A Brisbane nurse who miscalculated a surgery patient’s deterioration score the day before her death has told an inquest she was “genuinely surprised” she got it wrong.
In February 2022, Gold Coast woman Rosemarie Campbell died at her home of complications after gastric bypass surgery.
The procedure was carried out three days earlier by Dr Vahid Reza Adib, the partner of former Queensland premier Annastacia Palaszczuk, at the Wesley Hospital in Brisbane.
Dr Adib was quizzed heavily on the first day of a coronial inquest being held into the 62-year-old’s death, and on Tuesday registered nurse Teresa Formiatti, took the witness stand.Â
Dr Vahid Reza Adib with his partner, former Queensland premier Annastacia Palaszczuk, in 2023. (ABC News: Kenji Sato)
The inquest has already heard Ms Formiatti, who worked in the bariatric ward, had assessed Ms Campbell against the Queensland Adult Deterioration Detection System (Q-ADDS) on the day of her discharge.
She determined Ms Campbell was at a score of 0 which does not require escalation to a supervisor before a patient is discharged.
However, it was later determined Ms Campbell should have been recorded a level 2 in the morning of her discharge, and at a 1 at the time of her discharge some hours later.
Ms Formiatti told the court when she assessed Ms Campbell, she had no temperature, her respiratory rate was normal, her pain was being managed well, she was passing urine, and her blood pressure had improved from the morning.
“We take into consideration more than just a single observation, you assess them holistically,” she said.
Oxygen level ‘not abnormal’, nurse says
When asked about Ms Campbell’s oxygen saturation being at a level of 93 to 94, Ms Formiatti disagreed it was concerning.
She told the court it was “not abnormal” for a bariatric surgery patient due to how they breathe, and “because she is dry”.
“[The level] can be a little bit softer, her baseline oxygen saturation was 98,” she said.
Dr Vahid Reza Adib gave evidence at the inquest on Monday. (LinkedIn)
When asked whether the increase in Ms Campbell’s blood pressure was cause for concern she also said no, telling the court it was “a little elevated”, but still within in normal range.
“Her blood pressure was not unexpected,” she said.
Ms Formiatti told the court, according to her assessment Ms Campbell’s observations were “stable” and she was “otherwise well” and was asking to be discharged.
“A patient who is very unwell or deteriorating doesn’t say they’re going to feel better at home … they’re saying something doesn’t feel right, something feels off,” she said.
Approved to leave despite vomiting
The inquest has already heard on the second night after her surgery Ms Campbell began vomiting and continued to do so up until her discharge.
Ms Formiatti told the court although this was “not uncommon” she had decided to escalate it to her supervisor, as current anti-nausea medication was not working.
“She was spitting up, having small volume vomits,” she said.
Rosemarie Campbell received the surgery at The Wesley Hospital in Brisbane’s inner-north. (ABC News: Michael Lloyd)
The inquest has already heard Ms Formiatti and her supervisor spoke with Dr Adib about this, and he prescribed her with another anti-nausea medication and approved her discharge.
Ms Formiatti told the court this was the only reason she escalated it, “to give her something else” to try and assist with the vomiting at home, not because vomiting was a sign of not being clinically stable.
“It’s not any unusual presentation,” she said.
“I was concerned from the dehydration perspective.”
‘Due process’ followed during flood
When asked about the chart error, Ms Formiatti told the court “I was genuinely surprised when I had calculated the Q-ADDS (score) incorrectly”.
“I’m normally very accurate,” she said.
Woman’s death following gastric bypass inquest begins
Ms Formiatti said regardless, she was of the understanding that a score of 1 did not prevent a patient from being discharged “based on those observations”, just that it needed to be escalated to a supervisor.
“This is not an abnormal presentation,” she said.
The inquest has already heard at the time of Ms Campbell’s discharge Brisbane was experience a flooding event.
Ms Formiatti acknowledged she had been asked to do a 24-hour shift as other staff could not get to the hospital but denied there was pressure to discharge patients due to rising flood waters.
“No, we followed due process,” she said.
Team leader unaware of pain
Registered nurse Anna Langton, who was the team leader on shift, also gave evidence and was asked about processes at the hospital.
She told the court her experience was if a nurse scored a patient between 1 and 3 on their Q-ADDS chart, they would need to notify her and then they would “follow the local process”.
Ms Langton told the court one of these scores would “usually” require further observations of four hours before discharge.
“But it would depend on what the score was for,” she said.
Ms Langton accepted at the time of Ms Campbell’s discharge, she was not aware of what policy was in place or by-laws for The Wesley in respect of requirements for patients to be discharged or a specific discharge criteria.
The court heard before Ms Campbell’s discharge Ms Langton was given a briefing of her condition from Ms Formiatti, but she had not looked at her documentation herself.
“Normally the nurse would come to me with the bedside chart, and we would look at all the information … what the primary concerns were and escalate as necessary,” she said.
“I don’t recall that happened at that point.”
However, she did recall being concerned about reports of Ms Campbell’s continued nausea and vomiting, which is what was ultimately escalated to Dr Adib.
Ms Campbell’s procedure was carried out three days before her death by Dr Vahid Reza Adib at the Wesley Hospital in Brisbane. (ABC News: Michael Lloyd)
Ms Langton told the court this was “not necessarily” unusual, but she was also not made aware that at the same time the vomiting started the night before, she was given medication for severe pain, and this would have been a concern.
She said if she had all of the relevant information back then, Ms Campbell was “probably not” an appropriate patient for discharge.
Patient symptoms ‘quite worrying’, expert says
A bariatric and upper gastrointestinal expert was the final witness to testify at the inquest.
Professor Wendy Brown provided reports to the coroner about her opinion on a number of issues including whether she believed the bypass surgery was appropriate.
She said she would have wanted a “really good history” of Ms Campbell’s ongoing reflux issues and would have carried out at least one investigative measure, such as a gastroscopy, before considering the procedure.
“This is my practice rather than Australian guidelines,” she said.
Despite there being other medical procedures that could have been tried first, Professor Brown told the court gastric bypass was still a “reasonable option”.
“It will definitely improve people’s reflux,” she said.
“At the end of the day it comes down to a conversation between relative risks and relative options between the patient and the surgeon.”
Professor Brown told the court her assessment of what took place in hospital is that “something changed” the night before she was discharged.
She said the fact that Ms Campbell suddenly had pain and vomiting after a “fairly normal” first day of recovery, should have raised alarm bells for nursing staff.
“That all is quite worrying and not what you would expect at this time,” she said.
She disagreed with evidence heard that the volume of vomiting was normal in bariatric surgery patients and said: “I would not be comfortable letting them go home”.
“The amount they vomited was almost the same [amount of liquid] they’d taken in,” she said.
The inquest was adjourned, and Deputy State Coroner Stephanie Gallagher will now consider her findings.