Patel correctly diagnosed patient: court

JAYANT Patel correctly diagnosed the cause of bleeding in a patient who later died, a jury has been told.

The former Bundaberg Hospital surgeon, 62, has pleaded not guilty in the Brisbane Supreme Court to the manslaughter of Mervyn John Morris, 75, who died three weeks after a Hartmann's procedure removed a 15cm piece of his colon on May 23, 2003.

Patel performed the procedure to address Mr Morris' ongoing rectal bleeding - which he diagnosed as "bleeding diverticulosis" and is caused by the inflammation of tiny sacs that form in the colon.

Giving evidence for the defence of Monday, gastroenterologist Dr Johan van den Bogarde backed Patel's diagnosis that Mr Morris was suffering from diverticular bleeding and not radiation proctitis, or inflammation of the rectal lining from radiation treatment for cancer.

The Crown has contended Mr Morris was incorrectly diagnosed.

Dr Bogarde told the court he had "never seen" a patient with radiation proctitis present with symptoms similar to those of Mr Morris.

He said Mr Morris' pattern of bleeding was "completely different" to that of an individual with ongoing radiation proctitis.

Dr Bogarde said he believed the sigmoid colectomy and colostomy Patel performed to treat the ongoing bleeding was "sufficient" and in the last decade recommended it for between "10 and 15" of his own patients with diverticular bleeding.

He told the jury Mr Morris' surgery was non-elective because he appeared to have experienced an "acute" bleed in the days leading up to his admission to hospital on May 20, 2003.

Dr Bogarde said Mr Morris was in a "fairly stable state" when Patel performed the surgery and it was "a window of opportunity".

"A good surgeon knows when to operate, the better surgeon knows when to operate but the best surgeon knows when not to operate," he told the court, referring to a traditional medical axiom.

He said timing a surgery to suit the patient and their recovery was "very important and extremely difficult".

Mr Morris died of cardio-respiratory failure, liver protein deficiency, fluid overload, malnutrition and blood poisoning on June 14, 2003.

Patel is accused of being criminally negligent for misdiagnosing Mr Morris' rectal bleeding and performing an unnecessary surgery.

Barrister Ken Fleming QC, for Patel, told the court the accused had done his best before complications moved in.

The trial continues before Justice George Fryberg.

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Patient had one in 10 chance of dying

JAYANT Patel's patient had a statistical "one in 10" chance of dying after major surgery that removed a part of his bowel, a court has heard.

Patel, 62, has pleaded not guilty in the Brisbane Supreme Court to the manslaughter of Mervyn John Morris, 75, who died three weeks after a Hartmann's procedure removed part of his colon at Bundaberg Hospital on June 14, 2003.

Dr Dawid Smalberger told the jury he was unsure how much the ''significant'' weight loss experienced by Mr Morris would have increased the risk of him dying as a result of the surgery on May 23, 2003.

But he agreed the weight loss reported by Mr Morris may have increased that risk.

Mr Smalberger said Mr Morris may have had radiation proctitis - inflammation caused by radiotherapy - as well as diverticulitis - inflammation of sacs that form in the colon - which caused two different types of rectal bleeding as well as ''confusion'' for treating doctors.

He told the jury it was his opinion that Patel had ''conservatively'' treated Mr Morris' ongoing ''per rectum'' bleeding by using a ''watch and wait'' approach to try and explain ongoing blood loss.

Mr Smalberger explained how Mr Morris ''aspirated'' fluid into his lungs while doctors were trying to intubate him and said the patient's airways may have been permanently weakened as a result.

He told the jury it was his belief Mr Morris died from a bacterial infection that started in his abdominal cavity, spread into his blood and caused septicaemia and organ failure.

Patel is accused of criminal negligence for mis-diagnosing Mr Morris' rectal bleeding as diverticulitis and then operating on him despite his age and pre-existing health conditions that made surgery especially risky.

Crown prosecutor Peter Davis SC said the cause of Mr Morris' bleeding may have been radiation proctitis, but argued surgery should never have gone ahead without first finding the source of the bleeding.

Barrister Ken Fleming QC, for Patel, said his client was not negligent in treating Mr Morris, adding he ''did what he honestly thought was right'' but ''complications moved in''.

The trial continues before Justice George Fryberg.

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