A man who had to wait seven hours for medical tests is now suing Bermuda Hospitals Board, claiming the delay caused his appendix to rupture.Kamal Williams should have had surgery within four hours of arriving at King Edward VII Memorial Hospital, Michael Leitman told Commercial Court yesterday.Instead he waited five hours for a CT scan and another two hours for the results before he was operated on.Mr Williams started feeling pain in his abdomen around 10.15am on May 30, 2011, and went to the hospital for treatment.He arrived around 11.17am.Dean Okereke examined him and carried out blood tests before determining that he could be suffering from appendicitis or a kidney stone.The tests suggested that Mr Williams’ appendix had not ruptured and could wait for the results of a CT scan before undergoing surgery.Dr Okereke continued to monitor Mr Williams’ condition until his shift ended at 4pm.Christie DiLullo then took over.She examined Mr Williams around 4.34pm and found his condition was stable, but he was showing signs that his appendix may have perforated, potentially leaking biological waste and bacteria into his abdominal cavity.A CT scan was performed at around 5.15pm, after which Dr DiLullo examined Mr Williams again. She noticed that the worrying symptoms from the previous examination were no longer there.The results from the CT scan arrived at around 7.38pm.It showed some fluid in Mr Williams’ abdominal cavity near the pelvic region however the radiologist determined that his appendix had not perforated.Mr Williams went into surgery at around 9.24pm.Doctors expected it would be a routine appendectomy but discovered that his appendix had ruptured.They also had difficulty controlling his heart rate, which Dr Leitman said was a side effect of the perforated appendix.According to Dr Leitman, the accelerated heart rate caused a heart attack and potentially permanent damage to his heart.Meanwhile the inflammation caused by the perforated appendix resulted in Acute Respiratory Distress Syndrome, which forced Mr Williams to rely on a breathing tube for a time following surgery.Patients who undergo a simple appendectomy are typically hospitalised for a day or two following surgery.Mr Williams was kept in the Intensive Care Unit for two weeks.Dr Leitman argued that, based on the initial examination by Dr Okereke, Mr Williams’ appendix ruptured after he arrived at KEMH.If he had undergone surgery within two to four hours of his arrival the entire ordeal could have been avoided, Dr Leitman said.He said that both Dr Okereke and Dr DiLullo made appropriate decisions with the information available to them but the delay of the CT scan amounted to a defective standard of care.The doctor described Mr Williams’ condition as urgent, if not an emergency and as such, his CTscan should have been made a priority.Dr Leitman said that it usually takes 30 minutes’ maximum to read and analyse the results of a CTscan. In Mr Williams’ case it took more than two hours.BHB expert witness, Massachusetts General Hospital doctor Alasdair Conn highlighted a 2006 study that showed persons with appendicitis in the US generally wait ten to 14 hours for surgery once they’re admitted at a hospital.He said that the doctors who saw Mr Williams repeatedly noted his stable condition and said there was no sign he required immediate surgery.He insisted that the hospital provided a satisfactory standard of care.“My conclusion is that it was an appropriate time frame for managing a patient who appears with acute appendicitis and requires a CT scan,” Dr Conn said.