Senior anaesthetist who fell into a 'deep sleep' in operating theatre moments after putting patient under anaesthetic is suspended

Wednesday, January 31, 2024 – A senior NHS anaesthetist has been suspended after he fell into a 'deep sleep' in an operating theatre whilst a patient was undergoing surgery.

Consultant doctor, Thomas Herbst, 61, dozed off moments after he put the patient under anaesthetic and was said to be in such a deep sleep that he had to be tapped on the shoulder by a colleague to wake him up.

When asked if he was fit for work, Herbst drank a cup of black coffee and insisted he was fine but spoke 'incoherently' and repeated himself, according to Mail Online.

Later outside a changing room, he was said to have struggled to complete a timesheet whilst his 'scrub' trousers kept falling down without him realising.

Herbst who worked as a locum at South West London Elective Orthopaedic Centre based at Epsom General Hospital in Surrey initially denied falling asleep but later said he had been working long hours and claimed an undiagnosed illness which he said subsequently left him bedbound for three weeks was to blame for his fatigue.

It emerged the doctor had previously been given a warning by the General Medical Council for falling asleep in theatre in 2020 as another colleague was completing an operation.

At the Medical Practitioners Tribunal Service, Herbst, of East Sheen in Richmond-upon-Thames faced being struck off after he was found guilty of serious professional misconduct but he was suspended from practise for six months after he offered to cut down the number of shifts he worked each week.

During the Manchester hearing he claimed if anyone looked around at operating theatres across the UK, at least 100 anaesthetists would be seen with their eyes closed. He said NHS workers used to be applauded for going into work yet the GMC had decided to 'prosecute him in a horrible way' when he had 'become ill probably through working in a hospital.'

The incident occurred on September 27, 2022, after Herbst has been assigned to anaesthetise the patient ahead of a shoulder arthroscopy procedure. A fellow anaesthetist known as Dr. A told the hearing: 'I was working in another theatre when a nurse from Dr. Herbst's theatre asked me to come and speak with him to see if the anaesthetised patient was okay.

'Whilst doing so, I found Dr Herbst asleep. When I called his name I did not receive a verbal response and I said: ''Dr can you hear me - open your eyes'' in an attempt to wake him. He was in a deep sleep and he only woke up after I repeatedly tapped him on his shoulder. The patient was stable and my colleague and I took over Dr Herbst management of the patient until the end of surgery.'

A theatre support assistant known as Ms B said she had seen Herbst asleep on a chair which had two armrests and a back to it next to the anaesthesia machine as the surgeon was putting 'knife to skin'. She added: 'There are normally blue sheets up before we start an operation. I walked around the sheet, to wash my hands, and I saw Dr Herbst was asleep.'

A third colleague known as Dr E who spoke to Herbst about the incident said: 'He accepted that he had fallen asleep but tried to reassure us that this would not happen again as he had now had some black coffee. He explained that he had been working a number of long days sequentially and he had got home late the previous day and had to wake up early to get to work on time..'

He added: 'Dr Herbst speech was not only occasional incoherent but he appeared to have difficult talking and was using short sentences. His conduct was different from his normal personality in that he was very tired to the point of struggling with his verbal expressions. His speech was slow at times and occasionally incoherent.'

The hospital's Associate Director of Nursing said: 'I have not met Tom before and his behaviour concerned me. His pupils were constricted, and he was repeating himself whilst not being able to complete most of his sentences.

'He was in not in a position to be dealing with patients. He was a long time in the male changing room and he wanted to go home on a motorcycle and was carrying his motorcycle helmet. This worried me as he was unwell and unaware of his own ability.

'I offered to order a taxi for him and pay for it to which he replied: 'little girl I have been on my motorcycle longer than you had been alive.'

Furthermore, when Dr Herbst retrieved his bag from the changing room, his scrub trousers fell without him being aware.

'He was having difficulty filling out his timesheet, attempting to do so whilst leaning the timesheet against the wall. He was repeating himself, sometimes making sense and sometimes not.'

Herbst later claimed he was tired ion the day of the operation due to him spending most of the previous evening completing his tax return and at first denied he had fallen asleep.

But In a letter to the GMC 'I apologise for any inconvenience caused by my illness. I felt tired and generally unwell and it would have been better to have stayed at home. But I did not want to cause the cancellation of patients who had waited a long time for their operation.'

In evidence he said 'humans get sick' and when questioned if he was asleep, he accepting he may have closed his eyes, been daydreaming, or 'slightly snoozing.' He apologised for 'having been sleepy'.

He added: 'There is an allegation of having red eyes. Some 35 years ago I was driving a truck, loaded with 28 tonnes of medicines, to Lebanon, when it was hit by two missiles from an Israeli helicopter. It was a clear war crime but I survived. However, my skin and eyes became embedded with sand grains and other debris. Ever since then my eyes have had a tendency to look fairly red, especially after a long motorbike ride.

'With regards to speech, I prefer to speak clearly and concisely rather than twittering on at 300 rounds per minute. It is better to convey a meaning in ten precise words that in a hundred high-speed ones.

Sometimes I will repeat myself when I am not sure that the nursing staff have listened to what I was saying. Scrub trousers are notorious for becoming loose and need adjusting every once in a while.'

But counsel for the GMC Chloe Fordham said: 'Dr Herbst was not focusing on the risk to patient safety. He initially denied he had fallen asleep, and then provided a number of reasons for his behaviour. Whilst Dr Herbst was entitled to defend himself, he had demonstrated a lack of candour and failure to take full responsibility for his actions, rather blaming his assistant for not waking him up.'

MPTS chairman Mrs Claire Lindley ordered Herbst to face a review hearing later in the year.

She said: 'The Tribunal found Dr Herbst had fallen asleep in theatre and could not easily be roused, and that shortly thereafter he was speaking incoherently. At the time of this incident, Dr Herbst was subject to a warning from the GMC for similar conduct.

'The Tribunal noted the patient was potentially at risk and his poor responses after he was awoken, posed a potential further risk to patients had he continued with the theatre list.'