Dr David David (subs correct surname same as given name) head of the Australian Cranio-Facial Unit in Adelaide was giving evidence at the inquest into Brian Lankuts, who died aged five months on November 21, 1990, after surgery to correct a skull abnormality which threatened to compress his brain.
His report was tendered by Steve Loomes, counsel assisting the coroner, John Burns.
The report concluded that the operation performed on Brian was inappropriate.
“”There is no evidence that urgent surgery was necessary outside of a major cranio-facial unit,” it said.
In response to Stuart Littlemore, for neurosurgeon Dr Nadana Chandran, maxillary facial and oral surgeon Dr Peter Vickers and plastic and reconstructive surgeon Dr Alan Ferguson, Dr David criticised the setting up of an ad-hoc cranio service instead of sending the case elsewhere.
Mr Littlemore suggested that Dr David was putting a demarcation case like plasterers and plumbers. Dr David rejected what he called this “”abuse”.
He said this type of surgery was complex and serious and was better managed in specialist centres where people had the experience to give patients the best treatment.
He would have that view whether the centre were to be his unit in Adelaide or elsewhere in Australia.
He thought it inappropriate to allow major cranio-facial surgery to just happen without back-up by hospital management and extensive additional training.
His report said also, “”Blood loss from the procedure was inadequately recognised, controlled or replaced and this was the immediate cause of death.”
(subs: please leave this par in) Also appearing at the inquest were: Hugh Selby for the parents, Michael and Carol Lankuts; Paddy Bergin for the anaesthetists, Dr Raymond Cooke and Dr Nicholas Gammell-Smith; Pamela Burton for the ACT Board of Health; and Garry Dellar for the head of intensive care at Royal Canberra, Dr James Kearney.
Dr David said Brian had been born with a complex craniosynostosis syndrome. The parts of his skull had knitted together too quickly so the brain could not grow normally with the skull.
The decision to operate in these cases was a question of balancing cosmetic factors and the complications of pressure on the brain.
The distorted box might be big enough to take the growing brain. Then the decision would be mainly cosmetic. But if the brain were growing faster than the skull, “”then you are in trouble”.
Mr Littlemore referred Dr David to a textbook asking Dr David to agree that the operation described what the one his clients did.
Dr David: It is the surgery your clients conducted, but it is not the condition that Brian suffered.
Dr David said a CAT scan and tests on blood coagulation would have been appropriate.
He told Mr Selby that if he had been the operating surgeon he would have taken Brian from intensive care back to the operating theatre. He would have tried to reverse the blood loss.
“”If the child was to die, it is better that he dies with us working on him on the operating table,” he said.
He thought the operation should have been done in two stages. It would have reduced the exposure and bleeding time. He questioned the use of a Jackson-Pratt draining device that could do more harm than good.
He said that in these sorts of cases parents had to be given extensive information about risk and other matters, and he outlined what was done at the unit in Adelaide. The inquest will continue today, and Dr David is to face further cross-examination at a date to be fixed.