Death following anesthesia: the prosecution’s case

A 34-year-old woman died at the start of an operation to remove a swelling in the walls of the uterus known as a fibroid. The procedure the patient had opted for was laparoscopic surgery that would have hardly left her with a scar.
However, the patient died at the beginning of the surgery and two doctors who did the postmortem established that the patient died when the tube to administer oxygen and anesthesia was wrongly inserted into her oesophagus instead of her trachea. The patient’s doctor and the anesthetist were charged in court with causing death by a rash and neglect act.
The law states that any person, by rash or negligent act not amounting to manslaughter, causes the death of another person is liable to imprisonment for a term not exceeding seven years or to a fine not exceeding Shs70,000 or both such imprisonment and fine. A specific rash and negligent act included under the law is giving medical or surgical treatment to any person whom he or she has undertaken to treat.

To court the prosecution needed to prove the two ingredients of the offence beyond reasonable doubt and these were;
i.The two accused acting together did a rash and negligent act.
ii.The act caused the death of the patient.
The prosecution presented a number of witnesses to prove its case. A female relative of the deceased narrated to court how the patient was admitted and taken to theatre and how she was informed of the death of her relative soon after she was taken to theatre. She further told court of the request of the family for a postmortem examination on the body of her relative.

Doctor had case to answer
A doctor called to testify told court that this death was consistent with intra-operative neurogenic cardiac arrest associated with acute gastritis. The doctor told court that the surgeon who actually operated on the patient had stated that in his opinion the tube which should have supplied oxygen and anesthesia to the patient had been wrongly placed in the oesophagus of the patient instead of the trachea. This had two effects; the patient was not receiving adequate anesthesia and oxygen and the anesthesia which was going to the stomach caused irritation of the stomach wall leading to the bleeding.

This explained the presence of the blood in the stomach. To the doctor when a patient is poorly anesthetised and certain parts of the body are touched then the heart slows downs and subsequently stops. This is how this death was explained as there was evidence of bruising of one of the inner parts of the abdomen.
Prosecution also called on experts to testify in the case. One of the experts was an anesthesiologist who inspected the theatre where the deceased was operated from. The finding of this expert was that this particular theatre was inadequately equipped for laparoscopic surgery; it did not have the proper breathing tubes and did not have an automatic ventilator. It instead had a manual ventilator which posed many challenges in doing this delicate operation. And most importantly the theatre did not have a monitor for detecting the electrical activity of the heart.

A representative from the Medical Profession’s Body also testified. The Body had carried out an inquiry into this death and found among other things that the patient was under the care of the accused doctor and that the tube was wrongly placed during the operation and that the patient had died due to absence of oxygen supply to the body.
The Body concluded that the patient’s death was, therefore, an anesthetic accident and the accused doctor had a professional duty to monitor the patient as he was her primary doctor, which duty he failed to perform. This, to the Body, amounted to professional negligence.

To be continued