The High Court has ordered a hospital to pay a woman KES 6 million after finding it negligent in its failure of monitoring, escalation and medical review causing progression of her condition from a salvageable threatened limb to irreversible gangrene necessitating amputation.
It ruled that Pandya Memorial Society Registered Trustees which operates Pandya Memorial hospital through its nursing and resident medical staff and in breach of non-delegable duty of care negligently failed to monitor, escalate and secure UMM’s medical review during the night of August 8/9, 2008, causing the loss of her right forearm.
“If, contrary to that primary finding, it were said that initiating pathology might in any event have claimed some tissue, I would hold in the alternative that the hospital’s breach made a material contribution to the totality of the injury ultimately suffered, the loss of the whole forearm below the elbow,” ruled Justice Ngaah Jairus.
The money awarded to the plaintiff is inclusive of KES 4.5 million general damages for pain, suffering and loss of amenities (including loss of use of the right forearm), KES 1.5 million general damages for loss of earning capacity and KES 34,620 special damages.
The court heard that on or about August 7, 2008, UMM, then a child of three and a half years, was referred from the Kenya Ports Authority clinic to Pandya Memorial hospital, on account of an ailment of her left arm.
It also heard that an intravenous line was fixed on the wrist of her right arm, which had no complaint, through which antibiotics were administered.
The court ruled that failure of the hospital’s staff between 8pm and 3.20am to procure any medical review of a three-and-a-half-year-old child whose intravenous site was so painful that a cannula had to be removed and whose hand was tender to touch, was a plain breach of the duty of care.
“Pain at an infusion site of such severity as to require removal of the cannula in a small child, a patient who cannot articulate her symptoms and whose deterioration must be detected by those watching her, is a red flag calling for medical assessment of the limb, not for the child to be “left to sleep” with the matter deferred to the morning,” ruled the court.
The court also noted that the hospital's own contemporaneous plan acknowledged that the Resident Medical Officer “was to attend” but did not nor was the consultant under whose care the child was admitted told of a development, pain necessitating removal of his prescribed route of administration, which bore on his management.
“This is not territory in which competing schools of professional practice can be invoked in the hospital's defence. No witness suggested that any responsible body of nursing or medical opinion would regard it as proper to leave such a child unexamined by a doctor for over seven hours in those circumstances,” ruled the court.
The court also ruled that the negligence found against the hospital is independent of the initiating mechanism as it consists in the failure to detect and to respond to an evolving vascular emergency during the very window in which, on the evidence, it evolved.
The court also said that no question of contributory negligence arises as a child of three and a half years is incapable in law of contributory negligence, and nothing in her parents' conduct breaks the chain of causation.
“The mother, far from being passive, was the person whose vigilance at 8pm and again at 3.20am supplied the hospital with the very information on which it failed to act,” ruled the court.
The plaintiff had told the court that as a result of the insertion of the needle and the subsequent intravenous administration of the antibiotic, she developed profuse bleeding and incessant pain.
She said that despite her mother's insistence for intervention, the hospital's doctors merely recommended immersion of the affected arm in warm water and the administration of soporific medication.
The plaintiff claimed that on August 16 2008, following the first defendant's (hospital’s) inability to arrest the deterioration of her right arm, she was referred to Kenyatta National Hospital where a scan revealed severe vascular compromise with gangrene demarcating at five centimetres below the elbow.
The court heard that the plaintiff's right arm was consequently amputated below the elbow, leaving her permanently disabled.
The hospital denied any negligence, recklessness or breach of duty, averring that its employees exercised reasonable skill and care.
