Ken went into hospital for knee surgery. Three days later, he was dead

A man who died in hospital three days after having both his knees replaced was moved out of a high dependency ward despite nurses raising concerns about his heart days before his death.

Kenneth Toll, 62, collapsed and went into cardiac arrest at Albury Wodonga Private Hospital in July 2019, three days after a bilateral knee replacement surgery. He could not be revived.

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

A coronial inquest into Toll’s death on Tuesday heard the Wodonga man had a history of Type 2 diabetes and hypertension, and was at greater risk of venous thromboembolism (blood clots) due to his age and heart health history.

Toll had a primary coronary angioplasty to widen an artery in 2012, but the coroner heard his cardiology and GP records were not included in his paperwork when he was admitted to hospital.

Cardiologist Dr Naylin Bissessor told the inquest on Monday he “didn’t detect any irregular rhythm” in Toll’s heart in the months leading up to his surgery and subsequent death.

Anaesthetist Graham Libreri said Toll was “very keen” to have the surgery performed when he saw him for an appointment a month before the surgery.

The orthopaedic surgeon overseeing the surgery, Dr Elie Khoury, performed both knee replacements on July 17, 2019.

On his rounds the next day, nurses told Libreri that Toll had short runs of supraventricular tachycardia – an irregular heartbeat – around 2am, and had been nauseous and vomiting.

Libreri was concerned Toll would not have absorbed his regular blood pressure medication if he was vomiting, and arranged for him to have it delivered intravenously. He told the inquest he did not formally assess Toll again, but nurses in the high dependency unit said Toll had been seen by a cardiologist and had since moved to a general ward.

“[That] would have put my mind at ease,” Libreri told the inquest on Monday.

In documents submitted to the court, Dr Khoury said Toll was in “good spirits” when the surgeon was on his rounds just an hour before his patient collapsed.

The coroner heard staff on the ward were “extremely distressed” by Toll’s death, including one nurse who was in her first week of the job.

“Everyone feels in these circumstances what more they could have done,” Libreri said. “It’s a risky job we do.”

Albury Wodonga Private Hospital is operated by Ramsay Health Care, now Australia’s largest private hospital provider.

Toll, an army veteran, had two children and six grandchildren.

Deaths soon after joint replacement surgery are extremely rare. 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.

Cardinal George Pell died in Rome last year following hip replacement surgery.

The inquest continues.

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