A HIGH COURT judge has found gynaecologist Dr Kong Sheik Achong Low guilty of medical negligence in his treating of a pregnant woman who later bled to death shortly after giving birth to a stillborn baby.
Karen Lezama, 41, died on April 6, 2003 at Stanley’s Nursing Home in St Clair after giving birth to her stillborn son which was given the name Ryan.
In a 67-page judgment, Justice Ricky Rahim yesterday ruled in favour of Brian Lezama, husband and administrator of his wife’s estate, who brought a medical negligence lawsuit under the Supreme Court of Judicature Act and the Compensation for Injuries Act. According to the judge’s finding, Achong Low who operates out of Good Health Medical Centre at Fitzblackman Drive, Woodbrook, failed to exercise “all due care and diligence” in the treatment of Lezama.
“Management (of a patient) often involves literal life and death decisions with no time for leisurely reflection. Be that as it may, it is the responsibility entrusted to them by the public at large, in whose collective and singular interest, they must at all times act by adhering to the accepted practice in their area of speciality even under the most dire circumstances,” Rahim said in his judgment.
According to Brian Lezama, his wife — who was a mother of three — was a gestational diabetic and “known bleeder”. On April 2, 2003 at about 7 pm, a full-term Lezama was admitted to Stanley’s Clinic where bed rest was ordered and at about 9.30 am, the next day, she was discharged.
On April 6, Lezama was again admitted and drips administered to induce labour.
Achong Low visited his patient at about 11 am and left instructions to be called when Lezama was close to full dilation. He got the call five and a half hours later.
At about 4.53 pm, Lezama had a normal spontaneous vaginal delivery of a stillborn baby boy and almost immediately, began bleeding profusely with no clotting taking place. Achong Low was said to have directed that she be given more units of syntocinon (medicine for haemorrhaging) and intravenous fluids for what he assessed to be, coagulation problems.
Some 40 minutes later, Lezama went into shock, suffered an amniotic fluid embolism and died at 10.10 pm. The lawsuit alleged that Achong Low failed to heed that his patient was a “known bleeder” and request or consult her medical records.
The doctor was accused of failing to have done any blood investigations or ensuring there was sufficient blood on hand if transfusions were needed as well as failing to administer sufficient medication to stop the bleeding. In his defence, Achong Low who had delivered Lezama’s third child, denied knowing that she was a “known bleeder” and that he was guilty of negligence. He insisted he obtained the necessary amount of blood required for the patient and administered such while also taking all steps necessary as accepted in the field of Gynaecology and Obstetrics.
Lezama’s lawyers Stanley Marcus SC and Patricia Dindial called several medical practitioners as expert witnesses including Dr Mary Bhola-Singh, Dr Harold Chang, Professor of Pathology Dr Hubert Daisley, Dr Petronella Manning-Alleyne and Dr Waveney Charles. Achong Low’s attorneys’ Stuart Young and Michael Bullock called Achong Low, Dr Rawle Jibodh and Dr Hemant Persad in his (Dr Achong Low) defence.
Manning-Alleyne testified that she was present at the time of delivery and immediately informed Achong Low, when he entered the delivery room, that Lezama had experienced port-partum haemorrhage with her three previous deliveries.
She said that when Achong Low removed the stillborn baby, there was an abundance of blood while Lezama’s husband later testified that he was told by Achong Low that his wife was torn during delivery and he (Achong Low) could not see properly to do the stitching because of the profuse bleeding.
Achong Low instructed nurses to rub Lezama’s stomach to stop the bleeding. Lezama, in his testimony, said that at this time his wife began complaining that she was not feeling her legs and Achong Low suggested he (Lezama) rub his wife’s stomach for three to four hours and, “everything would normalise.”
At this point, Manning-Alleyne drew blood to run some tests. Lezama also testified that Achong Low refused the help of Dr Ajit Kuruvilla and noted he would have to send for blood. Lezama said at this time his wife became unresponsive and this was articulated to Achong Low, who appeared unaware of his patient’s condition.
At 7 pm, Lezama was asked to leave the room and a short time later when he wandered back into the delivery room, he observed Manning-Alleyne rubbing his wife’s chest while Achong Low was still rubbing her stomach.
Lezama said he saw Chang insert a needle in his wife’s body but he (Chang) said he could not find any workable vein because the veins had collapsed. By this time, Lezama’s condition had deteriorated and Achong Low advised she be taken to St Clair Medical.
When he returned to the delivery room, after being asked to wait in a waiting room with relatives, Lezama said his wife had gone into cardiac arrest at about 9.40 pm. Attempts were made to stabilise the patient and paddles were used in an attempt to shock her, but Lezama said there was a flat-line on the monitor. Achong Low walked out of the delivery room at 10.10 pm after attempts to resuscitate Lezama failed.
Lezama said that later in the month, he was unable to get his wife’s file and visited Achong Low’s office where he was that the doctor believed an amniotic embolism had killed Lezama but as there was no conclusive evidence to prove this, he (Achong Low) wrote, “post-partum haemorrhage” on the death certificate.
Achong Low also said since no autopsy was performed, he was unsure of the diagnosis and that was the reason he wrote haemorrhage and DIC (Disseminated Intra-vascular Coagulopathy).
Pathologist Daisley who was asked to provide his expert opinion on the possible cause of Lezama’s death, opined that she died from hypovolaemic shock (loss of large volumes of blood) following post-partum haemorrhage. He also stated that she delivered a macerated stillborn baby and was a gestational diabetic. The baby was said to be macerated because it had died in the womb three days prior to delivery.
Admitting there was no witness who could definitively say that Lezama would have survived had Achong Low called for help, administered more medication or gotten and administered blood at an earlier stage, the judge said that based on evidence of all the medical practitioners, the earlier the patient was given blood and blood products the more likely she was to survive an onset of post-partum haemorrhage.
“It therefore follows that it is more likely than not that the omission to administer more blood and blood products in a timely fashion resulted in the death of the deceased from post-partum haemorrhage,” Rahim said in his ruling. Damages are to be assessed and costs quantified by a Master of the Court.
Extracted From: Trinidad & Tobago Newsday Newspaper