Inquest into death of Haverfordwest businessman Malcolm Green told of delays to emergency surgery

Western Telegraph: Malcolm Green Malcolm Green

AN INQUEST in to the death of well-known and well-liked local businessman Malcolm Green opened today at the Pembrokeshire Coroner’s Court in Milford Haven.

Husband, father and grand-father Mr Green, of Green’s Motors in Haverfordwest, died at Withybush Hospital on June 30, 2012, following surgery on June 26 to remove a tumour from the right side of his colon.

He was 82, and although still active – playing golf and continuing to work - suffered from pre-existing hypertension, type 2 diabetes and stage three kidney disease.

Surgeon Dr Otumeluke Umughele hoped to remove Mr Green’s tumour using the less intrusive “key-hole” method, but lesions caused by previous abdominal surgery for an aortic aneurism repair meant he could not see the necessary markers required to safely carry out the procedure.

Instead, Mr Green underwent open surgery and spent longer in theatre as a result.

During the night following his surgery, Mr Green was monitored approximately every two hours. A blood pressure check at 6.30am on June 27 revealed a dangerously low reading of 66 over 40, and staff nurse Stephanie Reynolds called Dr Roger Lane to review Mr Green’s condition. He was given fluids and his blood pressure returned to the normal range.

Nurse Reynolds told the court she was on duty with one other staff nurse, and they each had 15 patients to care for, supported by two Healthcare Assistants. When questioned, she said this was the “normal ratio” of cover for a night shift.

As the morning progressed, Mr Green’s condition deteriorated and he said he was feeling pain. At first he was thought to have a cardiac issue, but it became clear he had internal bleeding. He was assessed by the medical and anaesthetic team and transferred to an operating theatre to receive intensive care, as there were no spaces in the HDU (High Dependency Unit). At 1pm he underwent a second procedure by Dr Umughele, who found clotted blood in his abdomen and managed to locate and stop the internal bleeding.

Mr Green could not be revived. He later died, surrounded by his family.

Statements given by Dr Umughele and consultant anaesthetist Dr Joel Green contradicted each other, with Dr Green saying he had to visit his colleague at his clinic to impress upon him the seriousness of Mr Green’s condition and his need for emergency surgery. Dr Umughele did not mention this visit. He said the anaesthetists were waiting for blood products to arrive before surgery could commence. He assumed he would be called when they did, so he had returned to seeing other patients in the meantime.

Through their legal representative, Mr Stephen Glynn, the Green family raised concerns about Mr Green’s care following his first operation, and wanted to know why it had taken so long for his second surgical procedure to take place.

John Green, one of the deceased’s two sons, told the court theirs was “a very close family” and he had seen his father every day when he was alive. In his statement to the court, John Green said when he asked Dr Umughele why his father’s surgery had not been performed earlier, he said it was because “he had been in a meeting”, a response which “shocked” John Green.

Assistant Coroner Mr Michael Howells told John Green he was sorry for his loss, and said: “Like most people in Pembrokeshire, I knew your father. He was a fine man.”

A post mortem examination found Mr Green had an enlarged and damaged heart, and had suffered multiple organ failure. The cause of death was reported as ischaemic (or coronary) and hypertensive heart disease.

The inquest will resume tomorrow.

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