'Back to front' X-ray blamed for tragedy

A surgeon accused of killing a kidney patient because of a blundered operation might have looked at the man's X-rays back to front.

John Gethin Roberts, 60, a consultant urologist, is accused of manslaughter with Mahesh Chard Goel, 40, a surgeon, at Prince Philip Hospital in Llanelli, south Wales, in January 2000.

Graham Reeves, a retired pipe lagger who was 69 at the time of the operation, died in March 2000, five weeks after his healthy left kidney was removed instead of his diseased right one.

Leighton Davies QC, for the prosecution, told the jury at Cardiff Crown Court that Mr Roberts said in a statement to police that he could have mis-examined the X-rays before the operation.

He said: "What Mr Roberts went on to say is this: 'I can only assume that when I put the X-ray films up to look at them I inadvertently put up the right kidney on the left side'.

"He appears to be claiming that he put on the X-ray films back to front."

Mr Davies added that the X-ray error would have been noticed if Mr Roberts had checked Mr Reeves' notes and consent form and that the consultant also told police he did not recall seeing any labels on the X-rays.

"What he was relying on was inadequate X-ray evidence in order to ascertain the side and he was dreadfully wrong in his conclusion," Mr Davies said.

The consultant described in another statement, as part of the hospital's internal investigation, how his "heart sank" when he heard Mr Reeves was not passing urine after the operation: "I became concerned lest we had removed the incorrect kidney. I went to see Mr Reeves.

"I came to the conclusion that I could not understand why I had previously decided that a left nephrectomy was correct when a second view made it obvious that the nephrectomy should have been right-sided."

Mr Davies said the mistake could have been picked up by the "simple and elementary step" of checking medical notes and that "to attempt to blame others is fatuous".

The court was told Mr Goel, who did the operation, admitted in a police interview that he did not cross-check Mr Reeves' notes with the operation list. Mr Davies said: "He admitted that prior to carrying out the operation he did not check the medical notes. He said by the time he came to the theatre Mr Reeves had already been positioned for a left nephrectomy.

"He said, 'I assumed the cross-checks had been done by my boss'. He accepted that he should have cross-checked as well. That was a pretty damning admission."

Mr Davies added that Mr Goel revealed he did not speak to Mr Reeves before the operation during a ward round because the pensioner was sleeping and was a high-risk patient. But he told police that patients were normally spoken to and that "usually we ask which side it is".

Mr Davies said: "When he was asked whether he had looked at the X-rays of Mr Reeves in the theatre, he said he looked at them but only from a far distance."

Questioned during the police interview as to why he did not get closer to the images, Mr Goel declined to answer, Mr Davies added.

Mr Davies asked Robert Ley, a junior doctor who held a pre-admission clinic for Mr Reeves and obtained his consent form: "Would you expect Mr Roberts and Mr Goel to look at the notes before the operation?"

Dr Ley replied: "I can't speak for other people, but personally I would have done."

Mr Roberts and Mr Goel both deny manslaughter. The trial continues.