A grieving mother is suing the Tasmanian Health Service over the death of her adult son at the Royal Hobart Hospital (RHH) in 2015.

James Maurice Smith, 38, died on June 13, 2015 following a cardiac arrest due to an aortic dissection.

The 2017 coronial investigation into his death found that had he been diagnosed, and surgery performed, on an earlier visit to the hospital’s Emergency Department (ED), he would have stood a 75 per cent chance of surviving and resuming a normal life.

His mother, Pauline Jane Smith, has taken the state’s health service to the Supreme Court of Hobart on behalf of herself and Mr Smith’s two young daughters, claiming a number of alleged failures, including failure to diagnose his condition, failure to take into account an earlier visit to the ED and failure to provide a surgical review in a timely manner.

Mr Smith was having a bath in June 2015, when he experienced “a rolling sensation” that crept down his neck and into his back, before radiating to the lower right side of his abdomen. When he got out of the bath, he was unable to control his right leg.

He was taken to the RHH by ambulance — during which time he developed lower abdominal and right lower back pain.

On arrival at the hospital, a test also showed his blood lactate levels — an indicator of sepsis, heart failure and other serious conditions — were double the upper limit of normal.

After a number of hours, the medical officer in charge concluded that Mr Smith had musculoskeletal lower back pain and viral gastroenteritis.

He was discharged with anti-nausea medication, a script for painkillers and advised to see his GP.

Days later he visited his mother, who said he looked “shocking” and “couldn’t eat or even hold down a coffee”.

The following day he returned to the ED at 2:55pm, where a registrar recommended he undergo a surgical review. That review did not take place for another eight hours.

Around midnight, a general surgical registrar listed a number of possible causes and ordered a CT scan of the abdomen.

Four hours later, a consultant radiologist reviewed the scans and recommended Mr Smith undergo further scans focussing on his heart and aorta and a vascular review.

Based on the advice provided to him — that it was a focal aortic dissection, meaning urgent surgery was not required — the vascular surgeon did not accept Mr Smith’s admission.

An hour later, whilst being attended to by a nurse, Mr Smith “appeared to stop breathing”.

CPR was performed but he could not be revived.

Opportunity to treat ‘effectively lost’ upon first presentation

A review by the medical adviser to the coroner found a number of issues, including:

• The initial diagnosis of musculoskeletal back pain and viral gastroenteritis was at odds with the clinical history

• It was “poor medical practice for Mr Smith’s blood lactate level to have been ignored” — further investigation may have revealed his condition was vascular in nature

• Whilst aortic dissection is difficult to diagnose, the symptoms and signs Mr Smith presented with on his first visit should’ve made it a consideration

• It was misleading to describe it as a focal aortic dissection

• The opportunity to treat him was “effectively lost”, when diagnosis was not made on his first presentation at ED

In his findings, coroner Rod Chandler said it was “a most regrettable outcome” that a correct diagnosis of Mr Smith’s illness was not made, despite his two presentations to the ED.

He said he accepted the medical advice that aortic dissection should have been included as a potential diagnosis on Mr Smith’s first visit to the ED.

“Appropriate steps taken then to investigate that condition would almost certainly have led to the diagnosis being made,” Mr Chandler wrote.

“Such an outcome would have given Mr Smith his best chance of survival.

“After Mr Smith presented at the ED on the second occasion, the prospects of his aortic dissection being promptly diagnosed and treated were compromised by the apparent failure on the part of the attending clinicians to inform themselves of the detail of Mr Smith’s earlier presentation and by the eight-hour delay before a surgical review took place.”

Mr Chandler concluded that the surgical review would have eventually led to the correct diagnosis being made.

“However, there was insufficient time for those investigations to be completed and for remedial surgery to be undertaken before Mr Smith’s cardiac arrest and regrettable death,” he said.

Mr Smith’s mother is suing the Tasmanian Health Service for an undisclosed amount under the Fatal Accidents Act 1934.

As part of her case, her lawyer Christine Schokman is alleging the hospital breached its duties in a number of alleged failures, including failing to diagnose his aortic dissection, failure to take into account the elevated levels of blood lactate, failure to review and provide a surgical review in a timely manner and failure to provide medical services and treatment to an ED standard.

As of July 28, 2020 the case has entered into mediation.

The Tasmanian Health Service has been contacted for comment.