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The following is issued on behalf of the Hospital Authority:
An Australian expert was earlier invited to provide independent comments and to evaluate the standard of care delivered by Tuen Mun Hospital (TMH) following the death of a 13-year-old boy who underwent a cervical spine operation. TMH Hospital Chief Executive, Dr Albert Lo, today (November 10) met the patient's parents to explain the report details.
According to the independent expert report prepared by the Australian anaesthetist specialised in difficult airway management, Dr Richard Riley, the TMH's medical care of the boy, including the pre-operative assessment, the operation and the post-operative resuscitation, is up to the standard.
The report pointed out that the decision to perform tracheal extubation following cervical spine surgery can be variable and dependent on the consideration of the specific clinical condition at the scene. Extubation could be done immediately after surgery in the operation room or in the Intensive Care Unit on the day after. Early extubation could facilitate the early monitoring of neurological function.
Dr Riley noted that all clinical criteria for an early extubation in this case has been satisfied. Dr Riley therefore opined that the TMH¡¯s decision of a tracheal extubation was not an error of judgement. As TMH reiterated earlier, the decision of extubation was a joint decision by the doctors participating in the operation.
"To further enhance our standard of medical care, TMH will work along the expert advice of Dr Riley to review the management of acute airway obstruction in high risk patients, including the enhancement of the medical team's training and its response mechanism, and provision of advanced medical equipment. TMH will set up a working group to map out related recommendations," Dr Lo said today.
Regarding the completeness of the patient's medical records presented to the family, TMH has already provided a complete set of records to the family on October 28. The same version of records was presented to Dr Riley and would also be submitted to the Coroner's Court.
TMH also noted the concern raised by the family that some content of the expert report has been quoted by the media before today's meeting. The hospital will follow up to look into the matters.
On the media arrangement, it was originally planned that Dr Lo would speak to the media on the expert report details after meeting with the family. However, the family has requested to stay at the press conference to understand what has been discussed. To avoid provoking the family's emotion, TMH decided to call off the scheduled press conference. The hospital would like to extend its apology to the media organisations. TMH has been handling this incident with an open and serious manner. The hospital will later submit the independent expert report to the Coroner.
TMH would like to express the deepest condolences again to the family and will continue to communicate with the family and offer them with whatever assistance they may need.
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Summary of Expert Report:
1. Tuen Mun Hospital had explained the associated risks of the surgery to patient's family. In addition, the possible outcome of not having the surgery had been discussed.
2. There are known potential risks of developing airway problem after cervical spine surgery. From 2000 to 2008, a total of 23 cases of mortality related to problem airway was recorded in the Australian Coroner's Court, among which, 13 cases happened after surgery while 2 cases occurred after cervical spine surgery.
3. Concerning the pre-operative and post-operative management, the medical teams had fully considered the presenting history of snoring symptom. Pre-operative evaluation as required had been conducted. No matter whether the polysomnography was done or not, the plan of the anaesthetic treatment and the outcome would not have been affected.
4. Dr Riley opined that early tracheal extubation after the surgery would facilitate the immediate post-operative neurological function monitoring, such as spontaneous breathing and limbs function. It was useful for evaluation and monitoring of the surgical outcome. The expert also listed the potential risk factors for airway obstruction in this case which included long hours surgery, prone position and the need to fix the cervical spine position by halo jacket after surgery. The report pointed out that there are different opinions on the timing of the tracheal extubation in this situation. There are different acceptable methods but the decision would depend on the consideration of the specific clinical condition at the scene. The decision on the tracheal extubation made by the TMH medical teams was not an error of judgement.
5. The team's management of the acute airway obstruction and resuscitation were considered up to standard.
Ends/Thursday, November 10, 2011
Issued at HKT 21:38
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