16 February 2010
Louise Field field died from a lack of blood to the brain following an operation to cure excessive sweating. An anaesthetist who admitted making mistakes during a fatal operation to cure a woman’s excessive sweating poses a ‘continued risk’ to patients, a hearing has been told. Louise Field, 27, died two days after the operation, during which Dr Wasfy Yanny failed to treat her dipping oxygen levels. The trainee accountant had chosen to undergo pioneering treatment – which involves disabling nerves behind the ribs – to reduce embarrassing sweating on her hands and feet. Her oxygen levels fell after vascular surgeon Dr Michael Orminston accidentally punctured her lung and pumped carbon dioxide into her stomach, during the operation the Bupa Hospital in Harpenden, Herts in 2002. When Mrs Field was rushed to another hospital, Dr Yanny gave no indication she might have neurological problems, which was likely given her lack of oxygen, the General Medical Council was told yesterday. He also failed to inform the specialist registrar at Hemel Hempstead General Hospital about the drugs given or provide a anaesthetic chart. Dr Yanny then failed to apologise to Mrs Field’s worried family, saying that ‘these things happened.’
Mrs Field failed to come round after the operation, but her parents Patricia and Philip Green were initially told she would be fine. It was not until the following day that another doctor spotted a blown pupil and sent Mrs Field for a brain scan – which revealed probable brain stem death. After further tests Mrs Field’s life support machine was switched off. A post mortem found she died from a lack of blood to the brain. Dr Yanny and Dr Orminston have both been found guilty of ‘below the standard expected of a medical practitioner.’
Dr Wasfy Yanny admitted to making mistakes after failing to treat Mrs Field’s dipping oxygen levels. The GMC council also ruled their conduct was ‘inappropriate and not in the best interests of the patient.’ The doctors are now being dealt with separately. While Dr Yanny was cleared of incorrect clinical procedures and dishonesty, the GMC is now considering whether his fitness to practice is impaired. Dr Yanny admitted ‘mistakes’ during the operation. GMC spokesman Sarah Plaschkes told the hearing Dr Yanny did not adequately investigate the cause of the low oxygen levels and did not check the position of the oxygen tube. She said faith in the medical profession would be undermined if Dr Yanny’s conduct was not ‘not addressed by a finding of impairment’.
‘He gave no indication of neurological problems and nor did he inform the specialist registrar of drugs given. When he arrived at the hospital he still gave no indication of neurological problems and didn’t provide a anaesthetic chart,’ she said. She added that on leaving the hospital he spoke with Mrs Field’s family but said he had a ‘taxi waiting’.
‘He told them, “I can spare only a couple of minutes”,’ said Ms Plaschkes.
‘After the operation, Dr Yanny did not take sufficient steps to rectify problems and compounded the errors by failing to undertake a proper hand over, and by failing to communicate properly with the patient’s family.’ She said the panel had to be confident Dr Yanny would not do the same thing again. ‘[But] in our submissions there is no material before the panel which could satisfy it that Dr Yanny’s behaviour would be different if the same situation arose again. ‘There is a continued risk to patients.’Tags: court case, death, died, ets, excessive sweating, hyperhidrosis, louise field, negligence, ormiston, surgery, yanny
23 June 2009
A nurse in charge of an operation which left a fit and healthy woman brain dead was a novice who had never performed the procedure before, a hearing heard today. Louise Field, 27, died after a surgeon punctured her lung during an operation to cure her excessive sweating, the General Medical Council has heard. But theatre sister Helen Parker was newto the procedure and was not given any advice by the surgeon, it heard. She did not have enough experience to know Mrs Field’s life was in danger when her fingernails and lips turned blue, it was said.
Vascular surgeon Mr Michael Ormiston and anaesthetist Dr Wasfy Yanni are accused of making a series of blunders at the BUPA Hospital, Harpenden, Herts, on March 20, 2002. Sarah Plaschkes, for the GMC, asked the nurse if she had any conversation with Dr Ormiston prior to the procedure. Miss Parker said: ‘The morning of the procedure I asked Dr Ormiston if he required anything specific or instrumentation. He said no.’ Ms Plaschkes added: ‘Apart from asking if there was anything specific he needed, was that the extent of the conversation you had with him?’ Miss Parker answered ‘If I had wanted to know anything before then I would have telephoned Dr Ormiston the day before. ‘I think I probably said I haven’t undertaken that procedure before.’ It was claimed that Ormiston had failed to properly brief his scrub nurse to minimise the risks to Mrs Field.
The surgeon successfully deflated the patient’s right lung in order to burn through the nerve ending behind the rib cage. But problems occurred with the left lung when he punctured the wrong cavity and pumped carbon dioxide into her stomach and abdomen, it is claimed. When Miss Parker was shown the deflated right lung on the theatre television screen she failed to recognise a problem. ‘That was your first experience of ever seeing a deflated lung on a TV monitor wasn’t it?’ Ms Plaschkes said. ‘Yes,’ the nurse admitted. ‘It looked very similar to the right side.’ A few minutes later Mrs Field’s fingernails turned blue and the monitors started beeping, the panel was told.
Miss Parker explained: ‘I recall remarking that the fingernails were tinged blue. Her oxygen saturation levels I noted had gone down. ‘It suggested that the CO2 levels were low and the alarms were going off to indicate that.’ At this point Miss Parker became ‘frantic’ with worry, the panel heard. ‘I probably wasn’t looking very sedate and serene, and yes I would have been shouting rather quickly for some assistance. ‘I took the drapes off and I noticed her abdomen was distended,’ she added. High levels of carbon dioxide gas had leaked into Mrs Field’s chest and stomach, creeping up to her neck and face. Her skin was bloated and crackly to the touch, the GMC has heard. But the inexperienced sister had never seen anything like that before, the hearing was told. Miss Plaschkes asked: ‘At that time did you have any idea why her abdomen would have been distended?’. ‘No,’ she answered. ‘Had you ever seen anything like that before?’
‘No,’ she added. ‘I’m not experienced enough to say how extensive it was but it was on her face and chest. ‘It was when you felt it that you had that crinkly feel.’ Mrs Field stopped breathing during the operation and her brain was deprived of oxygen, killing the brain stem and all function, it is claimed. Miss Parker admits seeing the anaesthetist Yanni administer drug Mannitol to the patient to minimise the damage. Yanni faces charges he failed to tell medical staff or the family about the possibility of brain damage to the patient and covered up his administration of drugs.
Mrs Field, of Wheathampstead, Harpenden, was transferred to the intensive care unit at Hemel Hempstead General Hospital on the afternoon of her operation, March 20, 2002. It was not until the following day when another doctor recognised two blown pupils indicating brain damage, the GMC was told. The trainee accountant was transferred to a specialist neurological hospital in Queens Square, London, where her life machine was switched off on March 22. Ormiston and Yanni face a total of 42 charges relating to the inappropriate treatment of Louise Field.
A postmortem revealed Louise died from a lack of blood supply to the brain caused by damage to her lungs. A pathologist found a puncture wound to her left lung, the hearing was told. Ormiston punctured the lung with an endoscopic tube by mistake before pumping high levels of CO2 through the hole into her stomach, the GMC allege. Yanni failed to stop the surgery despite dangerously low oxygen levels. Ormiston, and Yanni both deny misconduct.Tags: court case, death, died, ets, excessive sweating, hyperhidrosis, louise field, negligence, ormiston, surgery, yanny
16 June 2009
A ‘fit and healthy’ young woman was left brain dead after a pioneering operation to reduce her excessive sweating went catastrophically wrong, a medical panel has heard. Louise Field, 27, suffered severe brain damage when doctors accidentally punctured her lung and pumped gas into her stomach, the General Medical Council heard. She died two days later. Vascular surgeon Dr Michael Ormiston and anaesthetist Dr Wasfy Yanny face a catalogue of charges arising from the bungled operation at a Bupa Hospital in Harpenden, Hertfordshire.
Dr Ormiston, who had carried out the operation a handful of times, first punctured the keen sportswoman’s lung with a needle then pumped carbon dioxide into her stomach. Dr Yanny failed to take action when Ms Field’s oxygen levels dropped dangerously low and should have realised this damaged the patient’s brain, the hearing was told. Ms Field hadchosen to undergo an operation to reduce heavy sweating on her hands and feet, the GMC heard.
Sarah Plaschkes, for the GMC, told the hearing: ‘She was born on February 18, 1975, and was to die tragically on March 22, 2002, aged just 27. ‘She was fit and healthy and played a lot of sport however she was embarrassed by excessive sweating of the hands and feet. ‘Around the end of 2001, she became aware of an operation that could potentially cure this embarrassing condition and went to see her GP as previous medication had not worked.’ Ms Field chose to have a ‘bilateral endoscopic transthoracic sympathectomy’ – an operation to suppress nerves behind her left and right ribs. The procedure involved a key hole incision to deflate her lungs one at a time to access the hard-to-reach point.
Dr Ormiston performed the surgery at the Bupa Hospital, Harpenden, now called the Spire Harpenden Hospital. It was the first time this procedure had been done at the hospital and only the fifth or sixth time it had been performed by Ormiston, the hearing was told. The operation was successful with the right lung but problems occurred with the left lung, the panel heard. Ms Plaschkes explained: ‘The anaesthetic chart completed by Dr Yanni shows that for a substantial part of this procedure the patient’s oxygen saturation was at about 85 to 90 per cent. ‘It is the GMC’s case that this saturation level should have concerned both the anaesthetist and the surgeon.
‘An oxygen saturation of that level is out of the ordinary and it is the council’s case that unless the anaesthetist was clear about the cause of that low oxygen saturation and was satisfied it was safe to continue to the left side. ‘Both the anaesthetist and the surgeon should not have continued and the surgery should not have taken place on the patient’s left side.’ Dr Yanny should have told Dr Ormiston to abandon the surgery, the GMC claimed. But Dr Ormiston placed a needle in the wrong section of the left lung, then punctured it with an endoscopic tube. The surgeon then pumped more than three litres of carbon dioxide into the misplaced tube. Dr Yanni ignored alarms alerting him to the patient’s dropping oxygen levels and told the surgeon to continue, the panel heard. Ms Field turned blue and her entire body swelled up from the gas in her stomach and abdomen. ‘By this stage clearly something or things were amiss and undiagnosed,’ said Miss Plaschkes.
‘Theatre staff noted that the patient’s abdomen became distended. Her face and chest were swollen and felt bubbly to the touch. ‘She had developed gas under the skin.’ Ms Plaschkes said the doctors made a ‘grave error in judgement’ in continuing with the operation. When the patient stopped breathing, Dr Yanny administered drugs to ease any damage to her brain and attempted to take Mrs Field off the ventilator, the GMC heard. Ms Plaschkes added: ‘It is our case that Dr Yanny must have been aware that this patient had suffered a period of hypoxia – a lack of oxygen to her brain – and low blood pressure, which was sufficient for this patient to sustain brain damage.’ Ms Field would not wake up after the botched operation so was transferred to Hemel Hempstead General Hospital’s intensive care unit. It is claimed both doctors then failed to tell the family or staff at the second hospital about the risk of brain damage. When doctors assessed her on March 21 they discovered her pupils were dilated and unresponsive to light. She was transferred to a specialist neurological hospital in London where tests revealed she was brain dead as a result of the operation.
Ms Field’s life support machine was turned off on March 22. Dr Ormiston faces 17 charges relating to the botched operation while Dr Yanny faces 25 allegations. Dr Ormiston, from St Albans, Hertfordshire, and Dr Yanny, from Harpenden, Hertfordshire, both deny misconduct. The hearing continues.Tags: court case, death, died, ets, excessive sweating, hyperhidrosis, louise field, negligence, ormiston, surgery, yanny