RAH surgeon Dr James Edwards “horrified” he unnecessarily operated on Dennis Jackson

A surgeon who removed part of a man’s lung has told an inquest he was “horrified” and “disappointed” to discover the procedure was unnecessary.

A surgeon who removed part of a man’s lung after a pathology bungle which misdiagnosed him with cancer said he was “horrified” to learn he had operated on the man unnecessarily, a court has heard.

Royal Adelaide Hospital cardiothoracic surgeon Dr James Edwards gave evidence in the inquest into the death of 67-year-old Broken Hill man Dennis Charles Jackson on Thursday.

Mr Jackson died after a misdiagnosis of lung cancer and surgery later led to him suffering hospital-acquired pneumonia.

He died after spending several months in hospital – including 63 days in ICU – in January 2019.

Dr Edwards told the court the team had wanted to immediately work out what went wrong after the operation before disclosing the error to family in a meeting on August 24, 2018 – a week after the operation.

“We were horrified by the idea that we had taken out a non-malignant lobe,” he said.

Royal Adelaide Hospital cardiothoracic surgeon Dr James Edwards leaves the Coroners Court after giving evidence in the inquest of Dennis Charles Jackson.

During that meeting, he said he “expressed disappointment that we had gone ahead and done this operation”.

“I did reassure them that I was reasonably satisfied that the operation had been successfully completed without particular risk to him,” he said.

“Of course that turns out to have not been true.

“I would have told him that he had sufficient lung tissue remaining to function in whatever way he wanted.”

Instead of cancer, the court heard Mr Jackson had a granuloma, or benign inflammation of a small area. He remained in hospital for two weeks before being discharged.

Mr Jackson subsequently returned to hospital struggling to eat, drink and swallow a month later. He was diagnosed with hospital-acquired pneumonia and spent two months in ICU.

Dennis Jackson and wife Ramonda with their great nephew Paxton.

Dr Edwards said Mr Jackson did not have a completely healthy lung prior to the operation due to his history of smoking as well as working in mining and asbestos.

The court heard Mr Jackson had suffered nerve damage to his vocal chords, which an expert believed had indicated a “surgical error”.

Dr Jackson said it was possible the tube inserted by an anaesthetist may have caused the damage or that ventilation tubes while he was intubated in ICU had caused the damage.

He said it was also possible the combination of events that had caused the damage.

He said complications were “not always” avoidable during surgery but he did not believe he caused any damage to Mr Jackson’s nerves during surgery.

He said he did not “display” the nerve during the operation, so was unable to tell if it had been abnormal prior to surgery.

“I don’t believe I went anywhere near the nerve during his operation,” he said.

“I don’t want to sit here and say it was impossible that there was damage during the operation because that would not be true. But I didn’t think I did.”

Professor Phan Tien Nguyen leaves the Adelaide Coroners Court after giving evidence at the Dennis Jackson inquest. Picture: NCA NewsWire / Kelly Barnes

On Wednesday, the court had heard Mr Dennis had only required ongoing monitoring, rather than having part of his lung removed.

Royal Adelaide Hospital head of thoracic procedure unit, Professor Phan Tien Nguyen, told the Coroners Court he had a “quite vivid” memory of Mr Jackson.

He said he was “highly suspicious” a 12mm nodule found in a scan in Mr Jackson’s lung was cancerous and felt his suspicions were confirmed by the biopsy result.

He said Mr Jackson’s history, which included being a smoker for 50 years and working in mining and asbestos, along with his factors including his presentation of shortness of breath and the size of the nodule had also increased the likelihood he was suffering from cancer.

Professor Nguyen said he had recommended surgery to remove the upper lobe of the lung, which he recalled Mr Jackson being “happy about” because he had recently had family members suffer from inoperable cancer.

“My recollection is that his preference was surgery,” he said.

He said he “could not ignore” the results of the biopsy, which led to his initial diagnosis and recommendation for surgery.

Testing of removed lung tissue after surgery revealed Mr Jackson did not have cancer. Further DNA testing of the cancerous fragment that led to Mr Jackson’s misdiagnosis was found to belong to another patient.

Professor Nguyen told the court had the correct biopsy result been returned, his recommendation to Mr Jackson would have been different.

“I would have recommended a CT in three months to assess the growth,” he said.

He told the court he would have also recommended further monitoring at intervals over the following two years.

“I was highly suspicious if hypothetically the biopsy did not show carcinoma, we would have observed the nodule very closely,” he said.

Mr Nguyen said he had “no recollection of concern over the pathology report” but is now on alert at any mention of “free floating” or “separate” fragments in other pathology reports.

The hospital later apologised to Mr Jackson and his family for the error.

Mr Jackson was discharged from hospital after the surgery, but returned a month later suffering hospital-acquired pneumonia. He died on January 21, 2019.

His niece, Tanya Williams, had described her uncle as a well-loved man and hoped the inquest would lead to change to prevent and future similar incidents.

The inquest continues.