Dead End

To the coroner's jury that had heard eight days of testimony, it was a "gross technical error." To Dr. Jean-Paul Drouin, 50, of Ottawa's Montfort Hospital, it was a "complication." To three of Drouin's surgical patients, it meant slow, painful death.

The operation in question, a modification of one devised in 1912 for controlling incurable metabolic disorders, is chancy at best. It is based on the fact that shortening the digestive tract cuts down on caloric absorption, enabling excessively overweight people to shed pounds regardless of how much they eat. To perform it, the surgeon severs the small intestine near the end of the jejunum, or second section, and connects it to the ileum just above the beginning of the colon. This in turn reduces the length of the active small intestine from 23 feet to a mere 30 inches, drastically lessening the time it takes for food to pass through the system. This reduces the amount of digested material that can be absorbed through the intestinal walls.

Liaison Lack. Drouin had already performed 59 such operations when he scheduled three more patients in one 24-hour period last May. During the 90-minute operations, Drouin apparently became confused. Working "up to his elbows," as he put it later, he mixed up the different clamps he used to mark the ends of the bypassed small intestine. As a result, he hooked the ileum to the colon, connected the end of the small intestine to the jejunum (see diagram).

Drouin had dead-ended the digestive system, creating a closed tract that could only be emptied by vomiting. One patient, a 32-year-old truck driver who weighed 385 lbs., choked on his own vomit and died nine days after the operation. When an autopsy revealed the reason, Drouin brought the other patients, two sisters who weighed nearly 300 lbs. each, back into the hospital for corrective surgery. It was too late; both women had already developed abdominal infections and other complications; both died.

The deaths, and the ensuing inquest, jolted the Canadian medical community. Drouin now faces an investigation by the College of Physicians and Surgeons of Ontario, which has the power to revoke medical licenses. After hearing hospital personnel tell about missing reports and erroneous or unkept records, the coroner's jury cited the Montfort Hospital for a "considerable lack of liaison between the various departments" and urged it to adopt better administrative practices. It also heard testimony about other patients' postoperative problems (one woman told of an overwhelming though inexplicable desire to eat mud) which raised new doubts about weight-loss surgery.

Most doctors agree that the operation should be attempted only in rare cases complicated by such problems as high blood pressure or diabetes. Dr. J. Howard Payne of Los Angeles County-University of Southern California Medical Center regards it only as a last resort for the "morbidly obese"; he has performed 180 of the bowel bypasses and lost five patients since 1956. He has declined to operate on thousands of others.

Dr. Peter Salmon of the University of Alberta, who has lost five of his 120 patients, announced that he would do no more bypasses until all data on their value have been thoroughly reviewed. Officials at Ottawa Civic Hospital, meanwhile, stopped all obesity operations nine months ago.

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