Continuing from last week on the issue of medical negligence, there is also the more recent 1998 case of Rana Ramlal-v-South West Regional Health Authority, Dr Patricia Deonarine and Attorney General where the plaintiff was a 19-year-old, who, being 18 to 20 weeks pregnant, attended the San Fernando General Hospital with complaints of abdominal pains and bleeding.
She alleged in her case that she was negligently treated when a cervical polyp was mistaken for products of conception and she was treated for an incomplete abortion. Three doctors testified on behalf of the plaintiff namely, Dr Lackram Boodoo, Dr Krishna Rampersadsingh and Dr Manwah Abdullah. On behalf of the defendant, there was Dr David Ali, Dr Eric Richards, Dr Jehan Ali and Dr Patricia Deonarine.
The learned trial judge in that case went on to find out the facts inter alia that:
1On a balance of possibilities, Dr Deonarine used the sponge-holding forceps to pull on what was later identified as the cervical polyp which she apparently mistook for products of conception.
2 This tugging on the cervical polyp caused the plaintiff severe pain and she had been screaming.
3 The evidence of Dr Patricia Deonarine must be rejected when she said that she offered the plaintiff the option of being examined by a senior doctor.
4 The court accepted the evidence of the plaintiff that she asked for tests to verify that the foetus had died and that Dr Deonarine rejected this.
5 The court rejected the evidence of Dr Krishna Rampersadsingh as to the length of the polyp and the stalk.
6 Despite the plaintiff's claims that she was experiencing foetal movements, Dr Deonarine told her that her baby had died and could have been dead for a few days. The plaintiff continued her protests that the baby was alive and requested tests to confirm this, yet Dr Deonarine found these tests unnecessary and told the plaintiff as much and asked the plaintiff why she chose to attend the hospital if she did not wish to take her advice. The court accepted the plaintiff's evidence that Dr Deonarine became hostile.
7 After being put on drips to induce contractions, the plaintiff began feeling foetal movements again and turned off the drips. This apparently made the doctor furious and she sent the plaintiff for an ERPC.
8 In the operating theatre, an experienced obstetrician listened to the plaintiff's complaints and felt the foetal movements for himself and thus sent her back to the ward to be re-assessed by a senior practitioner.
9 The plaintiff by this time had not only lost confidence in the hospital staff but had become afraid of the possibility of a repeat of the tugging with the forceps and discharged herself from the San Fernando General Hospital. Within 48 hours, she was re-assessed by other doctors and found to be carrying a live baby and was diagnosed and treated for an endo-cervical polyp.
10 The court went on to make a finding of negligence and granted judgment for the plaintiff in this matter.
The case of Dr Patricia Deonarine v Rana Ramlal was appealed and the court held it is not sufficient for the plaintiff to adduce evidence to show that there is a body of medical opinion that considers the medical practice adopted by the medical practitioner to be wrong if there also existed a body of equally competent opinion that considered it acceptable.
This principle was affirmed in Sideway The Board of Governors of the Bethlem Royal Hospital where Lord Scarman said: "A doctor is not negligent if he acts in accordance with the practice accepted at the time as proper by a responsible body of medical opinion even though other doctors adopt a different practice." The appeal was dismissed.
In the case of Samdaye Harrilal v South West Regional Health Authority and the Attorney General of Trinidad and Tobago the plaintiff commenced an action in negligence against the defendant arising out of the stillbirth of the plaintiff's baby and care she received as a patient at San Fernando General Hospital. The court held that the SWRHA was running the hospital for the State and so could be held liable in damages. The court awarded exemplary damages in the sum of $140,000 against SWRHA plus interest at a rate of 6 per cent per annum.
I would also like to present the other side of the equation, too, in fairness to medical practitioners also. In Gudrun Joerpeland v North West Regional Health Authority, the claimant sought damages against the NWRHA for negligence for the death of her unborn child. The claimant alleged that the death of her child was a result of the lack of expertise of medical and nursing personnel, the failure to perform a Caesarean section and the failure to have in place an adequate system of care to properly provide for her treatment and that of the child.
The court held that while the death of a child is never easy, "it is well settled that a medical practitioner is not obliged to achieve success in every case that he treats. His duty is to exercise reasonable skill and care" per Mendonca JA in Deonarine v Ramlal paragraph 18.
It was held that in his treatment of the claimant, the doctor acted in accordance with the standard practice applicable to the circumstances. On being presented with a patient in pre-term labour he took reasonable steps to attempt to stop labour and to assist in the development of the baby's lungs by the administering of drugs which was in accordance with the practice at the time. The case was therefore dismissed. So it is not every case where something goes wrong that there is a case of medical negligence, but if the circumstances are such that the level of skill, care and treatment fell short of the acceptable standards, then it is clear that medical doctors in T&T are willing to come forth and give evidence even against their fellow doctors.