Hospital, doctor ordered to pay Sh4.35 million for misdiagnosis of child

The appellate court in Nairobi has ordered Aga Khan University Hospital and a Neurologist, Dr Donald Oyatsi, to pay Sh4.350,000 million to the parents whose daughter died from meningitis due to misdiagnosis.

Justices DK Musinga, M Ngugi and GV Odunga upheld Justice Joseph Surgeon’s verdict dated April 12, 2018, that found the hospital and Dr Oyatsi liable for the minor’s death.

Sylvester Kisonzo and his wife Beriah Warue sued the hospital and the doctor for misdiagnosis and poor management, including failure to conduct necessary tests to detect meningitis.

The parents said that the hospital and the doctor failed to properly and timeously diagnose their nine-year-old daughter with meningitis.

Kisonzi said that their daughter was misdiagnosed and subjected to an inappropriate psychiatric evaluation, which diverted attention from her true medical condition and delayed proper treatment.

The parents contend that their daughter’s condition was not adequately monitored and that the standard of care, skill, and diligence expected of competent medical practitioners was not met, leading to her deterioration and eventual death.

Kisonzi said his daughter fell ill in May 2009 and was admitted at the Aga Khan Hospital, where she was initially attended to by other doctors before Dr Oyatsi took over her management on May 24, 2009.

He testified that Dr Oyatsi downplayed the seriousness of the illness, attributing it to stress, and introduced psychiatric intervention despite persistent complaints about his daughter’s deteriorating condition that eventually left her admitted in the High Dependency Unit (HDU) where she passed shortly after.

He said the doctor maintained that she was clinically well and failed to undertake appropriate investigations to save his daughter.

Warue told court that her daughter fell ill on May 12, 2009 and was initially treated for a urinary tract infection before her condition deteriorated.

She denied that they prevented any medical procedures and maintained that they relied entirely on Dr Oyatsi’s expertise.

The appellate judges said that as the specialist assuming primary responsibility, D. Oyatsi was under a duty to review the patient’s history, reassess the existing management plan, and take such steps as were warranted in light of her condition.

“Dr Oyatsi expertise as a neurologist and the evidence that the deceased’s condition was deteriorating, he ought reasonably to have appreciated the necessity of that diagnostic intervention,” said Justice Musinga.

“The postmortem report confirmed that the cause of death was ‘Meningitis due to Septicemia/ Bacteremia, due to Broncho Pneumonia due to viral Encephalitis’ which, in our view, underscored the centrality of timely diagnosis and intervention,” the judges added.

 

The appellate judges said that the omission in the deceased’s medical care fell below the standard expected of a reasonably competent practitioner.

“We therefore find no basis to interfere with the finding that Dr. Oyatsi was negligent,” said Justice Musinga.

In his defense, Dr Oyatsi said that a lumbar puncture (Spinal Tap) had been recommended earlier by other specialists but was not carried out due to the parents’ reluctance to consent.

He argued that in the absence of the collecting cerebrospinal fluid (CSF) to diagnose central nervous system infections like meningitis, bleeding around the brain, and autoimmune disorders procedure, he relied on clinical judgment and treated the patient for a suspected brain infection, including meningitis.

The doctor maintained that he exercised due skill and care, reviewed the patient regularly, and thatthe poor outcome was due to the severity of the illness and not negligence.

Dr Oyatsi conceded that the lumbar puncture would have been important in confirming the diagnosis and that treatment for meningitis was initiated several days after he first saw the minor.

He said that certain aspects of the diagnosis were not expressly documented in his notes.

 Dr Oyatsi’s said that responsibility for the deceased’s deterioration cannot be placed solely on him, because the hospital’s staff including Dr. Jowi and Dr. Mativo whose omissions contributed to the outcome materially contributed to the outcome.

In In its appeal, the Hospital maintained that the deceased underwent several diagnostic tests, including EEG, MRA and MRV brain tests, all of which yielded normal results, and that she was continuously monitored and treated with appropriate medication, including antibiotics, but did not respond to treatment.

The hospital argued that health facilities and doctors are not insurers of successful outcomes, and that medical treatment is inherently attended by risk, such that a negative outcome does not, without more, amount to negligence.

In his judgment, Justice Surgeon held that the medical practitioner and a hospital owe a duty to exercise reasonable care, skill, and diligence in the treatment of a patient.

Justice Surgeon found that the minor was admitted at the hospital under the care of Dr. Oyatsi, and died from meningitis and related complications.

The judge further held that no definitive diagnostic test, particularly a lumbar puncture, had been conducted to confirm or rule out meningitis, and that there was no cogent evidence that the parents had declined consent for the procedure.

Justice Surgeon said that Dr Oyatsii failed to meet the required standard of care and thereby breached his duty.

The Judge also said that by admitting the patient and arranging her treatment, the hospital assumed a direct duty of care and was vicariously liable for the negligent acts and omissions of the medical practitioners involved.