A 38-year-old crew member on the controversial Ruby Princess cruise ship has spent the last month on a ventilator because of severe respiratory failure caused by COVID-19, with officials unable to contact his wife.
An intensive care doctor treating the man was forced to approach a tribunal last Thursday to seek urgent approval to remove the breathing tube from his mouth and insert it through his neck instead.
The man, a foreign national, fell ill while on board the Ruby Princess. He was intubated on the ship and later transferred to a public hospital onshore.
On the day of the urgent hearing about his treatment, he had been intubated and sedated for 30 days, 25 of those as a hospital inpatient.
The man's condition was improving and doctors had tried to reduce his sedation, but each time he became more conscious he became distressed and tried to remove his breathing tube.
The night before the hearing, the cuff of his tube had burst because it had not been replaced since he was first intubated. His life was at real risk if the tube was not removed, his doctor said.
She wanted to perform a percutaneous tracheostomy — the surgical insertion of a tracheostomy tube under anaesthetic — which would allow doctors to gradually wake him up and wean him from the ventilation, but the man could not consent because he was in an induced coma.
The doctor, an advanced trainee in intensive care at the treating hospital, filed an urgent application with the New South Wales Civil and Administrative Tribunal on April 23, which was heard by phone later that day. The tribunal can act as guardian when a patient cannot consent. The man, the doctor and the hospital were not identified in the tribunal's decision.
The tribunal heard the man's wife lived in a remote village and likely had limited access to mobile connection. Nobody had been able to contact her.
The tribunal's deputy president and head of the guardianship division, Malcolm Schyvens, and Dr Melanie Wroth agreed that the treatment should go ahead within 24 to 48 hours.
The crew member's doctor said the procedure risked causing bleeding and scarring, but that if the crew member had the procedure he was expected to make a full, but slow, recovery.
The Ruby Princess has been blamed for hundreds of coronavirus cases in Australia and more than 20 deaths. An independent inquiry looking into how it was allowed to dock in Sydney despite passengers experiencing coronavirus symptoms is underway.