4.Name of Case: Rana Ramlal v The South West Regional Health Authority and Dr.
Patricia Deonarine and the Attorney General of Trinidad and
Tobago HC 1291/1998
Type of Medical Negligence: Hospital Error/ Surgical Error
Date of Judgment: 28th March, 2003
Presiding Judge: The Honourable Mr.Justice Dean- Armorer
The Plaintiff was nineteen (19) years old and eighteen (18) weeks pregnant. She attended the San Fernando General Hospital on 11th November, 1998 after experiencing abdominal pains and bleeding. The Respondent was examined briefly by a doctor and then referred to the gynaecological ward.
The Plaintiff was examined by the most junior doctor, the second Defendant, who placed her hand on the Plaintiffâ€™s abdomen and informed the Plaintiff that she suffered an â€śincomplete abortionâ€ť and that the second Defendant needed to administer drugs to her to induce abortion so that the â€śremains of the babyâ€ť could be expelled. Although the Plaintiff informed the intern that she was feeling the foetus moving in her abdomen, the patientâ€™s complaints were dismissed.
The second Defendant proceeded to use a sponge holding forceps to remove what appeared to her to be placenta tissue but was later identified as the cervical polyp, which she mistook for the products of conception. This tugging on the cervical polyp caused the Plaintiff severe pain. The second Defendant paid heed to the Plaintiffâ€™s pleas and stopped the process. The Plaintiff was then given a drug to induce uterine activity to assist in expelling the foetus which was administered intravenously via a drip. The
Plaintiff, while on the drip continued to experience foetal movements and she consequently turned off the drip.
The second Defendant again dismissed the Plaintiffâ€™s complaints and ordered that she undergo an ERPC, a surgical procedure to remove the unexpelled products of conception.
In the operating theatre the surgeon noticed that the Respondent was crying and upon examination the surgeon felt foetal movement and sent the Plaintiff back to the ward. By this time the Plaintiff 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 San Fernando General Hospital. Within 48 hours, she was reassessed by other doctors and found to be carrying a live baby and was diagnosed and treated for an endo-cervical polyp.
The Plaintiff alleged that the cervical polyp was mistaken for products of conception and she was treated for an incomplete abortion.
Due to the second Defendantâ€™s negligent failure to heed the patientâ€™s complaints the second Defendant embarked in a tugging exercise which resulted in pain and suffering to the Plaintiff. This aspect of the second Defendantâ€™s negligence was actionable because it resulted in pain and suffering to the Plaintiff.
The Court is of the view that the â€śtuggingâ€ť was the direct result of the second Defendantâ€™s failure to listen, which rendered her misdiagnosis negligent. Negligent misdiagnosis was pleaded under the Plaintiffâ€™s Substance of Case, which though unusual, was allowed to remain on the pleading, without any application on the part of the Defendants to have it struck out.
The Court admitted that the injury to the Plaintiff was minimal. The actual pain of the â€śtuggingâ€ť appears to have subsided as soon as the tugging ended. There has been no suggestion of permanent injury. Moreover, the negligent acts did not lead to the death of the foetus. The Plaintiff had been able, by her own astuteness and the help of Dr. Abdullah to escape. .
The Court observed however that the negligent acts of the second Defendant did not prevent the Plaintiff from staying at the hospital. Those acts substantially discouraged her, but she had not been turned away and it may have been open to her even to return to the hospital for the surgical removal of the polyp.
Judgment for the Plaintiff. The Court made a finding of negligence stating that the Defendants negligently misdiagnosed and treated the Respondent and are to pay to the Plaintiff General Damages in the sum of $7,500.00 with interest at the statutory rate from the date of the Writ.
THE DECISION WAS APPEALED.
Dr. Patricia Deonarine v Rana Ramlal C.A.CIV.28/2003
Presiding Judges :Â Justice of Appeal Allan Mendonca
Justice of Appeal Stanley John
Justice of Appeal Paula Mae Weekes
Although the polyp could have been removed by twisting it off, that is not what the Appellant attempted to do and what she succeeded in doing was causing pain to the Respondent.
Reasonable and responsible practice dictated that the Appellant should have procured the consultant to direct an ultra sound.
The Appellant was found to be competent to treat the Respondent and fell short of the standard expected of a person of ordinary skill.
According to the Court of Appeal judgment delivered by Justice Allen Mendonca in 2003, the Court found that the doctor had mistaken the products of conception for an endo-cervical polyp which is extremely rare in pregnant women.
THE APPEAL WAS DISMISSED WITH COSTS.