A case of wrong doctor - Part II
Mr HNT, a 59-year-old man, sued a private hospital and the two doctors who attended to him for medical negligence. The gist of the matter was that the patient, who was diagnosed with pneumonia (a disease of the lungs), was admitted and treated for two weeks by a doctor who was a specialist in kidney diseases. His condition did not improve, in fact, it got worse and a chest specialist had to be called to attend to him. By the time the chest specialist was called, a lot of pus had accumulated in his chest and an operation was performed on him to remove it. He contended that this operation would have been avoided but for medical negligence.
There were two defense witnesses, the coordinator of the emergency unit and the kidney doctor. The coordinator admitted that they indeed received Mr HNT on February 12 in the emergency unit and he was correctly diagnosed using various tests and found to be having lobar pneumonia, which, although was severe, was not complicated.
This type of pneumonia is usually treated by a general physician and not every pneumonia is treated by a specialist. All physicians, according to her, are general physicians before they become specialists and are capable of treating pneumonia. The patient was admitted under the “on-call consultant,” who, although is a kidney specialist, is also a general physician. According to the coordinator, the patient was managed well but had a slow response to the treatment. The treatment given to the patient was the recommended prescription and the patient was reviewed daily. The poor response was not due to poor management but the response of the bacteria to the treatment and the general underlying health of the patient. It could not have been said that there was an alternative treatment.
The kidney specialist told court that he was a senior consultant physician, with a Master’s degree in Internal Medicine and a Postgraduate Fellowship in Kidney Medicine and that his experience and practice of medicine spanned 41 years. He testified that he was qualified to treat pneumonia and at least 99 per cent of patients with pneumonia are not even treated by physicians and specialists but by medical and clinical officers. He confirmed that he saw Mr HNT, who had been admitted with a diagnosis of a right lower lobar pneumonia, on February 12. According to him, the patient was very weak and ill and his blood pressure was 70/60 (the normal is 120/80).
Fear for the worst
This meant the infection had spread in his body and he was going into a state of shock, which is a medical emergency. The doctor told court that he managed to normalise the blood pressure and treat the infection. In two days, the patient had greatly improved as he was able to eat and walk about. It was only on the 10th day that they noted that the pneumonia patch was not clearing and this had become a complicated pneumonia. They sought to find out why the patient was not responding well to the treatment and also added extra antibiotics.
According to the doctor, he would have failed in his duty if he did not go out to look for the patient’s lack of response to good therapy. The doctor further told court that on February 24, he went to see the patient and explained to him the findings. The kidney specialist also told him of the need to call a chest specialist. According to the kidney doctor, there is no time frame when to decide to call a specialist, it is a matter of judgment depending on a patient’s condition. The chest specialist was called on February 25,and took over management of the patient. The doctor concluded that the poor response of the patient to the treatment was due to his rather advanced age, malnutrition (he only weighed 56 Kilograms), excessive consumption of alcohol and poor life style management. It came to light that the patient had previously been treated for the same problem the year before.
The lawyers for the patient submitted that the care the patient received from the doctors and the hospital fell short of that he reasonably expected of medical professions and of the standing of the hospital and that the hospital and doctors failed in their discharge of the standard of care expected of them, hence causing the patient pain, loss and disability due to the lengthy stay in hospital and debilitating surgery and its attendant effects. The lawyers further noted that empyema (pus in the chest) is a complex disease to diagnose and its signs should of necessity trigger a doctor treating a pneumonia patient to seek specialist intervention. The lawyers further submitted that the hospital and the doctors offered no rebuttal to the patient’s evidence. They concluded that when a physician or other medical staff member does not treat a patient with the proper amount of quality care, resulting in serious injury or death, they commit medical negligence.
Next week: Part III - Court Ruling.
