In Court this Week

In court this week

COURT AWARDS DAMAGES AGAINST FOREIGN GOVERNMENT DOCTOR FOR MEDICAL NEGLIGENCE

The Supreme Court presided over by Justice Ranjun Perera has awarded damages against a government doctor for medical negligence in favour of a minor and her mother. The Plaintiffs had sued the doctor and the government of Seychelles as the doctor’s employer for substantial damages as a result of the doctor’s failure to make a proper diagnosis. On the 10th September 2000 around 5.00pm, the 1st Plaintiff was swimming in the sea when she stepped on a sharp object and experienced excruciating pain. She could not walk thereafter, and had to be carried home by a neighbour. From there the mother took her to Beau Vallon clinic for medical treatment. The medical history shows that she arrived there at 5.33pm and was seen at 5.43pm by the doctor. The diagnosis and treatment stated in the medical report is as follows: “Injury in the left foot. Patient was in the sea when she sustained injury on the sole of her foot. Most likely she stepped on the sea corals. Clean and dress. Paracetamol 500mg. Amoxycillin 250mg, 3 times a day for 5 days.” According to the evidence the child’s mother disputed the doctor’s diagnosis and informed the doctor that it could be a stone fish sting.

Doctor’s Diagnosis was wrong

The doctor insisted that “this is not a stone fish, this is a dirty coral.” The young girl was then sent home with the prescribed medicine and dressing. The pain remained unabated and the girl was taken to the casualty section of the Victoria hospital the same night. The girl was seen by another doctor there at around 7.25pm and he diagnosed “allergy sting injury left foot.” The girl was given hydrocortisone 200mg injection, amoxicillin, piriton, flucloxacillin and prednisone. She was to continue treatment at the local clinic. After returning home she spent a sleepless night in pain. The next morning she was taken to the clinic of a private Seychellois doctor who immediately diagnosed the injury as a stone fish sting. The doctor prescribed analgesics and asked the girl to return two days later. During that period the pain subsided but the foot remained swollen. The doctor then decided that she should be admitted to hospital for surgery to remove the skin tissues which had become necrotic.

3rd Doctor advised on 3rd Operation

At the Victoria hospital the girl was seen by yet another doctor who gave her a penicillin injection and admitted her. By then the area around the injury had turned black and the foot was still swollen. Subsequently, surgery was performed and a skin graft was done. A second operation was done as the grafting had not set in well. After being discharged from hospital one month later, she underwent physiotherapy treatment. Later the nerves on her leg got swollen and the doctor told her that the skin graft had not healed well and set properly and hence a further surgical operation was necessary to set the nerves. The girl expressed fear and concern to have another operation done locally and her mother decided to take her to South Africa. In South Africa the girl was seen by Doctor Christo Wagenaar, who after examination issued the following certicate:

South African Doctor said 3rd Operation not neccessary

“The patient presented to me with a one and half year history of edema of the left foot…She had a skin graft done after a fish bite that had became necrotic. Blood circulation to the left foot is normal. Venous drainage is probably impaired after severe cellulites and necrosis. She has no neuroma at the site of the scar. She is neurologically intact. The child should be given time. The drainage should improve in due time. She might develop a neuroma and that should then be dealt with. She needs no further surgery. I will recommend for her to wear an ankle guard as necessary. Cellulites of the foot should be managed in the normal way. Please feel free to contact me should it be necessary.” The girl’s mother corroborated her daughter’s evidence and even stated that a nurse had suggested that the doctor administer hydrocortisone injection but the doctor refused. The nurse who has 40 years medical experience explained that in case of a stone fish sting the poison accumulates in the area and hence an antibiotic like amoxicillin was unhelpful as the poison would not be removed.

Doctor testfied that the 1st Doctor’s diagnosis was “vague and imprecise”

Another government doctor who was called as a witness in the case stated that the words “most likely” in the report indicated that the initial clinical presentation was obscure and hence the diagnosis was vague and imprecise. He stated that the poison in a stone fish is on its spine and hence there could be multiple punch injuries. The doctor stated that in the case of a stone fish sting, there would be excruciating pain as a symptom. The first line of treatment would be pain control and to surgically removed any pieces of the stone fish spine and poison by debridgement and irrigation. The doctor also stated that if not treated properly in time, stone fish venom could lead to cardiac arrest and sudden death. He stated that in Countries like Australia there was anti venom serum for stone fish stings but such venom could be denatured by immersing the affected area in hot water for about one hour. This, he stated was common practice.

Seychellois Doctor Confirms erroneous Diagnosis and Advise Otherwise

The Seychellois doctor who testified also shared the same view and stated that with proper treatment the poison could be denatured and the pain relieved within 48 hours. The doctor stated that during the first few hours, immersion of the injured foot in hot water at 40 degrees Celsius would have denatured the venom, otherwise skin tissues would die within seconds. Hence, he stated that proper diagnosis and treatment within the first few hours was crucial. The young girl had claimed R.80, 000 for pain and suffering and R.90, 000 for permanent disability and discomfort. The judge relied on another case as precedent and stated that a tortfeasor is liable to compensate the injury that he has caused. In that case the Defendant doctor used a vaginal speculum to examine the genitalia of a 16 year old girl and in the process caused a tear of the hymen and caused subsequent bleeding. It was established that he had negligently used an inappropriate speculum and also that he had not obtained the consent of the parents before commencing an invasive procedure, or even explained to the parents the risks involved. On a consideration of all the circumstances of the case the judge awarded R.75, 000 damages.

The judge awarded the sum of R.40, 000 to the girl as damages for pain, suffering, distress, anxiety and discomfort and also the disfigurement. The girl’s mother had claimed R.20, 000 as moral damages. The judge stated that the evidence in the case disclosed that the mother suffered anxiety, distress and inconvenience as a result of the complications her daughter suffered due to the negligence of the doctor. On a consideration of all these factors the Court awarded R.5000 under that head. The Court also awarded R.200 spent on the medical report. Judgment was accordingly entered in favour of the 1st Plaintiff in the sum of R.40, 000 and R.5200 to the 2nd Plaintiff against the doctor and the government jointly and severally.