Boy, 6, dies immediately after a fatal eye operation

On April 16, 2015, a consultant ophthalmologist was called to review a six- year-old child, who had sustained an injury to his right eye and specifically to the cornea. The boy was injured when he was playing with his siblings at home.

After examining the patient, the doctor suggested that the best treatment was an emergency cornea repair, with anterior chamber washout to be carried out under general anesthesia.

Consent was obtained from the mother of the child for the operation and a preoperative assessment of the patient was carried out before the patient was wheeled into the theatre.

The operation was successfully carried out, but just before reversal from general anesthesia, the surgical team was alerted that there was drastic change in the vital signs of the patient. Cardiopulmonary resuscitation was initiated. Unfortunately, this failed and the patient was declared dead.

The surgical team made a number of mistakes that the hospital dearly paid for later. When the patient died, the endotracheal tube and other accessories were removed from the body of the patient. The other error was that the hospital did not carry out a postmortem examination on the body of the child. Immediately after the unfortunate turn of events, the surgical team told the family of the deceased that they could not establish and, therefore, could not tell the cause of death of the patient.

The family of the deceased requested a pathologist to carry out a postmortem examination on the body of the patient and this was done on April 20, 2015. The pathologist’s key findings were food particles in the airways and in the stomach and his conclusion were that the child had died when he aspirated food particles into his airways in the course of the surgery that occurred under general anesthesia. The doctor classified the death as a surgical procedure related death.

The pathologist’s noted that the surgery was an emergency but due precaution was not taken. To the doctor, normally when an emergency surgery is being done, special tubes must be inserted into the airways of the patient to prevent food being aspirated into the airways, as it is assumed that the patient was probably not starved before the surgery. To the pathologist, it was more than likely that there were lapses during administration of anesthesia and specifically poor intubation that allowed food particles to enter the trachea and ultimately into the lungs.

The pathologist stated that during the postmortem examination, he did not find the endotracheal tubes used in the administration of anesthesia; they had probably been removed. He could, therefore, not tell if the right tubes had been used and if appropriate precautions had been taken or not. However, he was adamant that this death could have been prevented, if the right precautions had been taken.

Armed with the pathologists report, the family of the patient sued the hospital for medical negligence. The family was convinced that the patient died in the hospital in the course of or shortly after surgery and that the hospital was 100 percent responsible for the patient’s death. The evidence of the pathologist who carried out the postmortem examination was not challenged. The ophthalmologist in whose hands the patient died and who carried out the operation, simply told the family at the time the patient died that he could not tell the cause of death.

To make matters worse, the hospital never conducted any postmortem examination on the body of the deceased and did not bother to avail its experts during the time the family hired a pathologist to carry out the postmortem examination which was carried out in the hospital’s facility, where the body of the deceased had kept for the four days after death had occurred.

According to the bereaved family, the patient was admitted, operated on and managed in the hospital he died from and the hospital ought to have taken every care, skill and action to ensure that the patient received professional and expertise treatment.

The family also observed that before the patient was taken to the theatre, the patient was reviewed and was found to be fit for surgery and he, therefore, he could not have died of anything else other than what was related to the surgery.

The family was satisfied that it had provided court with all the evidence to prove negligence and this evidence was neither challenged nor was there any alternative evidence adduced by the hospital that could point to another cause of death. The responsibility for the patient’s death lay solidly and squarely on the hospital and the blame of the death needed to be apportioned to the hospital.

The hospital denied the allegations and stated that it employed well qualified staff, including doctors and that the surgery performed in this particular case was done professionally and the death of the patient was not due to any negligence or recklessness as alleged. The hospital content that there was no particular act of negligence or omission pinpointed, but rather speculation as to the possible cause of death.

The hospital also stated that the mother of the child was instructed not the give the child any food before the surgery and the hospital did not give the patient any form of food before the surgery. They also explained that the mother of the deceased was with him all the time and could not have done the damage by giving him food.

The hospital, in its defence, said that the anaesthetist took all the necessary steps and used the right equipment and tubes during the operation to ensure that no food particles could escape into the trachea. The courts of law have always held that the standard of reasonableness in medical negligence cases is not that of any ordinary person, but that of a person in the same profession. The case of medical negligence is not any ordinary case of negligence.

The test to be applied is not that of an ordinary reasonable man known in law, but that of an ordinary skilled doctor or consultant in that field. A person who approaches a doctor expects medical treatment with all the knowledge and skill that the doctor possesses to bring relief or solve a health problem. A doctor, therefore, owes certain duties whose breach gives rise to tortuous liability.

To be continued...