A patient who waited more than ten hours for an operation on his ruptured appendix is appealing a ruling that subsequent life-threatening complications he experienced were not caused by the delay.

Kamal Williams had sued the Bermuda Hospitals Board for $100,000 in damages after claiming that his operation at King Edward VII Memorial Hospital on May 30, 2011 should have been carried out several hours sooner.

At a hearing in December 2012, the Supreme Court was told that Mr Williams arrived at the hospital at 11.17am suffering from abdominal pain. But a CT scan was not ordered until almost two hours later, was not performed until 5.15pm, and the results were not received by doctors until 7.38pm. Mr Williams eventually went into surgery at 9.24pm when doctors discovered his appendix had already ruptured, leaking pus and fecal matter into his abdominal cavity. He subsequently suffered life-threatening complications, including a heart attack and a lung injury and remained in hospital for several weeks.

One doctor testifying on Mr Williams’ behalf said the patient should have been operated on within four hours of the CT scan being taken.

In his ruling, Justice Stephen Hellman found that Mr Williams’ appendix likely ruptured at around 3.19pm and that, even had the CT scan been sought on an urgent basis, the complainant would still have had a five- or six-hour wait before surgery from the time he arrived at KEMH — by which time his appendix had already ruptured.

But the judge also noted that the delay caused the complainant hours of unnecessary pain and discomfort. As a result, he ordered the BHB to pay Mr Williams $2,000 in damages and also pay his legal costs, believed to be around $80,000.

That ruling appeared to leave both parties dissatisfied. At a Court of Appeal hearing, lawyer Allan Doughty contested that the BHB should not have been ordered to pay Mr Williams’ expenses.

But lawyers for Mr Williams persisted with his claim for damages, arguing that the degree of seepage would have been far less severe had the operation been carried out earlier, even if it was carried out after Mr Williams’ appendix had ruptured.

Pointing out that the facts of the case were not in dispute, attorney Jai Pachai told the three-man Court of Appeal: “My submission is that the judge was right in really every respect in his analysis of the law, but where he got it wrong was the issue of causation.”

He said it was not unreasonable for doctors to carry out a CT scan before making a decision to operate, but pointed out that hospital protocols meant that urgent cases were not given priority ahead of routine scans. As a result, Mr Williams had to wait in a queue for his scan, allowing the leakage of pus to build up to such a degree that it resulted in sepsis or blood poisoning, which subsequently caused Mr Williams to suffer heart and lung injuries.

“Sepsis only occurs if there is a rupture and if the operation had taken place between 5.30pm and 7pm, there would be some sepsis but not as much as there was two hours later,” Mr Pachai said.

Mr Pachai pointed out that, according to medical evidence presented at the original hearing, appendicitis does not cause the appendix “to burst like a balloon” but is instead a gradual process in which toxins slowly leach into the blood stream.

The Court of Appeal will make its ruling at a later date.