Enough reasons for consultant to be indicted

A surgeon yesterday told a court she believed a boy operated for appendicitis was getting better despite post-op symptoms ranging from fever to bilateral orchitis.

Surgeon Mary Meilak said she operated the boy and eventually followed up the operation with ward visits.

She diagnosed the symptoms as resulting from a serum oozing from the wound and did not feel the need to consult with the pædiatric consultant heading the medical team or, when he was on sick leave, his replacement, despite the fact that he was still showing the symptoms four days after the operation.

Ms Meilak testified before Magistrate Consuelo Scerri Herrera in the compilation of evidence against a pædiatric consultant who is pleading not guilty to the manslaughter of Andrea Massa at St Luke's Hospital between February 20 and 28, 2001.

The consultant, whose name cannot be published by court order, is also pleading not guilty to committing a crime he was duty bound to prevent.

Magistrate Scerri Herrera, after hearing Meilak only in part, yesterday ruled there were enough reasons for the indictment of the consultant.

Ms Meilak yesterday took the witness stand and was cautioned that she had a right not to reply to questions if she thought the answer could incriminate her.

She said hospital records showed that the boy had been admitted into hospital on February 20, 2001, because he was suffering from stomach pains.

She first saw him during a ward round with the consultant and houseman Dr Suzanne Attard on February 21, 2001.

During that ward round the consultant examined the boy, who was labelled as a query appendicitis, but decided to wait for further observations before operating.

Ms Meilak said that the following day she saw the boy again during another ward round during which the consultant told her to operate the boy for appendicitis.

Andrea Massa's name was put at the bottom of the operating list because there were patients whose conditions were more urgent and who had to be operated before him.

Ms Meilak explained that the symptoms of appendicitis and mesenteric adenitis were very similar. The latter, she explained, was a situation common in children when a gland near the appendix swelled up.

She said that in order to be on the safe side when a doctor was not able to tell whether a patient had one or the other he or she operated for appendicitis.

If, during the operation, mesenteric adenitis was detected the patient was given antibiotics to combat the infection.

She explained that the operation on Andrea Massa was carried out on February 22, 2001, and gave no problems. There were no signs of mesenteric adenitis or any other pathological complications.

She also said it was not unusual that the consultant told her to operate for appendicitis and she did so without asking questions.

Ms Meilak said that the day after the operation, she was not present when Andrea Massa was visited during the ward round because there was other work she had to see to. She was however informed that the boy had post-op symptoms.

The next time she visited the boy was February 26, 2001. During the visit she noted that the boy had fever and that serum was oozing from his stitches. She ordered the stitches removed and a culture of the serum taken for testing.

During that visit she confirmed the diagnosis which had been previously made by a neurologist, that is, that the boy had a swelling in the testes.

Later on that day she went to check on the boy's conditions and a nurse informed her that his fever had gone down and that he had urinated (because a low urine output had previously been noted) so she went home with her mind at rest.

"I thought that the boy's condition was improving slightly and that the symptoms were the result of the serum oozing from the wound but I didn't think that they could have been caused by an internal ulcer or a leakage in the appendix.

"I didn't feel the need to inform the person replacing the pædiatric consultant or his replacement (because he was on sick leave on the day) because I was satisfied with the treatment I was giving the boy," Ms Meilak said.

When the court asked her if she informed the consultant about the symptoms she had detected Ms Meilak said that she did not because he was on sick leave.

She added that she did not feel the necessity to speak to another consultant because she was satisfied with the treatment she was giving the boy.

Ms Meilak said that when she went to visit the boy the following day, that is on February 27, 2001, she was informed that he had been visited by other doctors besides herself.

The hospital records showed that Dr Alexia Attard had ordered blood counts which showed normal results. The records also showed that urine analysis gave the result that the boy had bilirubin in his urine.

She explained that when bilirubin showed up in urine samples liver tests were usually carried out.

She ordered that the liver tests be carried out on him the following day to avoid puncturing the boy again on the same day.

But the following day she was informed that he had been taken to the Intensive Therapy Unit. When she went to check on him at ITU she learnt that he had undergone a second operation and was told that he was getting better and went to speak to the boy's mother to encourage her.

She explained that she thought that his condition was improving because of the treatment given to him in the ITU but she did not check about the type of treatment given to him.

The case continues.

Police Inspector Carlo Ellul is prosecuting.

Dr Michael Sciriha and Dr Hugh Peralta are appearing for the surgeon while Dr Giannella Caruana Curran and Dr Emmanuel Mallia are appearing in parte civile for the Massas.