NSW:Drug warnings after elderly patients died

AAP General News (Australia)
08-10-2011
NSW:Drug warnings after elderly patients died

SYDNEY, Aug 10 AAP - The deaths of two elderly patients who were treated by the same
doctor, now deregistered, has prompted a warning about the use of neuro-muscular blocking
agents.

NSW State Coroner Mary Jerram made a string of recommendations on Wednesday after handing
down her findings at the inquest into the deaths at a small NSW rural hospital.

Their treating doctor, Dr Balaji Rao, already has been found guilty of unsatisfactory
professional conduct and professional misconduct and in 2010 was deregistered for at least
a year.

Ms Jerram found that Ralph Leslie Grenfell, 69, died on October 5, 2005 at Tocumwal
Hospital, close to the NSW/Victorian border.

He died as the immediate result of the administration of Atracurium and Pancuronium
delivered intravenously without ventilatory support by Dr Rao.

The coroner found that Arthur Robert Cooling, 88, died at the hospital as the immediate
result of the administration of Atracurium delivered intravenously without ventilatory
support by Dr Rao.

"Atracurium and Pancuronium are forms of non-depolarising neuro-muscular blocking agents,"

she said, adding they cause muscle paralysis.

"A patient who receives those drugs in the quantities in which they were ordered -
in the absence of ventilatory support - will die within minutes."

Ms Jerram twice suspended the inquest so the Director of Public Prosecutions (DPP)
could consider laying charges over the deaths.

But the DPP declined to lay charges.

Ms Jerram said the drugs were "dangerous" and "have no role to play whatsoever in palliative
care".

"Any use of these drugs without mechanical ventilation and appropriate sedation risks
a patient enduring an agonising death of suffocation," she said.

"To the outsider the patient would seem still and at peace but in reality the patient
would be conscious, fully aware they cannot breathe but unable to move."

She recommended a NSW Health Safety Notice be issued warning doctors and nurses of
the potential negative effects of neuro-muscular blocking agents, and that they should
not be used without appropriate ventilator support.

Other recommendations included that Visiting Medical Officers be strongly encouraged
to avail themselves of specialist resources for palliative care and pain relief.

AAP mss/tr/jnb/nb

KEYWORD: COOLING

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