Post mortem test in surgical death with alleged negligence

The strict test to be applied should be: ‘Could death have occurred, if the operation had not taken place?’

• Information is required before beginning the medicolegal autopsy. The patient’s notes are essential along with some other relevant information. Equally important is the attendance of clinicians at the autopsy, more indeed, in deaths associated with anesthesia.
• Discussion among autopsy surgeon and the anesthetist may arrive at an amicable conclusion of opinion to offer the investigating authority.
• The hospital lab may be requested to retain any antemortem blood or fluid samples sent to them so that they remain available for analytical checks, such as blood grouping in transfusion mishaps, or creatine phosphokinase activity in malignant hyperthermia
• If death is due to a disease or disability, other than that for which the operation was performed, a distinction has to be drawn between those conditions that were known before the operation was and those which were unexpected. Naturally, operative and anesthetic techniques may have to be modified to take into account the known adverse conditions.
• Death may occur due to failure of a surgical technique. This may be inadvertent, from a true ‘accident’ sometimes caused by unusually difficult operative circumstances, to anatomical abnormalities or even failure of equipment.
• When death is a result of error of incompetence, then a legal action for negligence may ensue and the autopsy surgeon must be even more meticulous than usual in producing a detailed and impartial report.
• When a failure of equipment may be responsible, then expert examination and advice is required. Anesthetic machines, gas supply, compatibility of connections and all the sophisticated hardware of Operation Theater must be subjected to the most rigorous inspection if a malfunction is suspected. This is an important concern of the autopsy surgeon, as he is responsible for the eventual decision about the cause of death.
• Cardiac arrest was found to be the most common single mode of death, being seen on average once or twice a year in most busy operating suites even under the most careful surgical and anesthetic regimens. Most cardiac arrests occur either at the start or end of the surgical procedure.