Pandya Hospital ordered to pay Sh6m over child's amputated arm

Pandya Memorial Hospital in Mombasa County. [File Courtesy]

Pandya Memorial Hospital in Mombasa County has been ordered to pay over Sh6 million to a 42-month-old girl whose right hand was amputated due to negligence by hospital staff.

Justice Jairus Ngaah ordered the hospital to pay Sh6,034,620 to the child of Uchi Mwaura after establishing that the hospital’s nurses failed to monitor the child’s arm for seven hours during the night shift.

The judge said the failure by hospital staff, between 8 pm and 3.20 am, to obtain a medical review of the minor, whose intravenous site was so painful that the cannula had to be removed and whose hand was tender to the touch, amounted to a plain breach of the duty of care.

The judge said the child’s condition should not have been left unmonitored and unattended until morning, adding that the arm could have been saved through early recognition and decompression, but the delay made the condition irreversible.

“I therefore find, on a balance of probabilities, that the negligent failure of monitoring, escalation and medical review during the night of August 8 and 9, 2008, caused the progression of the minor’s (plaintiff's) condition from a salvageable, threatened limb to irreversible gangrene necessitating amputation,” said Justice Ngaah.

On August 7, 2008, Uchi Mwaura’s baby was referred from the Kenya Ports Authority (KPA) Clinic to Pandya Memorial Hospital with an ailment affecting her left arm.

Dr Awadh Hemed and Dr Rajab Karega attended to her and inserted an intravenous line in her right arm instead of the left arm that was affected, administering antibiotics through the healthy arm.

On August 16, 2008, the minor was transferred to Kenyatta National Hospital (KNH) after Pandya Memorial Hospital failed to arrest the deterioration of her right arm.

Her left arm went on to heal, but she lost her healthy right arm due to the alleged negligence.

At KNH, a scan revealed that she had developed severe vascular compromise, with gangrene demarcating five centimetres below the elbow. This led to her right arm being amputated at the elbow, causing permanent disability.

The hospital, Dr Hemed and Dr Karega were sued for allegedly failing to exercise reasonable care and skill in diagnosis and treatment.

Mwaura accused them of injecting and treating her daughter’s right arm instead of the referred left arm and failing to prescribe the correct treatment.

The hospital and the two doctors were also blamed for failing to prevent or arrest the pain and severe bleeding that occurred upon insertion of the needle, ignoring complaints made by the minor’s mother, Fatuma Bakari, and administering hot water to an arm that was turning black.

The hospital and the doctors were further faulted for administering antibiotics without a proper diagnosis and for carrying out their duties in breach of established medical practice.

They were also cited for failing to control or arrest the deterioration, bleeding, swelling and, ultimately, the gangrene that led to the amputation.

However, in his judgment, Justice Ngaah absolved Dr Hemed and Dr Karega of any blame and apportioned 100 per cent negligence to Pandya Memorial Hospital.

The judge said a hospital is answerable for the negligence of the professional staff, nurses and doctors alike, whom it employs to treat patients it admits.

He said Dr Hemed’s cannulation was performed without negligence and that Dr Karega’s diagnosis, treatment and responses constituted responsible professional practice.

“The claim against Dr Hemed (2nd defendant) fails. The plaintiff (Mwaura) has not proved that the cannulation was negligently performed. The claim against Dr Karega (3rd defendant) fails; his diagnosis, treatment and responses accorded at every stage with responsible professional practice, and the one systemic failure that hampered him, the want of notification, was Pandya Memorial Hospital (1st defendant), not him,” said Justice Ngaah.

According to the minor’s mother, Dr Karega diagnosed her daughter with cellulitis and possible septic arthritis of the left elbow and prescribed, among other treatments, an antibiotic to be administered intravenously.

Bakari said that during the insertion of the needle, blood came out with a lot of force, spilling onto Dr Hemed, and whenever medicine was administered through the line, blood would enter the cannula and the child would cry in pain.

She said her daughter’s right hand thereafter began to change colour and turn cold, as if it had an insufficient blood supply, and she was in such pain that she had to be sedated to sleep.

The mother said her daughter lost her dominant arm and that her dream of becoming a police officer was now beyond reach.

Bakari said her daughter’s education, career prospects and social standing had been gravely affected by stigma.

According to KNH orthopaedic and trauma surgeon Dr James Mogire, proper supervision or verification of the cannula placement would have detected the error early enough to salvage the arm.

Dr Mogire said the minor’s right arm no longer had viable blood vessels and recommended amputation on August 2, 2008.

Dr Mogire’s opinion was that the loss of the arm was avoidable because the cannula had been placed in the radial artery rather than a vein.

The surgeon said Doppler findings showed arterial spasm beginning at the radial artery at the very site of the cannula and later extending to the cubital and brachial arteries, causing damage to the arm.

Further, he said each forceful injection of Dalacin C against arterial pressure aggravated the injury and drove the drug into the soft tissues.

However, in his defence, Dr Karega, a private paediatrician consultant, said the nurses had removed the cannula at 8 pm on August 8, 2008, following pain at the site, without informing him.

Dr Karega said he diagnosed the minor with cellulitis and septic arthritis of the left elbow joint and ordered a full haemogram and an X-ray of the left elbow.

Later, he started empirical treatment with Dalacin C, Brufen and Bactroban cream.

On examination, he found a swollen right hand with poor blood flow, formed an impression of arterial spasm and recognised it as a surgical emergency.

Dr Gathua reviewed the child at 9.45 am and concurred that blood flow was reduced in her right arm. He suspected that there had been drug leakage into the tissues rather than a needle injury to the artery.

In his defence, Dr Hemed, a resident medical officer who is now an orthopaedic surgeon at the hospital and who was working under the instructions of Dr Karega, denied any negligence, recklessness or breach of duty.

Dr Hemed denied that the minor was referred with an “ineffective process of the left arm”

He said she had come from the KPA Clinic with fevers and a painful, swollen left elbow, which had already been treated at the clinic with powerful antibiotics.

He admitted that on August 9, 2008, a report was made of severe pain at the cannula site and that the cannula was removed for refixing.

Dr Hemed said that, upon consultation with Dr Gathua, a senior surgeon, warm compresses were commenced to increase blood flow and the mode of administration of the antibiotic was changed.