condition in the early morning of 15 May called for urgent intervention, and he should have been called earlier than he was. (T33) By the time Dr Eskandari-Marandi came into the picture, the situation was obvious and he acted promptly and appropriately. Mr Sarre said that it was not really possible to predict the likely outcome, even if Mr Jansen had been called in at 3:00am and operated then. He said: not really possible to say. I mean even at that stage she had established peritonitis and was ‘It’s presumably bacteraemic if not septicaemic, bacteraemia meaning bacteria circulating in the blood stream, septicaemia meaning actually reproducing and causing a release of toxins which is a fairly nasty situation. The chances of surviving that at her age are not all that good. The aim of treatment obviously would be to step in at the very first sign before there was established infection. Once infection was established, which I would say would have been within or shortly after 24 hours from the time of the initial injury, – the outlook would be fairly grave.’ (T60) Mr Sarre also supported Mr Jansen in his assertion that there was no good sign of peritonitis until early in the morning of 15 May 1999 (T65). Conclusion Having regard to the totality of the evidence, I find that there is no evidence that Mrs Sands received less than adequate care at LMH until the early morning of 15 May 1999. Although ideally an abdominal CT scan could have been performed which may have diagnosed the bowel perforation earlier, there is no certainty about that. Mrs Sands was in the care of an experienced consultant surgeon, and this was a question of clinical judgement for him at the time, and there is no evidence that the decision not to order one was incorrect. Mrs Sands’ condition deteriorated significantly during the night of 14-15 May 1999, and Mr Jansen should have been called to the hospital to perform emergency surgery at just after 3:00am. The fact that he was not called in decreased Mrs Sands’ chances of survival, although her prognosis was grave in any event. Recommendations
condition in the early morning of 15 May called for urgent intervention, and he should have been called earlier than he was. (T33) By the time Dr Eskandari-Marandi came into the picture, the situation was obvious and he acted promptly and appropriately. Mr Sarre said that it was not really possible to predict the likely outcome, even if Mr Jansen had been called in at 3:00am and operated then. He said: ‘It’s not really possible to say. I mean even at that stage she had established peritonitis and was presumably bacteraemic if not septicaemic, bacteraemia meaning bacteria circulating in the blood stream, septicaemia meaning actually reproducing and causing a release of toxins which is a fairly nasty situation. The chances of surviving that at her age are not all that good. The aim of treatment obviously would be to step in at the very first sign before there was established infection. Once infection was established, which I would say would have been within – or shortly after 24 hours from the time of the initial injury, the outlook would be fairly grave.’ (T60) Mr Sarre also supported Mr Jansen in his assertion that there was no good sign of peritonitis until early in the morning of 15 May 1999 (T65). Conclusion Having regard to the totality of the evidence, I find that there is no evidence that Mrs Sands received less than adequate care at LMH until the early morning of 15 May 1999. Although ideally an abdominal CT scan could have been performed which may have diagnosed the bowel perforation earlier, there is no certainty about that. Mrs Sands was in the care of an experienced consultant surgeon, and this was a question of clinical judgement for him at the time, and there is no evidence that the decision not to order one was incorrect. Mrs Sands’ condition deteriorated significantly during the night of 14-15 May 1999, and Mr Jansen should have been called to the hospital to perform emergency surgery at just after 3:00am. The fact that he was not called in decreased Mrs Sands’ chances of survival, although her prognosis was grave in any event. Recommendations