Australia has over 4,300 specialist anaesthetists, making anaesthesia the most significant medical specialty after General Practice. In addition to working with surgeons in operating theatres, anaesthetists lead pre-hospital retrieval teams, hospital resuscitation teams, high-dependency care areas of hospitals, and acute and chronic pain services. Because of their work across several hospital areas, anaesthetists are often found on hospital management and advisory committees, making anaesthetists, in addition to providing opinions on adverse surgical events, well placed to provide independent views upon broader and system-wide standards of care.  

The following summaries are taken from cases where it has been necessary to find an anaesthetist with experience specific to the matter under investigation to be instructed.  

Does continuing surgery after cardiac arrest constitute professional misconduct? 

Whilst undergoing cosmetic surgery in a suburban day surgery centre, a patient suffered a cardiac arrest. A professional conduct complaint was made to the OHO against the surgeon for continuing to operate after successful treatment of the cardiac arrest because of the elective nature of the surgery. An Anaesthetist was asked to provide an opinion on the treatment of cardiac arrest and upon the conduct of the surgeon for continuing to operate after cardiac arrest. 

Index Medicolegal’s expert anaesthetist had worked in similar day surgery facilities to the case in question to provide an opinion.  

Unreasonable delay in providing blood transfusion in Private Hospital 

In the operating theatre recovery ward in a small private hospital, a patient who had undergone an earlier surgical procedure was found to be anaemic and needed to return to the theatre urgently to identify the source of ongoing blood loss. It was determined that an emergency blood transfusion was required before the second anaesthetic could be safely administered. Two units of packed blood cells were urgently cross-matched and dispatched from an offsite private pathology laboratory. The blood bank issued blood packs that the courier transported to the private hospital but never arrived in the operating theatre complex for administration to the patient, leading to delay.  

After waiting more than two hours for the blood to arrive in the theatre recovery ward, the surgeon and anaesthetist transferred the patient by ambulance to the local public hospital, where two units of blood were crossmatched and transfused.  

Index’s expert anaesthetist regularly undertook work in both public and private health care facilities and sat upon a hospital theatre management committee was asked to provide a report to the Department of Health on the adequacy of procedures for out-of-hours emergency blood transfusions in private hospitals. 

Who bears responsibility for patient positioning during urological surgery?  

An older adult with osteoporosis suffered an injury to his hip whilst positioned in lithotomy for an elective minor urological procedure that left him immobile and no longer able to live independently. A negligence claim was brought against the urologist for inadequate standard of care in positioning the surgeon for breach of duty in positioning the patient. The surgeon claimed that placing a patient for surgery was not their duty but the duty of the Anaesthetist.  Several opinions were sought, with conflicting views on where the responsibility of patient positioning lies.  

Index Medicolegal’s expert anaesthetist, who worked with urological surgeons in several healthcare facilities, reviewed the matter and provided an opinion as to which members of the operating teams were usually responsible for patient positioning. 

Adequacy of resuscitation equipment in suburban Radiology Practice 

An elderly patient underwent an invasive procedure in a suburban radiology practice and, whilst recovering from the procedure, became hypotensive and suffered a cardiac arrest. CPR was commenced, but the patient did not regain consciousness and was declared deceased upon arrival at the local hospital.  

Index Medicolegal’s expert anaesthetist provided an opinion from a specialist anaesthetist instructed by the solicitor representing the deceased’s family to give an opinion on whether the adequacy of resuscitation care and emergency medical equipment available in the radiology practice was reasonable. 

Brachial plexus injury occurring during prolonged surgery 

A male patient who underwent prolonged abdominal surgery lasting more than 6 hours developed a nerve compression injury to his upper arm that he did not recover from—resulting in the patient not returning to their usual occupation. The patient claimed the anaesthetist had failed in his standard of care by not adequately cushioning the patient’s arms during the procedure.  

Index Medicolegal’s anaesthetist reviewed papers that recorded that the surgeon had repeatedly been asked not to press on the patient’s arm during the surgery. The claim against the anaesthetist was withdrawn.  

Epilepsy During Anaesthesia for Colonoscopy 

Whilst undergoing an elective colonoscopy, a middle-aged woman who worked as a school bus driver was administered procedural sedation using propofol, midazolam and fentanyl by a specialist anaesthetist. During the procedure, the patient exhibited seizure-like generalised muscle contractions, causing the procedure to be abandoned, anti-seizure medications administered, and the patient transferred to intensive care where, after EEG testing, a neurologist gave a diagnosis of epilepsy, resulting in a loss of licence and loss of employment. A case was brought against the anaesthetist for administering incorrect doses of anaesthetic drugs causing epilepsy. 

Index Medicolegal’s expert was an anaesthetist with expertise in day surgery sedation and adverse reactions to anaesthetic drugs who provided an opinion as to whether the choice and doses of medications administered were reasonable and whether administration of those drugs would have resulted in a diagnosis of epilepsy.  

Local Anaesthetic Eye Block by GP Anaesthetist 

An elderly patient underwent cataract surgery under a local anaesthetic nerve block in a day surgery centre. The nerve block was undertaken by a non-specialist GP anaesthetist and performed with the patient sitting upright in a chair. Within a few weeks, the patient developed neuralgic pain in the infraorbital nerve distribution that subsequently spread to involve the maxillary division of the trigeminal nerve, preventing the patient from chewing food and speaking normally. 

Index Medicolegal was able to provide an opinion from an expert specialist anaesthetist who had previously been a GP anaesthetist who was asked to give an opinion as to whether performing a local anaesthetic eye block in the sitting position was usual practice and whether there was any link between achieving a local anaesthetic eye block in the sitting position and the development of trigeminal neuralgia.