Pandya Memorial Hospital in Mombasa has been ordered to pay KSh6.03 million in damages after the High Court found the facility solely liable for the loss of a three-and-a-half-year-old girl’s right forearm following a medical emergency in 2008.
Justice Jairus Ngaah ruled that the hospital was 100 per cent liable, finding that its staff failed to properly monitor and escalate the child’s deteriorating condition during a critical seven-hour period on the night of August 8-9, 2008.
The award comprises KSh4.5 million for pain, suffering and loss of amenities, including the loss of use of the right forearm, KSh1.5 million for loss of earning capacity, and KSh34,620 in special damages.
The judge said the child’s young age, the loss of her dominant arm and the prolonged suffering she experienced before the amputation justified an award higher than several previous cases involving adult amputees.
How the Injury Happened
The dispute dates back to August 7, 2008, when the girl, then aged about three and a half, was referred from the Kenya Ports Authority clinic to Pandya Memorial Hospital with an ailment affecting her left arm.
An intravenous line was later inserted into her right wrist.
The plaintiff alleged that the procedure caused severe bleeding and pain, eventually leading to vascular complications, gangrene and the amputation of her right forearm below the elbow.
However, the court rejected the central allegation that the hospital’s resident medical officer negligently inserted the cannula into an artery.
Justice Ngaah said the evidence did not establish, on a balance of probabilities, that the cannula had been placed in the radial artery.
The claim against the doctor who inserted the cannula was therefore dismissed.
The case against the consultant paediatrician was also dismissed after the court found that his diagnosis, treatment and subsequent response were consistent with accepted medical practice.
The Seven-Hour Window
Instead, the court focused on the hospital’s response after 8 p.m. on August 8, when the child complained of severe pain at the intravenous site.
A nurse removed the cannula, but hospital records indicated that the planned medical review did not take place.
The child was left to sleep, with no doctor examining her limb for more than seven hours.
At about 3:20 a.m., her mother reported that the child’s fingers could no longer move.
About an hour later, at approximately 4:30 a.m., the treating consultant examined her and found a swollen hand with poor blood flow and cyanosis.
Justice Ngaah found that the period represented a critical window during which medical intervention could have prevented the irreversible damage.
“The limb … passed from a threatened state to a critically ischaemic state during the seven hours in which nobody with medical training looked at it,” the judge stated.
The court concluded that the hospital’s failure to monitor the child, escalate her deteriorating condition and secure a medical review allowed the condition to progress from a potentially salvageable state to irreversible gangrene requiring amputation.
Court Rejects Uncertainty Argument
Pandya Memorial Hospital had argued that the precise cause of the gangrene could not be established because no autopsy or biopsy had been performed on the amputated limb.
Medical experts disagreed on the mechanism that caused the injury, with possible explanations including arterial cannulation, drug leakage, thrombosis and chemical thrombophlebitis.
However, Justice Ngaah held that the uncertainty surrounding the precise medical mechanism did not defeat the negligence claim.
The judge found that the hospital’s failure to respond appropriately to the child’s worsening condition was independently established by the evidence.
KSh4.5 Million for Pain and Suffering
The plaintiff had initially sought KSh20 million for pain, suffering and loss of amenities.
The court awarded KSh4.5 million, finding that the amount sought was substantially outside the range of comparable awards for amputations.
Justice Ngaah took into account the plaintiff’s young age, the loss of her dominant forearm and the prolonged suffering she endured before the amputation.
The court also awarded KSh1.5 million for loss of earning capacity, finding that permanent loss of the dominant forearm constituted a substantial handicap in the labour market throughout her working life.
However, claims for future nursing and medical expenses and future earnings were rejected.
The judge said the claim for future medical expenses had not been properly pleaded or quantified. Future earnings could also not be established because the plaintiff was an infant when the injury occurred.
Of the KSh141,891 claimed as special damages, only KSh34,620 was strictly proved through receipts and awarded.
Pandya Memorial Hospital was also ordered to pay the plaintiff’s legal costs, as well as the taxed costs of the two doctors who had been defendants in the case but were cleared of personal liability.
Interest on the special damages will run from September 24, 2009, when the suit was filed, while interest on the general damages will run from the date of judgment until payment in full.
