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Patient’s appendix may have ruptured before he was seen

Life-threatening complications relating to an appendectomy could have been present before a man arrived at King Edward VII Memorial Hospital for treatment, according to an expert.

Kamal Williams is suing Bermuda Hospitals Board for $100,000, claiming that his appendix ruptured because he had to wait seven hours before he was operated on.

Alisdair Conn, Head of Surgery at Massachusetts General Hospital, said that Mr Williams’ appendix may have ruptured before he reached the hospital, based on fluids found by surgeons in his abdominal cavity.

The court heard that on May 30 last year, Mr Williams arrived at the hospital complaining of severe pain in his abdomen.

Within an hour of his arrival a doctor determined that Mr Williams might be suffering from acute appendicitis but that his appendix had likely not ruptured, and ordered a CT scan.

Mr Williams received the scan five hours later; the results of the scan were given to doctors more than two hours after that.

His surgery began at 9.24pm, more than ten hours after Mr Williams arrived at KEMH. Doctors then discovered that his appendix had ruptured, leaking fecal material into his abdominal cavity and sending him into septic shock.

A patient who receives a routine appendectomy is usually released from the hospital after a day or two; Mr Williams remained in the ICU for two weeks. His lawyer, Jai Pachai, said he has suffered lasting injuries to his heart, lungs and digestive system as a result of the incident.

Michael Leitman of New York’s Beth Israel Medical Center told the Supreme Court in such urgent circumstances, surgery should be carried out as soon as possible. He said that Mr Williams could have been in surgery within two to ten hours.

Based on studies at several US hospitals, a 12-hour time frame between admission and surgery is closer to the standard, Dr Conn insisted.

He cited a study that showed that patients at one US hospital on average waited ten to 14 hours after arriving in the Emergency Department before undergoing surgery, a time frame he described as acceptable. A study at another hospital showed results of between eight and ten hours, which he called “very good”.

Asked about his own hospital, Dr Conn said he was fortunate to have two CT scanners and a 24-hour radiologist in the Emergency Department. As a result, he estimated it would take only around four to five hours to get a patient suffering from appendicitis to surgery.

He called Dr Leitman’s four-hour suggested standard “pretty aggressive” noting that a study co-authored by Dr Leitman found that it takes on average 4.3 hours to receive a CT scan at Beth Israel Medical Centre.

Questioned about the progression of the illness in Mr Williams’ case, he said it was possible that the appendix may have perforated before he arrived at the hospital or earlier in the day, based on the quantity of pus found in his abdomen.

He said that if the appendix had ruptured late in Mr Williams’ time in hospital, pus would not have had time to form. Instead, he said surgeons would have likely found fecal matter in his abdominal cavity.

Dr Conn described the incident as a “worst case scenario”. He agreed that Mr Williams had survived a life-threatening situation, but said all of the doctors involved acted reasonably with the information available.

He acknowledged and agreed that the CT scan should have been performed quicker and the results should have been presented to doctors sooner.

The court heard that following the incident the hospital carried out a root cause analysis, which found that a STAT system to expedite the CT scan process for urgent patients and better communication between doctors should be established.

Mr Pachai said that the report indicated that the hospital was not meeting standard care, but Dr Conn said that the report only indicated that there was room for improvement.

He reiterated that the time between when Mr Williams attended the hospital and when he went under the knife met acceptable standards.

Bermuda Hospitals Board lawyer Allan Doughty described the report as a “frank and blunt self assessment” and said the hospital had treated Mr Williams properly, given the circumstances.

“What Mr Williams went through was undoubtedly a horrible experience that I wouldn’t want anyone to go through, but the standard of care was met,” he said.

Mr Pachai described the delay in receiving scans as excessive. He said if the scans were expedited Mr Williams’ appendix might never have ruptured, and noted that early examinations showed no evidence it had perforated.

Kamal Williams with his lawyer, Jai Pachai. (Photo by Mark Tatem)

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Published December 05, 2012 at 8:00 am (Updated December 05, 2012 at 1:01 am)

Patient’s appendix may have ruptured before he was seen

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