Doctor defends care of elderly patients


A doctor who separately saw two elderly patients before their deaths has defended his treatment of them, as a WA coroner investigating his care has indicated she is unlikely to make adverse findings against him.

Anna Maria Winter, 94, had a painful cancerous growth affecting her vulva when she was referred to specialist urologist Daryl Stephens at Waikiki Private Hospital in April 2014.

She had a suprapubic catheter inserted and Dr Stephens also conferred with a plastic surgeon, who agreed the lesion would require a resection.

"I recall the (catheter) procedure going very well," Dr Stephens said on Wednesday.

He said the suprapubic catheter insertion was usually an uncomplicated procedure but he believed she had a "very nasty cancer" and wanted her to be transferred to St John of God Hospital.

Dr Stephens said he was "surprised and a bit concerned" that she was still at the hospital the next day.

She was eventually transferred by taxi, which was contrary to the hospital's policy of doing transfers by ambulance.

Upon arrival, Ms Winter became ill and collapsed, receiving palliative care until she died from sepsis complicating management of vulval carcinoma on May 20, 2014.

Deputy state coroner Evelyn Vicker said she did not believe the suprapubic catheter had any connection with the sepsis.

Rather, she agreed with Dr Stephens that it was more likely to have been a rupture of a diverticulum, noting Ms Winter's rapid decline happened the day after the procedure.

Ms Vicker was concerned about the documentation at the hospital but said it was common across all hospitals four or five years ago to have similar problems and changes had since been made.

Separately, in April 2014, John Houghton, 72, had a urinary tract infection and an ultrasound also showed a bladder wall irregularity, which prompted his GP to refer Mr Houghton to Dr Stephens.

A radiology report also stated the possibility of a neoplastic mass lesion and a cystoscopy was suggested.

Dr Stephens testified that although he thought the chance of bladder cancer was low, he recommended Mr Houghton have a cystoscopy, but he could not get a date before a hip replacement procedure.

Ms Vicker said while the care and management might not have been optimal, it did not alter her view that it was pragmatic.

Mr Houghton had a right hip replacement in June 2014, but 10 days later went to Peel Health Campus emergency department.

A CT scan showed invasive bladder cancer and Mr Houghton was transferred to Fremantle Hospital, but his condition deteriorated and he received palliative care until his death on July 11, 2014.

The coroner will hand down her findings at a later date.