KNH to pay Sh2.4m for medical negligence

Kenyatta National Hospital (KNH) has been ordered to pay Sh2.4 million to a family after its kin died during dialysis.

William Njogholo Mwakisachi, who went to the hospital for the process in August 2023, died due to medical negligence, according to a case filed by his widow, Faith Nashika Ringo.

In her case, Ms Ringo claimed the doctor who attended to her husband failed to keep a close eye on him as required, leading to his death.

She sued KNH and Dr Joshua Kayima, insisting her husband died because of medical negligence.

Lady Justice Asenath Ongeri heard that Mwakisachi, who taught at Mary's Teacher College in Bura, was diagnosed with renal disease before going to KNH for dialysis, a procedure used to remove toxins from the blood.

The 38-year-old went to the hospital on August 18 after he was advised to do so by Dr Kayima.

After undergoing dialysis on August 26, he collapsed and died a few hours later.

His wife said Mwakisachi died as a result of negligence by Dr Kayima who was a doctor at KNH.

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A post-mortem showed the lecturer died because of a massive haemorrhage following an injury on the intercostal artery.

One Prof Kiama Wangai, who testified in favour of Ringo, said the cause of death was an injury to the intercostal during dialysis due to negligence. Intercostal are muscle groups situated in between the ribs that create and move the chest wall.

Wangai said his report was based on the findings of the autopsy done by one Dr Andrew Kanyi Gichii.

Ringo said the father of her two children also had diabetes that was being managed and that in 2003, he started having renal complications.

Prof S. Mcligeyo, who testified for KNH, said: "With all surgical procedures, the process of catheterization in preparation for dialysis and the actual dialysis is not without risk even for the most highly skilled doctors."

The hospital's renal unit was opened in 1984.

He said the risks are usually explained to patients and their representatives before the procedure because it's part of hospital policy that consent is sought.

Professional care

Mcligeyo said Mwakisachi was given professional medical care but his condition deteriorated fast leading to a heart attack. He died despite first aid intervention at the renal unit, he said.

The professor noted there are two methods of dialysis, catheter or artificial graft and fistula, and the former was used on the patient.

He said that Dr Kayima was one of his finest students and denied he was involved in Mwakisachi's treatment. He said he did not know what happened between 7:30 pm and 10:30 pm.

Dr Ahmed Twahir, a kidney specialist, told the court that high blood pressure may cause kidney failure which affects the heart.

He said Mwakisachi needed immediate dialysis. A catheter was inserted on the right side but did not work and it was inserted on the left side and it worked. A catheter is a tube that is inserted into one's bladder, allowing urine to drain freely.

Dialysis is dire as an emergency for patients with renal failure and a kidney transplant is a long-term solution, Dr Twahir said.

He said that Mwakisachi collapsed and died and that efforts to resuscitate him were not successful.

Twahir, whose testimony was based on records at KNH, said the catheter procedure was blind, meaning an error could not be picked then as is the case now.

Dr Kayima said he has been a renal specialist since 1992 and that his last contact with Mwakisachi was when he inserted the catheter.

He learnt that the patient went to the bathroom before he collapsed upon returning to his bed.

Dr Gichii, who conducted the autopsy, noted that Mwakisachi's right lung collapsed and that there was massive right side haemothorax amounting to 2.5 litres of fresh blood and clotted blood, which caused him to collapse.

Excessive bleeding

He said that the death was caused by excessive bleeding and that it would have taken two to five hours for one to lose 2.5 litres of blood.

Dr Gachii said Mwakisachi ought to have been monitored every 20 minutes to confirm whether complications had occurred. If the monitoring had been done, then the bleeding would have been noted.

Dr Twahir said there should have been readings provided on blood pressure. He said there were supposed to be six readings in the medical records conducted between 3pm and 11pm. He said there were no interventions indicated from 10 pm to 5 am.

Ringo told the court she learnt that after a catheter was inserted in her husband, Dr Kayima left the patient to nurses.

The court heard that normally, there is a dialysis form but KNH could not provide one in court and that in its records, there was no indication that Mwakisachi's condition was critical before the dialysis.

The hospital denied negligence saying they take all the necessary steps to ensure their patients are well taken care of.

Dr Kayima said there was no evidence showing he was negligent.

The judge found the defendants did not dispute the findings of the autopsy. She noted that after inserting the catheter, they did not closely monitor the patient's progress. They left this to nurses.

"I find that had the patient been monitored during and after the dialysis, the bleeding on account of the severance of the intercostal would have been noted," said Justice Ongeri.

She added: "I find that proper monitoring of the deceased, after catheterization and the subsequent dialysis, was not undertaken otherwise the bleeding on account of the severance of the intercostal would have been noted and documented and efforts made to address the attendant emergency."