A Victorian Coroner’s investigation into the death of a young woman, Lauren James, after liposuction has been in the headlines recently.
Kathryn Booth, principal of Maurice Blackburn (which represented Lauren James’ partner), and her colleague, lawyer Laura Vines, say the case has wider implications – for cosmetic surgery in particular, and quality and safety in health care more broadly.
“Lauren James was a healthy and beautiful 26-year-old who, for reasons that only she could have known, underwent liposuction by a plastic surgeon at a day surgery clinic.
Three days later she was dead.
Following a ten day inquest, Victorian Coroner Paresa Spanos found that Lauren died from post-operative complications including sepsis, decreased respiratory function and central nervous system depression.
The Coroner also found that the clinic and the treating surgeon failed in their duty to provide Lauren with adequate post-operative care; Lauren’s complications were treatable and her death could easily have been prevented.
This case is undoubtedly a tragedy. It was clearly devastating for Lauren, for her family, for her loved ones, and for the medical and nursing staff involved with the procedure and its aftermath. But it also provides vital warnings for the cosmetic surgery industry and for the provision of patient care generally.
Lauren’s death was preventable. Her surgery was optional, it was expensive, it took place at an apparently reputable clinic with experienced surgeons, but she still died.
Every single day in our legal practice we see heart-breaking cases caused by medical negligence and mismanagement. One of the most alarming features of our work is how many of these cases result from a simple lack of communication (between medical staff or between doctor and patient) or a failure to value patient safety above commercial interests.
Cosmetic surgery is a peculiar beast. It is not about healing. Most doctors are involved in treating illness and, to a greater or lesser degree, saving lives. Cosmetic surgeons providing elective procedures are paid to perfect the perceived physical flaws of ostensibly healthy people. There is an uncomfortable and at times blurry line between entrepreneurial and commercial interests, and the provision of medical care.
This article isn’t about begrudging surgeons a decent living, or saying that all cosmetic surgery is bad, it is about demanding that patient safety and well-being come first, not commercial interests.
Cosmetic surgery clinics advertise fiercely for patients and provide comfortable, user-friendly services which can trivialise the seriousness of the surgery and give patient’s unrealistic expectations about the outcome and the risks involved. It is elective surgery based entirely on the patient’s choice and in this context providing detailed information to allow the patient to make a fully informed choice is all the more important. No matter how simple the procedure, all surgery carries risks.
Cosmetic surgeons are used to treating healthy people in a lower risk environment than most surgeons and this can mean that when complications arise, these surgeons are less attuned to the signs and symptoms. It is an unfortunate human tendency to fail to see what we are not expecting.
On the morning of Lauren’s death, she attended the Clinic complaining of severe pain three days post-operatively. She was examined, injected with an opioid and discharged within approximately 30 minutes with the management plan effectively being to “wait and see”. No investigations into the cause of Lauren’s pain were ordered. She was not seen by the surgeon who operated on her. She was not kept for observations following the injection of a strong narcotic and she was not admitted to hospital for further investigation and/or monitoring. She was simply sent home.
As Lauren’s condition worsened that afternoon and evening, she experienced continuing strong pain, swelling, blistering and bleeding from her incision sites. Her partner made a total of six telephone calls to the Clinic asking for help, but he got only a farcical series of administrative and communication breakdowns. Messages were not passed on, no sense of urgency was communicated to the treating surgeon who put off calling back for hours, and no doctor ever suggested speaking directly to Lauren about how she was feeling.
These failures by the medical staff charged with Lauren’s care meant that the opportunity to save her life was lost.
The Coroner found that the weight of expert evidence presented at inquest was: “not only that the deceased may have survived with optimum treatment but that she would probably have survived.”
One expert medical witness put the time for effective intervention as late as mere moments before Lauren fell unconscious, never to re-awake.
The take home message for doctors and all health professionals is that the value of good old fashioned clinical examination – and taking the time to actually see or speak to the patient – cannot be underestimated. Sloppy communication endangers patients and leads to unmet expectations. It does not matter how reputable the clinic is, how experienced the surgeons seem or how glossy their pamphlets are, if medical staff do not prioritise patient safety, communication and thorough clinical examination the results can be deadly.”
• Maurice Blackburn Lawyers are the legal representatives for Lauren James’ partner Simon Dal Zotto. The firm represents people injured as a result of medical negligence through Coronial investigations and civil compensation claims.