Military hospital in botched delivery

Military hospital in botched delivery

…….Ordered to pay M12 million compensation to girl, parents…..

MASERU-THE Makoanyane Military Hospital (MMH) has been ordered to pay M12 million to a six-year-old girl and her parents as compensation for negligence.
The hospital belongs to the Lesotho Defence Forces (LDF), which is answerable to the Ministry of Defence.
The girl is suffering from cerebral palsy which she contracted at birth.

Delivering judgment last Friday, Ombudsman Advocate Leshele Thoahlane noted that “the child will not only require special adaptive aids and devices, she will also need permanent and continuous care”.
Cerebral palsy (CP) is a group of permanent movement disorders that appear in early childhood.

Signs and symptoms include poor coordination, stiff muscles, weak muscles, and tremors.
There may be problems with sensation, vision, and hearing, swallowing, and speaking.

“Allowance has also been made for both parents to undergo post-trauma counselling given the extent of injuries the mother incurred, which injuries have resulted in challenges during intimacy,” Thoahlane said.
Thoahlane said the compensation is for emotional pain and the suffering endured by the child, Nthatisi and parents ’Manthatisi and Tšotetsi Tšoeu.
“They will need a lot of counselling,” he said.

Thoahlane said the compensation will help cater for the child’s medical and related expenses for life.
He said the money will cover her medical expenses, assistive equipment (and replacement thereof) such as Dondolino-vertical standing frame, Dynamico, arm support, leg divider, birillo, head rest, worktable, customised computerised wheelchair, educational support through special school, orthopaedic shoes, speech assessment and therapy and other health necessities recommended by doctors.

Other aids the girl will need include CT scan of the brain, Intelligent Quotient (IQ) and cognitive function assessment by a psychologist, audiological assessment, visual assessment by the Ophthalmologist, dental assessment, neurologist assessment, physiotherapy- (transportation to and from), to improve head, neck and trunk control, encourage independent sitting and encourage weight bearing.
The girl will also need occupational therapy.

“For instance, the child might need to use disposable nappies for the rest of her life,” the Ombudsman observed.
According to evidence presented before the Ombudsman, ’Manthatisi was in her 40th week of pregnancy when she went to the MMH on New Year’s Eve in 2012.

She was admitted by Dr Mojalefa Bulane, who upon examination told her that he was going to induce her into labour.
Tšoeu told the Ombudsman that her antenatal record clearly indicated that she was carrying a “precious baby” which she had been made to understand was due to her “pelvic and shoe size”.
A pregnancy is deemed as precious if it comes after a long wait or is achieved after a fertility treatment or if the mother is past 40 years of age or in her teens.

Also women suffering from conditions like diabetes, hypertension, heart disease, genetic disorders, sexually transmitted diseases and kidney disorders become candidates of precious pregnancy.
A woman’s small shoe size can be related to the size of her pelvic bone, making a natural or vaginal delivery more difficult.

The Ombudsman found that the fact that ’Manthatisi’s pregnancy was precious was never “considered even though it had been indicated as a risk factor so that extra care could be given to her and her baby”.
’Manthatisi was given labour inducing pills for that day until January 1, 2013, having her progress monitored by Private Ntšiuoa Molapo-Lenkoe and one Private Masonyane.

When her husband, brother-in-law and mother-in-law visited they picked up that something was wrong as she had difficulty in breathing and her body was swollen.
The trio asked Private Molapo-Lenkoe to call the doctor so that he could take ’Manthatisi for Caesarean Section but Molapo-Lenkoe told them to go home and let her do her job.

’Manthatisi claimed that no nurse or doctor attended to her for close to five hours, forcing her to ask her ward mates to assist her as she felt she about to deliver.
They called for help but none of the medical staff was available, the Ombudsman heard.

Molapo-Lenkoe allegedly found her helplessly heading towards the labour ward, and although she was using crutches she tried to run to ask for help and came back with four men, all soldiers.
’Manthatisi testified that at around 8pm Molapo-Lenkoe met her on the corridor, assisted by another pregnant woman.

Molapo-Lenkoe allegedly asked her to get into the labour ward, lie on the examination couch and then she looked “down there” to see what progress had taken place.
Molapo-Lenkoe “looked frightened and tried to run, but because she used crutches then, she could not”.
Molapo-Lenkoe reportedly returned in the company of the four men.
One reportedly held ’Manthatisis’s stomach, two held her feet and told her that they were going to help her deliver the baby.

When it became evident that there was a problem in getting the baby out, the fourth man whom ’Manthatisi thought must have been a nurse, cut her twice (double episiotomy) but the problem still persisted.
The baby allegedly did not breathe or cry, raising concern.
The Ombudsman found that Molapo-Lenkoe had no training at all in midwifery but was a mere “ward attendant whose job was to bathe and take care of patients”.

The Ombudsman also expressed shock that Molapo-Lenkoe dismissed ’Manthatisi’s husband, his mother and brother when they requested that she be taken for a Caesarean section, saying they were “not experts and could therefore not make such decision”.
’Manthatisi said her husband was willing to sign consent forms but Molapo-Lenkoe “dismissed them saying they should let her do her job and they left”.
Later on Dr Bulane arrived and decided to take the baby to Queen ’Mamohato Memorial Hospital (QMMH), leaving its mother behind. She only joined the baby a day later.

’Manthatisi told the Ombudsman that there was no information whatsoever given to her about the condition of her child except that she would be assessed and observed for three months.
The Ombudsman heard that approximately two years and six months later ’Manthatisi was advised by an occupational therapist to attend a meeting where she had learned with utter dismay that her child had cerebral palsy.
’Manthatisi said she was traumatised by the whole ordeal.

The family then sought medical advice and found that there was a slim chance that their child would be normal.
They approached the Ministry of Health for intervention.
Dr ’Nyane Letsie, Health Director-General, sent them back to MMH for mother and child records and ’Manthatisi found out that there was some missing vital information from such records.

There was no record of how her labour had progressed and the delivery process had not been recorded.
The Ministry sent its doctors to go to MMH to find out what had transpired.
The doctors reported that the information was sketchy, making it difficult to ascertain with certainty events leading to the botched up delivery.

The family also approached the Ministry of Defence and the Commander of Lesotho Defence Force for help.
The then Principal Secretary Colonel Tanki Mothae sent MMH personnel to go see the child, who later asked that the child be taken to MMH for physiotherapy.
Colonel Mothae had further promised that he would ask for assistance from the Chinese Embassy to have the child sent to China for medical attention as there was a chance that she could get some help.
This however never happened.

The family then decided to approach the Ombudsman for intervention when no help seemed to come forth.
They had lost faith in both the Ministry of Health and Ministry of Defence.
In front of the Ombudsman, the hospital management tried to put the blame on ’Manthatisi but they did not succeed.
Colonel ’Matšotetsi Tlelai told the Ombudsman that ’Manthatisi had given inaccurate information claiming that she had never been pregnant before while in fact she had been.

This, to the LDF management, meant there was something material that ’Manthatisi was hiding.
’Manthatisi told the Ombudsman that her prior pregnancy information did not appear in her health record.
The LDF also said the child’s disability could have been inherited.

To this, ’Manthatisi told the Ombudsman that she once had a problem of excessive bleeding during her menses and the doctor told her that he suspected that she might have just conceived but there had not been any implantation.
The LDF management was of the view that labour process had been normal, that ’Manthatisi had been monitored and periodically given doses.

They said complications had occurred during delivery due to shoulder dystocia that could not and had not been picked up before delivery.
The LDF said this was not a result of negligence on the part of the hospital.
They said the fact that the baby had suffered birth asphyxia or difficulty in breathing had not been caused by prolonged labour, but could have been brought about by lack of or too much oxygen.

The LDF also said the fact that there was no record of progress of labour had nothing to do with the delivery in as far as MMH management was concerned and in the premises the LDF did not accept that there was negligence on the part of its staff.

However, the two doctors assigned by the Health Ministry to probe the matter, Dr Maama Mojela and Dr Masupha, found that:
1. ’Manthatisi took too much time in the induction phase and that this should have told the caregiver that the induction was having challenges and therefore ought to call the doctor but that never happened.
2.  ’Manthatisi’s heart beat going up was a sign of distress but this was not picked up or at least nothing was done about it.
3.  There was no vital information on active labour and with such vital information missing it was not clear as to what happened prior to the child’s birth – this information would have helped understand where the problem arose.
4. In their opinion if something had not been recorded then it meant it had not been done.
5. Once induction had been set in motion, the patient became a priority because induction drugs could react differently on different patients, this never happened with ’Manthatisi.
6.  Partogram was used as a guide to the doctor or care giver on how the patient was progressing so that they could make an informed decision on what to do at what stage, so the absence thereof was worrying.
7.  ’Manthatisi was said to have had her feet swollen; this may have been the result of protein deficiency which could have a bearing on the uterine expansion, elasticity and recoil, resulting in labour taking longer than expected.
8.  The “precious baby” inscription should have meant that the patient needed to be handled with extra care but this was not the case, ’Manthatisi was instead treated like a normal patient.

Subsequently a letter was written to Dr James Ger, a gynaecologist at Queen Elizabeth II Hospital, to examine ’Manthatisi to establish the extent of the injuries she sustained during birth and make a report thereof to the Ombudsman.

The doctor did examine ’Manthatisi and duly submitted his findings to the Ombudsman.

Staff Reporter

Previous Clarification
Next Phori, BKB talks collapse

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