‘A huge hole’: Family hopes man’s death after knee surgery sparks change

It did not take long for Magistrate Sally McLaughlin to realise the modest third courtroom at Albury Local Court would not be big enough to accommodate the family and friends of Ken Toll.

Five years after his death, they were here for answers. They wanted to know how the beloved husband, father and grandfather went to hospital for what they believed was a “routine” knee replacement surgery and never came home.

A coronial inquest is examining how Kenneth Toll, 62, died following bilateral knee replacement surgery five years ago.

“The unexpected passing of Ken has left a huge hole in our family that will never be filled or repaired,” the Toll family said in a statement read to the court on Friday. “As a family, we have all suffered some level of mental illness following Ken’s passing … [his death] is so vivid in our memory it haunts us every day.”

The 62-year-old army veteran collapsed and went into cardiac arrest at Albury Wodonga Private Hospital on July 20, 2019, three days after surgery to replace both his knees. The court heard Toll suffered a pulmonary embolism as a result of developing deep vein thrombosis.

The family said the sight of his body on the bathroom floor had been “distressing”.

Toll’s wife Wendy, son Mark and daughter Lisa sat through five days of harrowing and detailed evidence from medical and nursing staff who treated Toll in the days before and after his surgery. A video stream was set up in another room for wider family, media, and members of the public.

In their statement on Friday, the family pushed back on anaesthetist Graham Libreri’s assertion on Monday that surgery was “a risky job” and “occasionally, these things happen”.

Their response was blunt: “Dr Libreri said at the end of his evidence that death is an unfortunate part of surgery, but people’s lives are in doctor’s hands, nurses and hospitals hands, and that needs to be taken seriously when a patient consents to surgery.”

Much of the inquest focused on Toll’s condition in the high dependency unit immediately after surgery, and the decision to move him to a general ward the day before his death.

The court heard the Wodonga man was nauseous, vomiting, and had short runs of supraventricular tachycardia – a fast and erratic heartbeat – in the hours following his surgery.

Expert anaesthetist Dr Ross Macpherson told the court on Friday these irregular heart rhythms were common after surgery and were unlikely to have contributed to Toll’s deep vein thrombosis. Macpherson said that apart from his age and type 2 diabetes, for which he was not medicated, Toll was a suitable candidate for anaesthesia.

“Really, his general health was very good,” Macpherson said.

On Wednesday, the family’s lawyer Jennifer Hillier grilled orthopaedic surgeon Dr Elie Khoury about two other patients who had died after having bilateral knee replacement surgery on his watch.

Hillier said Khoury had performed more than 1600 arthroplasties by the time he operated on Toll, 94 of which were bilateral total knee replacements. Khoury told the court the 3 per cent mortality rate was within the acceptable range.

In Australia, 0.08 per cent of patients – eight in every 10,000 – die within 30 days of knee replacement surgery, according to a study published in the ANZ Journal of Surgery.

Bilateral joint replacements are considered more risky. Khoury said he would have preferred to perform one knee replacement at a time, but Toll had struggled with arthritis in both knees since at least 2006 and was “very keen” to have both done.

The hospital investigated Khoury’s practice after Toll’s death, the court heard. Asked what could be learned by Toll’s death, Khoury said the hospital needed to improve its communication and referral systems.

Earlier in the week, the inquest heard the nurse admitting Toll to hospital before his surgery was not aware of previous heart issues because his cardiology and GP records were not included in his admittance paperwork.

On Friday, the family acknowledged some processes had changed at the hospital since Toll’s death.

“It is comforting for the family to know we’ve been listened to, and hopefully, although we don’t get to have our loved Ken with us, other families don’t endure what we’ve had to endure,” they said.

They listed the events Toll had missed, including his son Mark’s wedding and daughter Lisa’s 40th birthday. “Ken is missing seeing his grandkids grow up into the amazing young people they are,” they said.

The court was shown a slideshow of photos from Toll’s childhood, his 20 years in the army, and his 40 years of marriage, set to Redgum’s I Was Only 19. A visibly emotional Magistrate McLaughlin adjourned, thanking the family for sharing “further insights into the life of Ken, and the consequences that his loss has had on all of you”.

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