Much of the inquest focused on Toll’s condition in the high dependency unit immediately after surgery, and the decision to move him to a general ward the day before his death.
The court heard the Wodonga man was nauseous, vomiting, and had short runs of supraventricular tachycardia – a fast and erratic heartbeat – in the hours following his surgery.
Expert anaesthetist Dr Ross McPherson told the court on Friday these irregular heart rhythms were common after surgery and were unlikely to have contributed to Toll’s deep vein thrombosis. McPherson said that apart from his age and type 2 diabetes, for which he was not medicated, Toll was a suitable candidate for anaesthesia.
“Really, his general health was very good,” McPherson said.
On Wednesday, the family’s lawyer Jennifer Hillier grilled orthopaedic surgeon Dr Elie Khoury about two other patients who had died after having bilateral knee replacement surgery on his watch.
Hillier said Khoury had performed more than 1600 arthroplasties by the time he operated on Toll, 94 of which were bilateral total knee replacements. Khoury told the court the 3 per cent mortality rate was within the acceptable range.
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In Australia, 0.08 per cent of patients – eight in every 10,000 – die within 30 days of knee replacement surgery, according to a study published in the ANZ Journal of Surgery.
Bilateral joint replacements are considered more risky. Khoury said he would have preferred to perform one knee replacement at a time, but Toll had struggled with arthritis in both knees since at least 2006 and was “very keen” to have both done.
The hospital investigated Khoury’s practice after Toll’s death, the court heard. Asked what could be learned by Toll’s death, Khoury said the hospital needed to improve its communication and referral systems.
Earlier in the week, the inquest heard the nurse admitting Toll to hospital before his surgery was not aware of previous heart issues because his cardiology and GP records were not included in his admittance paperwork.
On Friday, the family acknowledged some processes had changed at the hospital since Toll’s death.
“It is comforting for the family to know we’ve been listened to, and hopefully, although we don’t get to have our loved Ken with us, other families don’t endure what we’ve had to endure,” they said.
They listed the events Toll had missed, including his son Mark’s wedding and daughter Lisa’s 40th birthday. “Ken is missing seeing his grandkids grow up into the amazing young people they are,” they said.
The court was shown a slideshow of photos from Toll’s childhood, his 20 years in the army, and his 40 years of marriage, set to Redgum’s I Was Only 19. A visibly emotional Magistrate McLaughlin adjourned, thanking the family for sharing “further insights into the life of Ken, and the consequences that his loss has had on all of you”.
Source Agencies
