Doctors testify about struggle to keep Hugo Chetcuti alive

Bojan Mitic, man accused of murdering Hugo Chetcuti, is back in court this morning, as the compilation of evidence in the case against him continues.

In today’s sitting, doctors have given the court a chronology of the medical battle to save Chetcuti’s life, after he was stabbed at one of his outlets by Mitic, a former employee.

Emergency consultant Jonathan Joslin took the stand first before magistrate Marse Anne Farrugia.

He recounted how he was called out at 10.49pm on 6 July 2018, and was dispatched in an emergency ambulance to Paceville.

On the way, as he arrived at the Kappara Roundabout, he was told to stand down, because the victim was in another vehicle, not an ambulance, and was already being rushed to hospital.

Joslin then found Chetcuti in the resuscitation room, conscious. He took a step back, because the medical team was working on the victim.

A rapidly-taken scan of the abdomen determined that there was bleeding and a suspected perforation of the bowel or solid organs.

Chetcuti’s blood pressure started to drop, and within moments he was in Class III haemorrhagic shock, needing to be rushed to the operating theatre within 15 minutes of his arrival.

Emergency doctor Josef Mifsud, who was on duty on the day, was next to testify. He explained that his role was leading the resuscitation on Chetcuti until the victim arrived in the operating theatre.

Chetcuti was pale, had a fast heart rate and low blood pressure, and appeared anxious, but he was speaking. He was given fluid to stop the bleeding, and an ultrasound of his abdomen was taken, indicating the presence of blood.

Mifsud said the entrepreneur was taken straight to operating theatre.

“This was Class III or Class IV shock, he had lost at least 1.4 litres of blood. He would have died during the CT scan, that was the urgency,” he said in reply to a question by lawyer Joe Giglio.

This was Class III or Class IV shock, he had lost at least 1.4 litres of blood. He would have died during the CT scan, that was the urgency

After he was transferred to theatre, he ceased to be under Mifsud’s care.

The next witness, Mater Dei registrar and surgeon Ayman Mostafa, was cautioned that incrimination was a possibility as he took the stand.

Mostafa said he had seen Chetcuti in the casualty resuscitation room. He appeared in shock, was in pain and hypotensive, but could speak.

“We started giving him fluids to increase his blood pressure, but after 10 minutes of this, he remained hypotensive, so we decided to go to the theatre directly. It was 10 or 15 minutes after 11pm,” Mostafa explained.

Chetcuti had suffered two stab wounds on the left side of his body. When the surgeon opened the abdomen there was a “huge amount” of blood, Mostafa told the court.

Some two litres of blood was aspirated out. The injury was found to consist of multiple perforations in the small bowel, and in the main arteries of the bowel.

“We managed to stop this bleeding and sutured another minor bleeding wound,” Mostafa said.

After stopping the bleeding they checked the internal organs for injury.

“We found four perforations and… after I closed these up, we washed out the abdomen from blood and checked for further bleeding. I checked three times, including the large intestine, which was far from the stabbing site. After we were sure, we put two drains in the abdomen to remove any fluid.”

The bowel was closed and the patient was sent to the Intensive Therapy Unit. After an hour in ITU, Chetcuti was stable, and there was no bleeding.

That was the last time the doctor saw him that night, handing over to the consultant on call.

The next time Mostafa saw Chetcuti, he was suffering from multiple organ failure. There was no leak or drainage on the drains, however, the surgeon said.

The leak was discovered over 30 hours after the operation had taken place.

“The leak started Sunday morning, which was a very ‘late’ leak. It might have been a very small, ‘micro-perforation’, by the knife. This wasn’t leaking during the operation I carried out on Chetcuti, but it later became necrotic and became wider and wider. Even the surgeon who looked at Chetcuti after me didn’t pick it up.”

Consultant surgeon Alex Attard took the stand next. He had been friends with Chetcuti, and had been his doctor over the years.

“He or his family wanted him under my care, because they had a lot of trust in me,” he said, having been released from professional secrecy by Chetcuti’s heirs, and therefore able to disclose certain information to the court.

“He was a fit man,” he said of Chetcuti.

Chetcuti was in an induced clinical coma, and was being woken up when Attard saw him first. “When he opened his eyes I was by his side. He was speaking, stable, and in a good clinical condition. We were quite confident that, barring any complications, he would pull through.”

“On Sunday morning, I again called my assistant, and told him to check up on the situation and do any tests needed so he could assess the results.”

“I found that he was again on a ventilator.” This dramatic change was due to a changing oxygen requirement, he said, adding that he was worried about the victim’s abdomen.

The features of the abdomen were not consistent with his condition as a post-op patient, Attard said. “I was concerned that something was going on in the abdomen, and I wanted to operate.”

“I opened the abdomen through the same incision. When one of the drains was removed, air was released - which is not normal - and from another drain, bowel fluid came out. They were properly blocked. We use drains, and drains do fail. We don’t rely on drains and some don’t use them,” he said.

“There was a purulent exudate, a bodily secretion in response to infection - pus. I suspected that there might be another perforation. The stitches were intact.”

“You can have one perforation and ten holes, and five perforations and no holes. It’s pot luck whether it hits a major vessel and you drop dead,” Attard said.

Lawyers Ishmael Psaila and Marc Sant are legal aid for the accused.

Lawyers Joe Giglio and Sarah Mifsud are appearing for the parte civile.

Inspector Nikolai Sant is prosecuting.

More to follow.