THE family of a well-known local businessman who died at Withybush Hospital following surgery for bowel cancer have pushed for a verdict of neglect at an inquest in to his death.
Well-known and popular Malcolm Green, of Green’s Motors in Haverfordwest, was an active 82-year-old when he went in to hospital to have a tumour growing on the right of his colon removed.
Mr Green suffered from pre-existing health issues but was deemed in good enough health to undergo the procedure, which took place on June 26, 2012.
Surgeon Dr Otumeluke Umughele planned to use the “keyhole method” to remove the tumour. Lesions caused by previous abdominal surgery in 1994 for an aortic aneurism repair meant open surgery was required, and Mr Green and spent longer in theatre as a result.
He returned to the ward that night and was monitored approximately every two hours.
A blood pressure check at 6.30am on June 27 revealed a low reading of 66 over 40. Staff nurse Stephanie Reynolds called Dr Roger Lane – a senior house officer who qualified two years previously - to review Mr Green’s condition. Dr Lane correctly diagnosed Hypovolemia (decreased blood volume) and upped Mr Green’s fluid intake.
As the morning progressed, Mr Green’s condition deteriorated and he felt pain. At first he was thought to have a cardiac issue or a pulmonary embolism, but he had internal bleeding. He was assessed by the medical and anaesthetic teams and transferred to an operating theatre to receive intensive care, as there were no spaces in the HDU (High Dependency Unit). By this time he was unresponsive. He was resuscitated and given a blood transfusion. At 1pm he underwent a second procedure by Dr Umughele, who found clotted blood in his abdomen and located and stopped the internal bleeding.
Following the operation Mr Green developed multiple organ failure and could not be revived. His treatment was withdrawn and he died on June 30.
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. Mr Glynn also asked why, given his age and medical history, Mr Green was not sent to the HDU following surgery for more intensive post-operative monitoring.
A post mortem examination the primary cause of death to be coronary and hypertensive heart disease, exacerbated by the major bowel surgery.
Expert witness, Professor of surgery and ex-bowel surgeon Michael Keighley, said a number of markers indicating Mr Green was bleeding internally were missed.
“I believe, on balance, that if that if the blood loss had been stopped by 10.15am Mr Green would not have developed multiple organ failure and died. He would probably have survived if he had been operated on earlier,” said Prof. Keighley.
Dr Ian Robertson-Steel, a registered medical practitioner who at the time of Mr Green’s death was director of clinical care at Withybush Hospital, said there were “key learning concerns” from his case that the Hywel Dda Health Board have since “taken forward”.
Assistant Coroner Michael Howells retired to consider the evidence, and will deliver his verdict in writing in due course.