A five-year-old girl died during an operation when a trainee surgeon used an unfamiliar piece of equipment without her parents' knowledge, an inquest heard yesterday. Bethany Bowen died after the morcellator, a coring device with a blade, cut through a major blood vessel during the operation to remove her spleen.
Richard Bowen, her father, told the hearing that the first he and his wife had heard that surgeons were using a new piece of equipment was in the days after Bethany's death. Richard Whittington, the coroner, asked Mr Bowen if he would have given his consent if he knew a different surgical method was to be used during the operation in July 2006 at the John Radcliffe Hospital, Oxford. He replied: "We absolutely and completely trusted the people involved. If they had said they were using new equipment they had never used before, that was a different matter. You would think, `It is a new piece of equipment - why are they using it now?'."
Stephen Gould, a consultant paediatric pathologist who carried out the postmortem examination, told Oxford Coroner's Court that he had never before seen the type of internal injuries he found in Bethany's body. He could not give an accurate cause of death, adding later that the aorta could have been twisted and torn. He said that Kakina Lakhoo, the hospital's consultant paediatric surgeon, told him that the most likely cause of trauma was the morcellator. He added that he had never heard of the device.
Bethany, who lived with her parents and two brothers in Cricklade, Wiltshire, suffered from spherocytosis, a hereditary condition. It involves the body producing the wrong-shaped red blood cells, which are attacked and destroyed by the spleen. The anaemia it causes can be cured only by removing the spleen. Mr Bowen said that despite her condition Bethany was a "happy and lively" little girl who had a "whale of a time" during her first year at school.
The inquest heard that her brother, William, also had the condition and had his spleen operation when he was 2. Mr Bowen said he had assumed that the same surgeon who had carried out William's operation would conduct Bethany's. The inquest heard, however, that William Sherwood, a trainee surgeon, carried out the procedure on July 27 last year, despite having had no substantial training in using the morcellator device.
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Australia: House full, overstretched midwives at NSW public hospital warn
SENIOR staff at the state's busiest hospital have threatened to close its doors to women in labour because there are not enough midwives or beds to cope with the baby boom and they fear lives are in danger. Angry midwives at Royal Prince Alfred Hospital in Camperdown wrote to the Herald to complain women were left to labour in chairs because the beds were full, and that they were asked daily to work double shifts to cope with demand. They said the maternity unit was down 29 midwives, and some staff were working three shifts in a 34-hour period.
"Our maternity services are stretched beyond a safe working capacity. We are constantly . asked to care for more mothers and babies than is humanly possible," one midwife, who sought to remain anonymous, said. "Patient safety is continually compromised . bed block is occurring every day. Delivery suite is constantly overcrowded with 14 women in an 11-bed unit and unsafe staffing levels." She said staff had requested that the maternity unit be closed to new patients when full or overcrowded to ensure its safe operation, and that women be transferred to other maternity units in the area.
"Our members have told us it is a complete crisis," said Hannah Dahlen, secretary of the NSW Midwives Association. "They have had vacancies they cannot fill, the staff are burning out and going elsewhere - they are getting desperate." While Ms Dahlen said that many other hospitals were in similar dire straits, she said Royal Prince Alfred was experiencing particular pressures because of a local baby boom. More than 5000 babies were delivered at the hospital last year - almost 1000 more than expected. "That is a 25 per cent increase in the birthrate, and there hasn't been a staff increase, in fact staff have been leaving." Add to that a crisis in the midwife workforce, where up to 600 positions are vacant across the state, and there was an increasing likelihood of mistakes and other problems occurring.
"The gold standard is one midwife to one woman, yet what we currently have is three labouring women to one midwife - it isn't the best care and we do know that the risk of adverse events increases when that happens." It was understandable that the midwives had chosen to make their complaints via a series of unsigned letters to the Herald, given all staff were under threat of disciplinary action if they spoke out against the state's area health services, she said.
However the executive director of Royal Prince Alfred Hospital, Di Gill, disputed the figures, saying there were only 15 vacancies in the unit. Miss Gill also denied that the delivery room was ever overcrowded and insisted "no woman has ever given birth in a corridor". She scoffed at the idea that nurses or midwives might feel that their jobs were under threat if they spoke out about conditions in the unit. "That is rubbish. I am not in the habit of sacking people and certainly not midwives."
Yet the nurses' union backed the midwives' claims. Its general secretary, Brett Holmes, confirmed to the Herald that less than two months ago, there were 29 vacancies in the unit.
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Australia: New Victorian public hospital will have everything
Except enough doctors and nurses and beds. That's too hard. One billion dollars just to provide 46 extra beds? Unbelievable. But I guess that it compares with the $702m for just 27 more beds that the NSW government is spending
THE new $1 billion Royal Children's Hospital will have its own aquarium, Scienceworks, cinema -- even visits from zoo animals -- to help take patients' minds off their illness. Plans for the Royal Park hospital were unveiled yesterday, with work to begin within five weeks and finish by 2011. The new buildings will contain 353 beds -- 46 more than the existing hospital -- capable of treating an extra 35,000 patients a year. The original $850 million price tag has grown to an estimated $1 billion to accommodate a 90-room hotel, gym, two childcare centres and a small supermarket.
Premier John Brumby said the $150 million "add-ons" would be paid for by private investors with no cost to taxpayers, under the public-private partnership with the Children's Health Partnership consortium. "It will make it the most state-of-the-art, environmentally and family-friendly children's hospital, not just in Australia, but anywhere in the world," he said. Patients and families will have more privacy, with 85 per cent single bedrooms complete with bedside entertainment systems and pullout double beds for parents. It will be built in parkland immediately west of the present hospital.
A two-storey coral reef aquarium will dominate the hospital entrance, while Melbourne Zoo will bring animals to the hospital for interactive education programs. A Scienceworks display with 20 hands-on experiences and two large exhibit spaces, and a bean-bag cinema, will also help children relax between treatments. McDonald's has the option of keeping a store at the Royal Children's.
Having spent a combined three years in the hospital fighting cystic fibrosis, Leanna Babet, 15, said the comforting surrounds of the new design would put patients at ease. "It is overwhelming when friends come to visit sometimes because this hospital looks so much like a hospital, and with the new designs it just looks funky and cool," she said.
The Royal Children's will be Australia's first five-star green hospital, with a 45 per cent reduction in greenhouse gases and 20 per cent reduction in water demand [What a hot and smelly place that will make it -- if other "Green" buildings are a guide]. But that has not eased the concerns of Melbourne City Council environment committee chair Fraser Brindley, who said the Government missed the opportunity to increase the size of Royal Park by relocating the hospital to Docklands. The Government has promised to demolish much of the old hospital by 2014. It has also said there will be no net loss of parkland.
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