Death-case surgeon one of NHS group called ‘cancer in system’

Andrea Green bled to death just 14 hours after routine surgery for back pain which may have been unnecessary in the first place.

Miss Green, 42, died after consultant surgeon Hany Ismaiel accidentally cut an artery during an operation which was not picked up afterwards.

Her death came just weeks after consultants in the orthopaedic department at Barnsley District Hospital warned management of the “grave risks” to patient safety because of staffing levels.

The issue sparked a feud between management and the consultants. Divisional medical director Christopher Ruddlesdin said in an email to Mr Ismaiel six months after Miss Green’s death: “The remainder of the division sees the orthopaedic surgeons as the cancer in the system.”

Miss Green’s inquest was halted last year by the Sheffield coroner who asked police to investigate following the emergence of the rift. A file was sent to the Crown Prosecution Service considered evidence of corporate manslaughter but no proceedings followed due to insufficient evidence.

Miss Green’s family have already lodged a claim for medical negligence which has been settled out of court for a six-figure sum.

Lawyers for the family claimed serious internal bleeding after the operation should have been spotted and treated by doctors who could have saved Miss Green up to 30 minutes before her death on March 13, 2010.

At the resumed inquest in Sheffield, it emerged the breakdown between management and the orthopaedic surgeons had been simmering for months.

Consultant orthopaedic surgeon Zafar Ijaz Nur said there were a “multitude” of problems in the department and these had been raised with management at a meeting on February 24.

He said the department, which was losing £2m a year, was three consultants short and there were not enough junior doctors and nurses to cope but bosses did not listen.

“We were feeling unsafe in our practice,” he told the hearing. “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 under-performing and not meeting targets and failing.”

In a letter on March 23 following the suspension of Mr Ismaiel, orthopaedic consultants sent a letter to the Barnsley Hospital Trust’s then chief executive Sandra Taylor which stated a “catalogue of systemic failures” had led to the patient’s death. It ended: “It was only a matter of time before this would lead to significant patient morbidity and mortality.”

Mr Nur said the department was running at a loss because sometimes beds were unavailable so they did not have the capacity to meet management targets.

But Mr Ruddlesdin, now retired, told the inquest there was adequate cover in the department and said: “I don’t think there was ever an unsafe situation.”

He said he had only recently been made aware of the letter sent by the surgeons. “I was aware they had made representations about my management style but I was not aware they had serious concerns about clinical safety.”

He said the crux of the matter was “slow-timing” where surgeons worked too slowly and did extra theatre lists in the evenings and weekends at a “significant rate of pay” to earn more money.

Miss Green, an administrator, of Carlton, Barnsley, began suffering back pain in October, 2009. By the time the operation was due she was much better but was told by doctors that if she did not have surgery the pain could return.

Mr Ismaiel was supposed to scrape away the protruding portion of a prolapsed disc but got the wrong disc, piercing through it and rupturing an artery.

Unaware of the damage caused, Miss Green was sent to recovery. Although her abdomen was inflated and she complained of stomach ache nothing was done.

The inquest continues.