Orthopaedic surgeon and anaesthetist found liable to a man who was rendered paraplegic during spinal surgery.

In Issue

  • Whether doctors should have utilised spinal cord monitoring for the duration of a surgery.
  • Whether it was reasonable for doctors to continue a surgery after the plaintiff suffered a number of hypoxic and hypotensive episodes.
  • Whether the plaintiff should have been turned supine (lying flat on his back) when he began experiencing respiratory difficulties.

Background

The plaintiff, Brendan Hobson, was born with Noonan Syndrome, a genetic disorder that prevents normal development in parts of the body. As a result of this condition, the plaintiff had severe lordoscoliosis (combined backward and sideward curvature in the spine) which caused his chest to be shaped unusually. At the age of 24, the plaintiff was having significant difficulty breathing and was to undergo two operations at the Royal North Shore Hospital to remedy the defect.

The plaintiff’s first surgery on 13 November 2009 was successful. The second surgery was to be performed two weeks later; however the plaintiff’s breathing difficulties led the anaesthetic and spinal teams to bring the surgery forward to 17 November 2009.

During his second surgery, the plaintiff began to experience respiratory difficulties while he was in the prone position (lying flat on his front) on the table. In response, the surgical team administered a muscle paralysing agent which meant that spinal cord monitoring was no longer able to be performed. Following a number of respiratory complications, including low blood pressure and oxygenation, the plaintiff suffered a hypotensive insult to his spinal cord (spinal stroke) resulting in permanent paraplegia.

The plaintiff sued Dr Gray, the orthopaedic surgeon who performed the second surgery, and Dr Sparks, the attending anaesthetist (together, ‘the defendants’), alleging that their negligence during the surgery caused his paraplegia.

Decision

The court focussed on the failure by the doctors to abandon the surgery and found that the defendants had breached their duty of care to the plaintiff by failing to abandon the second surgery in a timely manner when he began to experience respiratory complications. The court agreed with the joint orthopaedic experts that, if the defendants had abandoned the surgery when the complications arose, the plaintiff would not have been rendered a paraplegic.

The court also relied on expert opinion in finding that the plaintiff should have been turned supine (lying flat on his back) rather than kept in a prone (lying on his front) position when his respiratory complications arose, and that that this would have resolved the problem.

While the court noted that the defendants’ lack of spinal cord monitoring should have made them more cautious while performing the surgery, this was not relevant to the decision in relation to the finding of negligence in continuing the surgery.

The plaintiff was successful against Dr Gray and Dr Sparks and was awarded $3,828,075 in damages plus costs.

Implications for you

This case highlights the need for doctors to monitor a patient’s condition closely during surgery, and to ensure that patients are medically fit for the relevant surgery prior to that surgery being performed.