An inquest into the deaths of two stroke patients at the Royal Adelaide Hospital (RAH) while two specialist doctors were on leave has found the deaths did not occur because the doctors were away. State coroner Mark Johns made no recommendations. The inquest looked into the deaths of two stroke patients at the RAH when its only two Interventional Neuroradiology (INR) specialists, Dr James Taylor and Dr Rebecca Scroop, were on leave at the same time in April 2017. Leslie Robert Graham, 87, and Michael John Russell, 60, needed life-saving clot retrievals, but hospital staff had to scramble to find a specialist qualified to do the procedure. The procedures were performed by the state’s only other fully accredited INR specialist Dr Steve Chryssidis, who worked at Flinders Medical Centre. The inquest previously heard evidence about personality clashes between Dr Scroop and Dr Chryssidis. Dr Chryssidis gave evidence that there had been “an insidious hate campaign” against him. In his findings, Mr Johns found Dr Scroop was not a “convincing witness”. “All of this material supports the conclusion that Dr Scroop certainly ran an autonomous INR service at the RAH and her influence in that service was dominant.” He said Dr Scroop tried to “deflect responsibility” to management for failing to find adequate service cover during the April period when both she and Dr Taylor would be away on leave. Mr Johns said “it verged on near panic” when hospital staff were frantically trying to find an INR specialist when it became apparent Dr Taylor and Dr Scroop were both unavailable. Mr Johns also found it was “extraordinary” that the need for a third INR specialist at the RAH was overlooked and set aside in the lead-up to the roster bungle. He said it was overlooked “by what can only be described as a bureaucratic response to a highly regulated and industrialised set of employment practices”. Mr Johns found the procedures conducted on Mr Graham and Mr Russell by Dr Chryssidis were performed within an adequate time and he was not responsible for the unsuccessful outcome. He said the deaths did not occur because Dr Taylor and Dr Scroop were on leave.
