Correct diagnosis may not have altered outcome

DEAN KOZANIC/The Press

UNCERTAINTY: Acting clinical director Professor Michael Ardagh addresses the Coroner's Court yesterday.

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Dean Carroll's care "was not good enough", Christchurch Hospital's emergency department chief told an inquest yesterday.

Carroll, 25, died on April 14, 2007, after leaving hospital the previous night with severe back pain.

In his evidence to the Coroner's Court in Christchurch, acting clinical director Professor Michael Ardagh said "the tragedy of losing a son or loved one is hard to fathom".

"We have superimposed on that tragedy a layer of uncertainty – which is our fault because he wasn't seen quickly enough, wasn't seen in the right environment, the doctor was rushed.

"If we had done all those things perfectly and he still died, at least we would know we had done everything."

The junior doctor who saw Carroll sobbed before the start of yesterday's hearing, and was hugged by Carroll's mother.

Ardagh said the Canterbury District Health Board had commissioned an independent report into Carroll's care to help prevent similar incidents.

"The doctors and nurses involved in Mr Carroll's care were competent, but compromised by the context in which they were working."

The report had made 10 recommendations to address emergency department overcrowding.

Ardagh said Carroll today would have a different experience, but the outcome would probably be no different.

Carroll's "extraordinary" condition made a diagnosis of epidural spinal abscess, particularly in a fit 25-year-old, extremely difficult to make, Ardagh said.

While back pain was common, a spinal epidural abscess was relatively rare – about 1.1 per 10,000 hospital admissions, he said.

"My considered opinion is that a review by a senior doctor would have made no difference. However, I concede that there is a possibility that such a review may have lead to further tests or referral.

"Had he been under close observation in hospital when he deteriorated, it is possible that aggressive resuscitation and intensive care might have saved his life.

"However, considering Mr Carroll's rapid deterioration, his survival would have been far from certain."

Dr David Richards, an emergency department consultant on duty that night, said had he examined Carroll, he may have been more inclined to admit him.

However, "even if Carroll had been admitted there is a high chance there would not have been a change in the outcome".

An MRI scan would have been required to make a diagnosis and was not likely to have been given late at night, Richards said.

"The fact his condition led to a rapid deterioration, even if he had been closely monitored it would have been very difficult to resuscitate."

Expert witness Dr Peter Freeman said if Carroll had been kept in hospital he "would have stood a better chance".

However, given his rapid deterioration, Freeman was almost "100 per cent sure" Carroll would have died before he was able to be admitted, an MRI scan performed, a surgical team put together and the abscess drained.

"His chances of survival were very poor from the outset.

"I don't think any individual made an error that would have changed the outcome."

The inquest continues.

- © Fairfax NZ News