Doctor jailed for “culpable homicide” and possessing child pornography
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《英国医生杂志》
A Dutch paediatric cardiologist has been found guilty of "culpable homicide" after a 7 month old baby girl died following heart catheterisation. He was also found guilty of possessing a large quantity of child pornography and has been banned from practising medicine for six years and jailed for 18 months, with six months suspended.
Dr Paul H, 45, had, the court accepts, intended to help Charlotte Floor, who had been born with a severe heart abnormality. But his "gross carelessness" and "irresponsible decisions" meant he is to blame for her death.
In 2001, Dr H had operated at Utrecht抯 Wilhelmina Children抯 Hospital, to insert a stent into one of the infant抯 arteries. Expert witnesses told the court that such a high risk operation was then "scarcely known" in a child under 12 months, although it would be possible in extreme circumstances. But Charlotte did not present as an emergency.
She died because of a chain of events, the most important of which were damage to an artery during surgery and conservative treatment for later bleeding.
Charlotte had had a double aortic arch with coarction. Angioplasty had not resolved her problems and Dr H discussed the option of a stent with his most experienced colleague. His colleague said, "Keep all options open."
When Charlotte was admitted for further angioplasty, tests showed that placing a stent was possible. Dr H chose this option without informing her parents of the risks involved. Colleagues observing the operation had not objected, although the most experienced paediatric cardiologist was not present because of a personal row. Dr H was helped by a junior doctor who had never previously done a heart catheterisation (BMJ 2002;325:1318).
Dr H found that the sheath used in placing the stent was too long and he cut it using a lancet and the underside of a metal beaker. On removing the sheath, he noticed that where he had cut it was a rough edge. He advised nursing staff that echocardiography should be done because of the risk of thrombosis but did not specifically report his concerns to the anaesthetist responsible for Charlotte抯 aftercare.
Later "a lump the size of an orange" was discovered in her abdomen. She was taken to intensive care but died.
The court judged that Dr H had used the wrong sized stent and sheath, did not ensure the correct materials were available in the heart catheterisation room, and had not requested help from the most experienced paediatric cardiologist.
His defence argued that the decisions taken were not black and white but about a medical consideration of risk. He acted in the interests of the infant, whose condition could have resulted in sudden death.
The next year a police investigation discovered an estimated 400 000 pornographic images of children aged 0 to 16 at Dr H抯 home. The prosecution allege that both cases show his "fundamental lack of respect for children." The court said the "bizarre combination" of the two cases had created public alarm. "Patients and their parents," it noted, "put trust in doctors and their profession."(Utrecht Tony Sheldon)
Dr Paul H, 45, had, the court accepts, intended to help Charlotte Floor, who had been born with a severe heart abnormality. But his "gross carelessness" and "irresponsible decisions" meant he is to blame for her death.
In 2001, Dr H had operated at Utrecht抯 Wilhelmina Children抯 Hospital, to insert a stent into one of the infant抯 arteries. Expert witnesses told the court that such a high risk operation was then "scarcely known" in a child under 12 months, although it would be possible in extreme circumstances. But Charlotte did not present as an emergency.
She died because of a chain of events, the most important of which were damage to an artery during surgery and conservative treatment for later bleeding.
Charlotte had had a double aortic arch with coarction. Angioplasty had not resolved her problems and Dr H discussed the option of a stent with his most experienced colleague. His colleague said, "Keep all options open."
When Charlotte was admitted for further angioplasty, tests showed that placing a stent was possible. Dr H chose this option without informing her parents of the risks involved. Colleagues observing the operation had not objected, although the most experienced paediatric cardiologist was not present because of a personal row. Dr H was helped by a junior doctor who had never previously done a heart catheterisation (BMJ 2002;325:1318).
Dr H found that the sheath used in placing the stent was too long and he cut it using a lancet and the underside of a metal beaker. On removing the sheath, he noticed that where he had cut it was a rough edge. He advised nursing staff that echocardiography should be done because of the risk of thrombosis but did not specifically report his concerns to the anaesthetist responsible for Charlotte抯 aftercare.
Later "a lump the size of an orange" was discovered in her abdomen. She was taken to intensive care but died.
The court judged that Dr H had used the wrong sized stent and sheath, did not ensure the correct materials were available in the heart catheterisation room, and had not requested help from the most experienced paediatric cardiologist.
His defence argued that the decisions taken were not black and white but about a medical consideration of risk. He acted in the interests of the infant, whose condition could have resulted in sudden death.
The next year a police investigation discovered an estimated 400 000 pornographic images of children aged 0 to 16 at Dr H抯 home. The prosecution allege that both cases show his "fundamental lack of respect for children." The court said the "bizarre combination" of the two cases had created public alarm. "Patients and their parents," it noted, "put trust in doctors and their profession."(Utrecht Tony Sheldon)