Teacher bled to death 14 hours after surgery after surgeon failed to notice he severed an artery

An English teacher died after her surgeon cut through an artery in her spine by mistake during a routine operation to relieve her severe back pain.

Andrea Green 42 died 14 hours after her back surgery at Barnsley District Hospital in March 2010. Miss Green bled to death after consultant surgeon Hany Ismaiel made a fatal error and severed the artery during an operation on a slipped disc.

Mr Ismaiel did not notice his mistake and after the operation and moved Andrea Green into recovery. Miss Green was left with extreme internal bleeding – which was identified during her post mortem as the cause of death.

Around the time of her death, orthopaedic consultants at the hospital issued a warning about the ‘grave risk’ to patient safety because of the department’s inadequate staffing levels.

The inquest was told the team was worried that it was ‘only a matter of time’ before a serious clinical incident like Miss Green’s death might occur because of the work pressure and ‘unsafe’ level of work in a bid to meet targets from management.

Six months after her death an email to Mr. Ismaiel from the hospital’s divisional medical director Christopher Ruddlesdin said: ‘The remainder of the division sees the orthopaedic surgeons as the cancer in the system.’

The Daily Mail reported that:

“He claimed the team were deliberately working slowly amassing a heavy workload in a bid to secure evening and weekend clinics at a ‘significant rate of pay’ thus boosting their earnings.”

The Sheffield coroner suspended Miss Green’s inquest last year and asked police to investigate the rift between consultant orthopaedics and the hospital’s management team.

Accusations of corporate manslaughter were looked into but no proceedings followed due to insufficient evidence being found. The family of Miss Green pursued a claim for Medical Negligence, which settled out of court for a six-figure sum.

The inquest has now resumed in Sheffield and the Coroner was told that a breakdown between management and the team of surgeons had been expected for months before Miss Green’s death of March 13, 2010.

Consultant orthopaedic surgeon, Zafar Ijaz Nur, said that the department had a ‘multitude’ of problems which had been raised in a meeting with management on February 24th, 2010.

He said that the department, which was hemorrhaging £2 million a year, lacked three consultants, junior doctors and experienced nurses who could offer support to the consultants. Despite this, he said that the trust bosses would not listen.

“We were feeling unsafe in our practice” he told the inquest. “We were worried because this whole scenario might end up in a serious clinical incident.

‘”We had come to the point when it was becoming extremely difficult for us to function.

‘”We were under stress because we were constantly told we were underperforming and not meeting targets and failing.

“Our view was that we were working harder than we were before but the amount of work required was not possible. We did not have the capacity to do the work that was contracted.’” He said ward rounds assessments of patients prior to surgery and the care and attention given after operations were suffering because of this.

“We were under pressure to perform the surgery quickly to start the next case” he added.

Following Mr Ismail’s suspension, his colleagues drafted and sent a letter to the chief executive at the time Sandra Taylor saying that a ‘catalogue of systemic failures’ for Miss Green’s death adding ‘It was only a matter of time before this would lead to significant patient morbidity and mortality.’

Mr Nur claimed the department was losing money because beds were often unavailable and because of this the team could not operate. He said that they could not meet management targets because they did not have the capacity or resources to be able to meet them.

But Mr. Ruddlesdin who has retired since the incident told the inquest the orthopaedic department had enough cover and said: “I don’t think there was ever an unsafe situation.”

Mr Ismaiel was the only permanent surgeon who did spinal work at the hospital and had been taking on an ‘ever-increasing workload,’ as spinal units closed down in nearby hospitals.

Mr Ruddlesdin asked whether the surgeon had been ‘treating patients unnecessarily,’ but an independent assessment concluded that Mr Ismaiel had good judgement.

He said that he had only recently learnt of the orthopaedic team’s letter.

He told the inquest: “I was aware they had made representations about my management style but I was not aware they had serious concerns about clinical safety.”

He claims that the main problem was down to something called ‘slow-timing,’ where surgeons worked slower in order to earn more money.

He went on to say that catch up surgeons then would be required to carry out extra operating lists in evening and weekends at a ‘significant rate of pay.’

In the operation, Mr. Ismaiel was meant to scrape away the portion of the prolapsed disc which was protruding but got the wrong disc and in the process piercing through it and rupturing an artery. Miss Green was then stitched up and sent to recovery.

Her abdomen was severely inflated and she complained of a stomach ache, but the staff didn’t spot that her blood pressure was falling – a sign of internal bleeding – so the artery was not repaired.

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