Clinic feels pain of botched contraception procedure

By Wahome Thuku

Nairobi, Kenya: Intrauterine contraceptive device (IUCD), commonly known as coil, is a popular family planning method, preferred by many women in Kenya.

In 2004, Ms Faith Ruth Nyambura Irungu sought family planning services at Marie Stopes Clinic and requested to have an IUCD inserted into her body. This was done without a problem.

When she decided to have a second baby, she went back to the same clinic and the device was removed. After getting the baby, she went back to the clinic in February 2007 for another IUCD insertion.

At first a nurse tried to carry out the procedure but failed. She called Dr Mark Imbusi a senior gynecologist who made a first attempt but also failed.

He sent Nyambura for a scan and after getting a report, Imbusi managed to carry out the procedure.

Nyambura said she felt pain and complained to the clinic personnel. She was informed that this was as a result of staying without the IUCD for long and that the pain would subside. A month later she was still in pain.

She went back to the clinic on March 9, 2007, and explained the problem to Imbusi.

The doctor sent her for another scan. The report of the scan indicated that the IUCD was “misplaced”.

The doctor tried another procedure which, Nyambura thought was an attempt to remove the device. The procedure was painful and it failed.

Imbusi called a colleague who advised him that the device had to be removed.

They referred Nyambura to Eastleigh Nursing Home where she was taken the same day. She consulted a Dr Gekara who told her she had to undergo a surgery to have the translocated device removed.

Nyambura was shocked. She had a young baby who was still breastfeeding.  She, however, agreed to have the surgery, which was carried out the following day. She stayed at the hospital for four days. During this time, her baby was fed on powdered milk.

Nyambura filed a complaint with the Medical Practitioners and Dentists Board (MPDB).

In 2009, she brought Imbusi and Marie Stopes Clinics before a Chief Magistrate Court in Nairobi for medical negligence.

She accused Imbusi of being incompetent. She claimed the doctor who conducted her first IUCD at the same clinic had done it properly. But she blamed the hospital for assigning an “incompetent” doctor to attend to her.

Nyambura said she had confidence in the clinic because the insertion of the first IUCD was successful and did not cause any problems to her. She told the court that she took three years to heal. She had developed a phobia for IUCDs and stopped using them.

On September 27, 2012, the MPDB wrote back to her informing her that Imbusi was not in their register in the year 2005 to 2011. The board, however, exonerated the clinic from blame.

Nyambura was represented in the case by Prof Kiama Wangai, an advocate who doubles as a pathologist.

By the time the case was being heard, Imbusi had already left Marie Stopes Clinics.

He was not traced by the hospital to give his side of the story. Imbusi did not testify, neither did the nurses who attended to Nyambura.

The clinic called one of its doctors, Dr Fred Oyombe Akonde an obstetrics/gynecology specialist to testify.

He told the court that as far as he knew, Imbusi was a qualified professional having acquired qualifications from Moi University.

Oyombe said the IUCD could be inserted by doctors, nurses, clinical officers or even midwives.

Looking at the scan report, he said the device in Nyambura had gone past the uterine cavity to the posterior uterine wall, which was not the normal position.

He said this could have been as a result of migration even if it had been put in the right position.

He said Imbusi had used the correct procedure to insert the device but conceded it had caused injury to the uterine wall.

On cross-examination by Wangai, the witness conceded that the patient may have had an injured uterine wall during the insertion and the device may have followed the injury into the Pouch of Douglas, where it was traced.

Not problematic

Oyombe testified that the insertion of the IUCD is a blind procedure as the person doing it does not see where it is inserted.

But if incorrectly inserted, one of the signs is pain and discomfort either immediately or days later depending on the site of injury.

The magistrate considered that Nyambura had not called expert evidence and that Oyombe’s evidence could be biased in favour of his employer. The court, however, observed that the defence had not challenged the veracity of her evidence which was in the form of scan report indicating the IUCD in her body was misplaced. That had even been confirmed by Oyombe and also Gekara who had it removed.

The question for determination was what caused the translocation of the device? The only reason for Nyambura to accuse Imbusi was that she had undergone a similar procedure before that was not problematic.

Considering Oyombe’s evidence, the court concluded that  it supported the argument that the IUCD was not properly inserted. He had conceded that the translocation was puncture to the uterine wall during the insertion.

The court held that the clinic owned Nyambura a duty of care as their patient.

“Dr Imbusi owed Faith a duty to use diligence, care, knowledge, skill and caution in administering treatment to her,” the magistrate held.

The magistrate said the translocation of the IUCD was not a side effect of the insertion as claimed by the clinic. It was not properly inserted and the doctor and the clinic were 100 percent negligent, the court concluded.

Nyambura’s lawyer asked for Sh4 million as adequate compensation. The hospital argued that she could only get Sh50,000 as compensation for minor soft tissue injuries.

The court concluded that Nyambura had proved her case against Imbusi and the clinic on a balance of probability.

It awarded her Sh1.5 million as general damages, Sh50,050 as special damages and Sh5,000 are transport expenses during the medication plus interest and costs of the suit.