Unknown complications behind post-op death
Lisa Turner
(CNS): A 61-year-old woman who died four days after a relatively routine operation to remove an ovarian cyst was the victim of complications relating to the cystectomy and salpingectomy, according to the conclusions of a pathologist’s report. Lisa Anne Turner died on 14 February this year following keyhole surgery on 10 February at the CTMH Doctors Hospital. As the inquest into her death opened Tuesday, the jury heard from the pathologist, who explained the medical conditions, including disseminated intravascular coagulation (DIC) and sepsis, arising out of the complications, but neither he nor the surgeon who performed the operation were able to identify the underlying cause.
When Dr Suzanne Muise, the gynecologist who performed the surgery, took the stand, she related the chain of events that led to the surgery and how her patient became critically ill a few days after the procedure. She explained that after two years of seeing Turner in connection with the cyst, a change in the size of the tumour and increased discomfort in November 2016 led to a discussion and decision about the surgery, which was, after some date changes, fixed for February.
Muise told the Coroners Court that the operation took place in the afternoon of 10 February and all went as expected. The cyst was removed and the patient appeared to be stable and recovering, and was well enough to be discharged from the hospital the same evening.
But the next day, when the doctor called to check up on her patient, Turner complained of having a fever and feeling some nausea. Muise said she gave some advice on how best to deal with it but was not overly concerned at that point, as such ailments are not uncommon after any surgery. But when her symptoms worsened the following day, Muise arranged to meet Turner at the CTMH.
At around 8:00pm on the Sunday evening a friend took Turner to the hospital, where they met with Muise, who began running tests and treating her for the symptoms. When a blood platelet test came back unusually low and the patient began to rapidly deteriorate, the doctor made a decision to take Turner to A&E at the government Cayman Islands Hospital (CIH). But when she tried to get an ambulance, the 911 centre told her there was only one and it was in West Bay and it would take as long as 45 minutes to reach them at the CTMH.
As a result, Muise travelled with Turner, who by that time was hooked up to oxygen, and her friend to the government hospital in a private car because, she said, there was no time to waste and in her opinion it was the best option to cover the two minute journey between the two facilities. The journey was uneventful, she said, but she was surprised to see two ambulances in the A&E area on arrival.
At the CIH, Muise and her patient were met by an emergency team and she was taken to the ICU as the doctor related the medical information to the doctors on call at the government hospital. Muise said that she did not know the underlying cause behind her patient’s rapid deterioration but she was in a critical condition and she was later placed in an induced coma and on a ventilator.
The possibility of a perforated bowel was raised as the potential cause, and medical staff knew they needed to operate to find out, but there were no platelets at the hospital, so if they attempted to perform surgery on Turner she would die.
The court heard that by Monday a decision was made to transfer the patient to a hospital in Florida. But when the emergency transfer team arrived, they came with only one or two units of platelets, even though the doctors had asked for six, which was not enough to help Turner out of her critical condition.
Turner’s friend who had originally brought her to the hospital stayed with her through her time at the ICU at CIH as well. When she gave evidence, she told the court that when the medical team attempted to take Turner to the airport, she had a cardiac arrest in the ambulance minutes into the journey. The team brought her back to the ICU later Monday evening where she suffered a second attack early Tuesday, 14 February, and was pronounced dead that day.
During the course of Turner’s deterioration both Muise and, according to Turner’s friend, other medical staff had raised the possibility that a perforated bowl could be the cause of the DIC and the infection that Turner was suffering from, but the autopsy found no such injuries. However, Muise stated that DIC does not happen on its own and in this case was a result of an unknown underlying cause.
During the course of the evidence, Coroner Eileen Nervik QC repeatedly stated that the inquest was not seeking to find liability or blame. Despite the presence of two lawyers at the hearing representing Dr Muise and Turner’s family, the coroner repeatedly shut down any speculative questions or attempts by the attorneys to probe what that underlying cause may have been. She said there was no evidence of an injury which could have caused an infection on the autopsy report.
Turner was originally from Canada had lived in Cayman for many years. She was well known in the community, where she worked for a local design company.
The inquest continues.
Category: Local News
I worked with Lisa many years ago in Toronto Canada. She was an angle, I am in shock she is gone. I am so sad. May she rest in peace.
I would like to know the circumstances leading up to why Dr Muise has lost privileges at George Town hospital and ctmh. In addition why did she leave Dr Richters office only after a few months after coming to the island. It is serious when you loose privileges. What has been reported to the Health Practice Commission regarding her practice? I agree with the other writer, Google her and beware.
Why can’t the public know, as within other countries, when doctors have been reported. It is a mater of public safety and right to make an informed decision for your personal care.
The public will never know the true instance of this situation.those people who know need to be honest and speak up.
This situation should not have occurred. Muise, and I will not use the term doctor, should have followed up with a face to face evaluation when concerning symptoms, in terms of general surgical practice, presented themselves. Preventable. Period.
I am replying to todays write up in the other news source. No matter how nicely you write it, the cold, hard fact remains that Lisa Turner, a beautiful, vibrant, HEALTHY woman, went to Dr. Muise and CTMH for a routine operation and died a tragic and unnecessary death 4 days later. If she had not had this operation she would still be with us today. As a lesson learned, please do your research before having surgery. Do not sign your life away without doing some research. The facts are out there. Please use them and hopefully another tragedy like this will be avoided.
Care to name all the other doctors involved in her care? Or do you just want to continue to make insinuations about one when the evidence (and jury’s verdict) confirmed she did nothing wrong?
Is there not a blood bank at the hospital?
When the blood bank gets low, do they not have a drive for blood donations?
Where does the blood come from now for the blood bank?
Can someone from the lab please chime in?
Platelets aren’t blood. They are the clumping agents that form clots or heal cuts and stop bleeding. When you do not have enough platelets your body can not form clots and heal. The platelets can be used for a maximum 9 days only. So most hospitals do not stock them but rather source them for patients. I suspect this is why HSA had to wait for them to arrive.
Platelets are different than “blood”, They last a week at the most. Platelet procurement and management is not a Cayman specific issue. I’m not sure it would have mattered in this case as surgery would only be able to repair a torn/damaged organ. The infection vector appears to be something other than a perforation, perhaps even a sterilization issue. Sepsis can turn bad quickly, and the body enters a point of no return, once even one organ fails (to perform its function). I don’t think a medivac on Sunday night would have changed the outcome.
An infectious agent was introduced in some manner.
Death after cystectomy in people under 50 is 1 in 1000 and Chrissie Tomlinson have had 2 since 2010 (Lisa Turner and Tanya Joseph). That means they must have done 2000 of them or questions need to be asked why the unexplained deaths
Exactly and Remember most nursing staff or on work permits. They won’t say much. The mentality of “ the doctor is the ultimate” still is alive and well here.
Tanya didn’t have a cysectomy, and it was a completely different medical team.
Yet Government and HSA have refused the services of the new ambulance company, which spent almost half a million $$ on new ambulance, staff, training, etc. on Government’s assurance that it would use the services.
Thank God for Health City Cayman Islands, a first class hospital with accolades from many, many international patients!
This is a tragedy for the poor woman and her family, but the inquest raises serious questions about public health cover well beyond this specific incident. You cannot tell me that the primary) only?) ER facility on this island had no – yes, zero – platelets available. An ER room that doesn’t have the fundamental blood products to deal with major trauma and operative intervention? And apparently no methods for replacing them when needed other than asking a private sector casevac facility to bring some? How did they run out without some emergency measures being taken to replace the front line stock? I have relatives living in a third world country where the accepted practice is to ask friends and relatives to contribute blood for emergencies and operations, but this is Cayman, for heavens sake, where the HSA budget is millions of dollars a month, and who spent millions on an “Ebola tent” but apparently doesn’t have the fundamental basics needed for emergency care. Good grief.
I hear you, but I need to step in to defend the HSA. The team that cared for Lisa at George Town hospital would have done any big city hospital proud. While one team was working to stabilize her there were others on the phone and email contacting hospitals in other countries for platelets. I think by the Monday morning they had called everyone they could in a thousand-mile radius. It’s just one of those sad things. I miss her every day, but the HSA did everything that they could.
YES questions need to be raised in the LA on the issue of lack of platelets alone. what if we had mass casualty situation? I imagine though it will require some ruckus to take place on talk shows etc before anyone raises this very same question with those at the top at HSA.
Judging from the comments here sounds like you all have third world medical practices straight down to the lack of ambulances. A sad situation considering you all are the envy of the Caribbean. Very sad for the lady and her family.
I miss Lisa every day – her humour, her love of life and intelligence are sorely missed. A bright spark in a sometimes very dark world. Let this tragedy be a lesson to us all – always, always, always get a second opinion when it comes to your health and ensure that you do your research on both the procedure and the doctor performing the procedure.
don’t get sick in Cayman.
CNS – I’m surprise you open comments on this matter with the inquest ongoing.
CNS: It’s not a trial.
This is a tragedy for the patient ,her family and the attending physician.!
Before every one casts a stone and puts blame on the Doctor,one should wait for the outcome of the inquest. It seems the patient died from disseminated intravascular coagulation and septic shock. This is an end process and doesn’t really tell us the underlying cause.A small bowel perforation at surgery would have been the most likely cause but according to the pathologist there was no evidence of this.
A slight fever the day after surgery is usually not related to infection but due to the lungs not being completely expanded ( atelectasis) Infections usually take 2-3 days to develop.
20/20 hindsight is a wonderful thing and yes in retrospect the doctor should have seen the patient regardless, when she called the next day.Whether this would have changed the outcome no one knows.Its likely she would have found very little clinically at that stage.
Other medical induced causes of septic shock can include unsterile instruments, catheterisations , the administration of intravenous drugs by the anathetist or nurses etc.etc.
Before pointing the finger and putting blame on anyone it would be prudent to await the findings of the experts and allow the process of the inquest to reach a conclusion.
Google the doctor.
Or alternatively review the evidence if you’re actually interested in what happened instead of malicious speculation.
Agreed! Isn’t Google amazing?!
RIP?
Suffering a high fever within 24 hours of invasive surgery is a sign of a bacterial infection, of the two that would be considered most common & in lieu of a viral infection , as a medical sign. Why an attending physician would not immediately admit a patient in this example to I.C.U for further evaluation is beyond comprehension. There are obviously many more facts that need to be investigated in this story. Has Muise ceased to function as an OB/Gyn here?
There is a difference from a slight fever and a high fever.You are distorting the facts.!
She had a high fever!
Which is the distortion, the slight fever or the high fever?
What a list of half-assed failures from the surgery to the autopsy. This is why I buy the trip insurance EVERY time I go to Cayman. In case of emergency, I want to be on that air ambulance heading back to the US at the first opportunity.
I guess people don’t die in the good old US.
Usually not like that. We have platelets and ambulances when needed.
People die in the US but you can bet your ass people are held accountable for any malpractice and it doesn’t get swept under the rug.
Correction: The surgery was performed without any “failures” according to 10 witnesses and the post mortem.
I assume the pathologist was employed by Government.
No. The pathologist was brought in from Florida.
How sad. At leas this Gyno wasn’t trying to hide or cover up anything like the other criminal Gyno here.
That another Gyno is practicing because you are silent. Yet, bringing up “down below” issues to court is not something people are willing to do as every single detail would be up for public to read on a small island of 50,000. A friend of mine had lifetime consequences of his incompetence and already had 3 corrective surgeries elsewhere. Another Gyno (a female) had performed a mini- surgery on a wrong patient, simply because they looked alike and were booked close together, but the first one didn’t show up, so she grabbed the wrong chart. You can’t make this up.
There aren’t that many gynos and trincay/deosaran has a law suit for an allegedly botched op where he didn’t report a complication but where it was repaired badly so allegedly he knew but didn’t say. Was reported here on CNS and in Compass. Problem is that everything takes so long here these people just continue
OMG…..I have so much to say on this tragedy.. but am speechless.
This is so heartbreaking and I’m saddened to read about all the many hindrances to get her back to good health.
There is no such a thing as routine surgery. The first few days after any surgery are critical, blood clots kill many people exactly 2-5 days after a surgery. Then, there are genetics that may predispose you to post-operative complications and or new medicine you can have an adverse reaction to. A person who is discharged the very next day after any surgery is at high risk and on its own. Complaints of high fever the very NEXT DAY AFTER a surgery must have been a HIGH ALERT for ANY doctor.
My aunt and a former co-worker both died from a post-operative blood clots.
D-dimer blood tests are used to help rule out the presence of a blood clot. But when you are discharged from a hospital how would you know your D-Dimer? should be zero by the way. I learned about this test when HSA hospital sent me home with D-Dimer above 700. They followed the protocol and scanned me for clots, yet, released me with such a high D-Dimer without figuring out why it was so high. I had told my relative, a medical professional in my home country about abnormal D-Dimer before going to bed. I was awakened later by Police banging on my door who came to check on me – my relative insisted on that, knowing what elevated D-dimer means.
Many doctors are too relaxed when it comes to post-operative period. They rely on statistics. For some reasons they forget that we all have different genetic and biochemical makeups. Not all patients respond to drug therapy in a uniform and beneficial fashion. What saves one, can kill another.
An example of how ALL doctors overlooked a simple test that could have saved a
25-year-old bodybuilding mom Meegan Hefford (New York Post)? No one knew she had a rare genetic disorder that would make the breakdown of protein acutely toxic for her until after her death. The doctors did NOT check her ammonia levels. They never do if liver function test comes back normal. AND THAT IS NEGLIGENCE.
Used to see her at the gym – very quiet, humble and polite! How can someone go in for a routine surgery in this 21st century and lose their life?
Agreed. Especially someone so fit. We may never know…
There should be some follow up on the ambulance situation, EMS coordination in life and death situations, and the availability of blood and platelets when the CIG Blood Bank is in the habit of “giving away” blood products to the for-profit elective surgery health city. We shouldn’t have “secret” blood product shortages like this when lives could hang in the balance. This stuff shouldn’t be an afterthought.
My thoughts with the family…very tragic that complications (what is a possibility in any surgery) results in loosing a loved one. Why or if the Doctor underestimated the signs of a possible problem has to be clarified! In regards to the Ambulances, just this weekend (Pirates Week weekend), we have been at the hospital for 5 hours while a relative was treated for a sport injury…We saw 4 Ambulances outside the hospital. During a nice chat with one of the drivers it got clear that 2 of them parked there are being used as “spare vehicles” and the other 2 just came to the hospital within minutes bringing a patient. I was extremely surprised that (according to her info) there are at any time only 3 “on duty” ambulances for the entire island!!!
Hospital, East End and West Bay. This is very disturbing as a resident considering the distances between the districts…
Confirmed. Three on duty ambulances, but they are stationed at the West Bay Clinic, George Town Hospital, and the North Side Clinic – not East End.
And when one of those is on a call, even a routine transport, then the other ambulances have to cover. When two are on a call at the same time that leaves one ambulance to cover the entire island. That could leave the North Side ambulance responding to a call in West Bay, or vice versa.
Ambulance crews are not permitted to abandon a patient. So once they have made contact with the patient they have to carry that case through to conclusion, either transporting to more advanced care at a clinic or more typically a hospital; or if the patient signs off refusing care. So an ambulance could be tied up with a relatively minor case while an ambulance from further away responds to a more critical case.
The old ambulances stay parked at GTH for possible use in a mass casualty incident where off duty paramedics would be called in. So you might see three ambulances at the hospital but only one might be staffed.
Ie. Totally inadequate geographical and population-based EMS coverage. Thanks for clarifying how alarming the situation actually is.
Wow, I mean WOW. A few years ago, not too long but proving nothing has changed, I had to wait over 3 hours for a critical case transfer from CTMH to GT. I was in a critical condition and my wife was freaking out at the delays. Luckily I had been sufficiently stabilised by one excellent doctor at CTMH who very quickly recognised my problem and took appropriate initial action – saved my life and I’m forever grateful to that doctor. I say this as “all” ambulances were tied up with a multiple vehicle accident in which someone died. All very tragic of course but this proved we have no depth of resources as discussed in the post above. Its not good enough quite frankly, not good enough at all.
What is his name? Doctors like him must be recognised! I am too was lucky to have a competent doctor (Nelson) on duty who quickly connected the dots and sent me to Miami for diagnostics after a consultation with Miami cardiologist, since they had no appropriate equipment locally. He was 100% соrrect in his initial diagnosis. Other doctors on my previous ER visits as well as my internist who now has her own practice XXXXX were dismissing all my complaints to anxiety. Health City has such equipment now.