time, for
re-use of syringes, and therefore did not breach Right 4(2) of the Code.
3.38 Right 4(4) of the Code states that “every consumer has the right to have
services provided in a manner that minimises the potential harm to … that
consumer”.
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