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Friday, June 16, 2006

Doctors avoid prison for malpractice death

Inept trio used manual for surgery option


Staff writer

Three Jikei University School of Medicine doctors were handed suspended prison terms Thursday for a botched 11 1/2-hour operation during which they had to use a manual to do a procedure they were unfamiliar with, causing their 60-year-old prostate cancer patient to die.

The Tokyo District Court found Jun Madarame, 40, the head surgeon; Taro Hasegawa, 37, the patient's attending physician and an assisting surgeon; and surgical resident Shigetaka Maeda, 35, guilty of professional negligence for conducting a new procedure to remove the man's prostate gland when they did not have enough experience to do it.

The 11 1/2-hour operation was conducted on the prostate cancer patient at Jikei University School of Medicine's Aota Hospital in Tokyo on Nov. 8, 2002. Madarame had only assisted in the procedure, and the other two doctors had no experience.

The doctors were so unsure of what they were doing, they had to have a manual open over the man's body as well as the device's manufacturer and another doctor on the phone telling them what to do. In the process, they ruptured veins.

The man, whose family has asked not be named, was declared brain dead after bleeding profusely. He died when his lungs failed that Dec. 8.

"If we could only have them spend one day in prison to reflect on their actions, they might be better doctors, better people," said the patient's son. He said he detected no remorse in the three defendants during the trial.

"What grieves our family most is that these doctors are free to operate," he said. "A two-year license suspension is much too lenient."

The university fired Hasegawa and Madarame in December 2003 and the health ministry suspended their medical licenses for two years. That suspension ended in April. Maeda was barred from the operating room for 10 days.

Presiding Judge Tsutomu Tochigi said the defendants' misplaced ambition led them to proceed with the operation even though they did not have sufficient training.

"The three put their desire to gain more experience ahead of their patient's safety and forgot the most basic part of a doctor's obligation," Tochigi said. "There was no need to choose this type of operation. There was ample opportunity to (use another procedure) and save the patient's life."

Prostate gland removal is a serious but standard operation.

Hasegawa had recommended the man have a new procedure done in which a laparascope — a tube with a light and camera lens — is used to aid the gland removal, saying it would only require a few small incisions, the court said.

What Hasegawa did not tell the man was that the procedure was risky and that another type of surgery, requiring a large incision, would be quicker. In addition, his insurance didn't even cover the cost of using the laparascope.

During the operation, the surgeons damaged a major group of veins near the prostate gland, which led to massive blood loss and resulted in the brain death.

All three had pleaded not guilty. Their lawyers claimed the direct cause of death was the anesthetist took too long to get blood for a transfusion.

Although he condemned the doctors' behavior, the judge said they got suspended sentences because of the organizational failures at Jikei University and the fact that their superiors also were to blame for approving the operation, knowing the three lacked the ability required.

Tochigi also laid blame on the anesthetist for not making sure there was sufficient blood on hand and not telling the doctors how serious the blood loss was.



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