Court awards mother sh147m over newborn's death, faults Kibuli Hospital
Court heard that Jaridah Kyofuna attended antenatal care at Kibuli Muslim Hospital from August 2018 until she delivered her son by elective Caesarean section on October 5, 2018.
Court awards mother sh147m over newborn's death, faults Kibuli Hospital
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The High Court in Kampala has awarded a mother sh147m in damages after finding that negligence by Kibuli Muslim Hospital and one of its doctors materially contributed to the death of her newborn baby.
Acting Justice Bonny Isaac Teko held that Kibuli Muslim Hospital and Dr Dickens Aturwanaho breached the duty of care owed to baby Jibreal Jumah Sewankambo by delaying medical attention, failing to secure timely specialist assessment, carrying out inadequate investigations and conducting an emergency blood transfusion in a manner that fell below accepted medical standards.
The judge, however, said the evidence did not prove that the blood transfusion alone caused the baby’s death, but found that the cumulative failures in his management materially contributed to the fatal outcome.
“The defendants breached the duty of care owed to baby Sewankambo during his admission and treatment at Kibuli Muslim Hospital,” Justice Teko ruled.
Court heard that Jaridah Kyofuna attended antenatal care at Kibuli Muslim Hospital from August 2018 until she delivered her son by elective Caesarean section on October 5, 2018.
The baby was born alive and healthy and began breastfeeding normally. However, on the night of October 6, 2018, he developed breathing difficulties.
According to Kyofuna, she repeatedly sought medical help after noticing her baby’s condition had worsened, but no doctor attended to him for about eight hours. He was only reviewed the following morning before being admitted to the neonatal nursery.
Doctors later diagnosed the infant with suspected haemorrhagic disease of the newborn after finding that he was anaemic and had a low platelet count.
Evidence before court showed that after the hospital and neighbouring health facilities failed to obtain a compatible blood donor, doctors on the advice of consultant neonatologist Dr Margaret Nakakeeto Kijjambu, carried out an emergency direct blood transfusion using the mother’s blood.
The baby’s condition continued to deteriorate after the procedure, and he died on October 9, 2018.
She contended that the emergency blood transfusion was conducted contrary to the Ministry of Health Clinical Guidelines on Blood Transfusion in Uganda because it was performed without documented compatibility testing, proper transfusion equipment, adequate infection screening or informed consent.
She further alleged that the hospital delayed responding to her baby’s deteriorating condition and failed to carry out essential investigations that could have identified the cause of his illness.
The defendants denied negligence and maintained that the baby was already critically ill before the transfusion.
They argued that the emergency procedure was undertaken as a life-saving intervention after a compatible donor blood could not be obtained and insisted that the treatment given was appropriate under the circumstances.
The defence further contended that in the absence of a post-mortem examination, there was no evidence linking the treatment provided to the baby’s death.
The High Court directed the Uganda Medical and Dental Practitioners’ Council to investigate the complaint before the trial proceeded.
The Council established several shortcomings in the baby’s management, including an unexplained delay of about eight hours before meaningful medical review, failure by the consultant neonatologist to physically examine the baby, omission of critical investigations and deficiencies in the emergency blood transfusion procedure.
It also found that there was no documented blood compatibility testing, no documented screening for transfusion-transmissible infections, uncertainty regarding informed consent and inadequate supervision of the nurse, who carried out the transfusion.
The Council recommended that Kibuli Muslim Hospital be reprimanded for institutional lapses, Dr. Aturwanaho be reprimanded over discrepancies in the treatment records and that Dr. Nakakeeto be summoned to explain her role in the baby’s management.
However, the Council also found that the baby’s condition had already started deteriorating before the transfusion was carried out and that there was no evidence of an acute transfusion reaction.
It further observed that the absence of a post-mortem examination and complete maternal and obstetric history made it impossible to conclusively establish the precise cause of death.
He found that an eight-hour delay before meaningful medical review was unacceptable, noting that newborns can deteriorate rapidly and require immediate medical intervention.
The judge also faulted the failure to secure timely bedside assessment by an experienced neonatologist, observing that telephone consultations could not substitute for physical examination where a baby’s condition was progressively worsening.
Justice Teko further held that the omission of essential investigations, including oxygen saturation monitoring, clotting studies, blood chemistry and screening for infection and bleeding disorders, fell below the standard expected of competent medical practitioners.
Regarding the emergency blood transfusion, the judge distinguished the decision to transfuse from the manner in which the procedure was performed.
He held that although the decision to transfuse was intended to save the baby’s life, the procedure itself was marred by serious deficiencies, including the absence of documented compatibility testing, failure to use proper transfusion equipment, inadequate documentation, uncertainty over informed consent and the fact that it was carried out by a nurse whose training and supervision had been questioned by the Medical Council.
Justice Teko ruled that, taken together, the delay in medical review, lack of timely specialist assessment, inadequate investigations and deficiencies in the transfusion amounted to medical negligence.
Although the court found that the evidence did not prove that blood transfusion alone caused the baby’s death, it held that the cumulative failures materially contributed to the fatal outcome by reducing the opportunities to properly diagnose and manage the baby’s condition.
The court also held Kibuli Muslim Hospital vicariously liable for the negligent acts and omissions of its employees, including Dr Aturwanaho and the nursing staff involved in the baby’s treatment.
Justice Teko awarded Kyofuna sh17.36 million in special damages, sh100 million in general damages and sh30 million for loss of expectation of life.
However, the judge declined to award exemplary and punitive damages, saying the evidence adduced showed that although the medical personnel acted negligently, they were attempting to save the baby’s life and had not acted maliciously.
The court further ordered the defendants to pay costs of the suit.