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CCJ rules against doctor in case of child developing cerebral palsy

Sunday, April 13, 2014    

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PORT OF SPAIN, Trinidad, (CMC) — The Caribbean Court of Justice (CCJ) has dismissed an appeal by a Belizean-based doctor against a lower court ruling that he failed to follow procedure sanctioned as the proper practice for an obstetrician during the pregnancy of a woman who later gave birth to a child with cerebral palsy.

The five-member panel of the CCJ said it had also ordered costs against Dr Raju Meenaalli in the case that also involved doctor-patient relationship.

The Court heard that Georgia Matute had visited the clinic of Dr Meenavalli, an obstetrician and gynaecologist after she discovered that she was pregnant.

The Court was told that at the time she informed Dr Meenavalli that her last menstrual period (LPM) occurred on April 27, 2000, but the doctor ignored her instructions and noted that her LMP was March 27, 2000.

Consequently, he proceeded on the basis of an erroneous LMP which led to Matute's premature delivery of the baby, Janae Matute, which eventually caused Janae's development of cerebral palsy.

The CCJ, which is the final court for Belize, ruled that it had decided to "leave undisturbed the findings by the trial judge and the Court of Appeal that Dr Meenavalli's failure to act in accordance with established professional standards caused Janae Matute's cerebral palsy".

The Court noted that Counsel for Dr Meenavalli did not dispute that Janae suffered cerebral palsy but that he contended that there was a break in the chain of causation in relation to the cause of Janae's asphyxia.

The Court also noted Dr Meenavalli's invitation for it to find that there were multiple causes for Janae's condition and since the conventional 'but for' test could not apply, he should not have been found negligent.

But in its ruling, the Court however found that the lower courts could properly find that, on a balance of probability, Janae's condition was due to a pre-term delivery which caused the onset of hyaline membrane disease at birth.

It accepted that if Janae did not develop hyaline membrane disease, there would not have been resuscitation and exposure to sepsis.

"The Court noted that the lower courts did not find that there were multiple causes of Janae's cerebral palsy or that there was an indeterminate class of persons one or more of whom were responsible for Janae's condition and subsequently decided to leave undisturbed the findings of the lower courts, resulting in Dr Meenavalli's failure on this ground of appeal."

Addressing Dr Meenavalli's submission that no standard of care was established, the Court highlighted the classic statement of the standard of care of a professional exercising some special skill or competence which it said in the context of medical negligence means the failure of a medical practitioner to act in accordance with the standards of reasonably competent practitioners.

"After considering the evidence before the lower courts, the Court concluded that the Court of Appeal was correct to conclude that Dr Raju Meenavalli failed to follow procedure sanctioned as the proper practice for an obstetrician, failed to record Matute's LMP accurately, to take account of the La Loma Luz ultrasound of the pregnancy and so misled himself when he came to assess Matute's case in the closing stages of the pregnancy and to decide on the most appropriate date of delivery."

The CCJ also ruled that there are special but higher standards for those who profess specialism "but that does not mean that they do not also owe an ordinary duty of skill and care applicable to general practitioners, including to record and consider relevant information supplied to them by patients."

It rejected the medical doctor's submission that no standard of care was established as he was not only in breach of the common standard of care applicable to medical practitioners but also of the standard of care applicable to specialists in the field of obstetrics and gynaecology.

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