What you need to know:
The elder brother of the deceased instituted a civil suit against the hospital and the health workers claiming special and general damages for medical negligence amongst other claims
AA patient, Robert Byaruhanga, died in Kabarole Hospital on January 14, 2015 shortly after a surgical operation for a scrotal-inguinal hernia.
The operation was scheduled for January 15, but brought forward when the patient purportedly came to the hospital to confirm the date of the operation.
The elder brother of the deceased instituted a civil suit against the hospital and the health workers claiming special and general damages for medical negligence amongst other claims.
The particulars of the negligence, as pleaded, were the following;
• Unnecessary and needless rescheduling of the operation when the patient’s condition was not an emergency.
• Failure to take appropriate precautions while carrying out the surgical operation on the deceased.
• Failure of the health workers to administer anesthesia and perform the surgery with reasonable skill and care.
Evidence before court was to the effect this was a minor operation that required local anesthesia to numb the area where the surgery was to be performed. This evidence was given by the surgeon himself.
This is the standard and expected anesthesia that is given during an operation for a hernia that is not complicated.
However, the surgical team decided to give the patient general anaesthesia when he complained of a lot of pain during the operation. The patient vomited shortly after the general anaesthesia was administered and his heart stopped.
The surgical team called the hospital anaesthetist who rushed to theatre and helped resuscitate the patient. The operation was then completed and the patient then transferred to the ward where he died shortly after.
Cause of death
A postmortem examination attributed the death of the patient to extensive lung damage that he suffered when he vomited in theatre and aspirated some of the stomach contents.
A case of medical negligence such as this is a civil case and is proved on the balance of probabilities. For such a case to succeed the complainant must prove that the hospital and health workers owed the deceased a duty of care, which duty was breeched resulting in the death of the patient.
It must be proved that the consequence of the breach was not too remote to be foreseen. It is also necessary to prove that what the health workers did during the surgery was not what any other competent health would have done and that what was done was not in accordance with the opinion of a medical body.
It was not in contention that the deceased went for a medical examination on January 8, 2015 and was seen by a doctor at Kabarole Hospital who made a diagnosis of an uncomplicated hernia that would require a surgical operation to treat it.
This finding was documented on the patient’s medical form. Further, when the deceased went to hospital on January 14, 2015 and was prepared for the surgery that day, there were medical documents to that effect and these were submitted as evidence before court.
The health workers who attended to the patient in theatre also confirmed in their evidence in court to having attended to the deceased. To the court’s satisfaction a doctor-patient relationship had therefore been established.
The other issue that court had to decide was whether or not the health workers were negligent in their actions or omissions. To court doctors take the Hippocratic Oath which requires them to apply all measures for the benefit of the sick.
They are required to have sympathy and understanding and to tread carefully in matters of life and death. Health workers are expected to hold a special obligation to all human beings, those of sound mind and body as well as the infirm.
The Hippocratic Oath, in effect, calls upon medical doctors to refrain from causing harm or hurt and to live an exemplary personal and professional life.
The Allied Health Professions Council is the medical body that supervises health professions such as anaesthetists. This body was called upon to investigate the conduct of the anesthetist of Kabarole hospital during the time when Robert Byaruhanga was in theatre.
The report noted that one of the health workers who, in the operation notes, was named as an anesthetist had, in fact, no formal qualification in anesthesia. In the report it was documented that the patient was first given local anesthesia then later general anesthesia when he complained of pain. The cardio-pulmonary arrest that occurred when the patient was on table was also documented as was the evidence of aspiration.
The report of the Council observed that the patient’s stomach was not empty before the surgery which is an ideal requirement for general anesthesia. It was clear from the evidence on record that the patient had not fasted long enough before the surgery which resulted in the vomiting and the subsequent clogging of the lungs by the stomach contents. This, according to the report, is what led to the cardio-pulmonary arrest that occurred during surgery.
The report concluded that the incompleteness of the theatre team at the beginning of and during the operation led to difficulties in the management of the patient.
The report also faulted the poor post-operative care and lack of oxygen on the ward and failure to refer the patient to the Regional Referral hospital as some of the factors that contributed to the death of Byaruhanga.
Court, however, in a strange twist of events and in total disregard of this report exonerated the health workers and ordered the relatives of the deceased to pay costs of the case to the health workers.
To be continued