October 8, 2023

Surgical misadventures in the case of infants can have devastating consequences.

Sosefina Puletua and her husband had taken their son – around 3 months old – to Sydney Children’s Hospital on 28 April 2021 with a high fever, a cough and a runny nose.
A provisional diagnosis of viral upper respiratory tract infection was made before he was discharged home the same day.

Two days later, they presented again with baby Meki showing worsening symptoms including fever, intermittent grunting and increased difficulty in breathing.

The hospital detected an elevated heart rate and initiated acute care.

By 5 am the next morning, he was transferred to the Children’s Short Stay Unit with ongoing symptoms. He was reviewed by a registrar and underwent further treatment and investigation.

At 11:35 am the next morning, he was reviewed by the respiratory team and a recommendation for the insertion of a chest drain, to drain fluids was made.

By 12:46 pm, he was reviewed by the surgical registrar who noted a further deterioration in his symptoms.

Treatment continued until he was transferred to the operating theatre for surgical insertion of a chest drain on 1 May.

During the operation baby Meki suffered internal bleeding, leading to hypoxia and hypotension, which led to hypovolaemic cardiac arrest. This led to severe haemorrhaging and multiple organ failure.

At the age of two, Meki has been left with a hypoxic brain injury and spastic dystonic quadriplegia – a type of cerebral palsy – as well as other serious conditions.

In October 2022 his mother filed a lawsuit on Meki’s behalf alleging that the injuries were caused by the hospital’s negligence.

Both parents also sued for damages for their own psychiatric illnesses arising out of the catastrophic injuries their son sustained.

When the matter came before Justice Richard Cavanagh in the NSW Supreme Court, the family relied upon a report from Melbourne paediatric expert Professor Warwick Butt to the effect that there were multiple instances of error and delay in the baby’s initial care.

The hospital’s ultimate diagnosis had been correct but the surgery – although appropriate – had been tragically bungled.

“The major inexcusable failure was the placement of a chest drain into the left lower lobe of the lung,” explained Professor Butt. “This complication was not recognised and two manipulations occurred which extended and magnified the lung injury and caused substantial bleeding”.

The expert was in no doubt that the resulting hypoxia, hypotension, cardiac arrest and long-term neurological problems all were a result of those surgical errors; errors that an experienced surgeon would have avoided.

The court hearing was for the approval of an interim payment of $400,000 on account of the damages the family are seeking from the hospital.

Under s 82 of the NSW Civil Procedure Act, a court may order a defendant in any damages proceedings to make one or more payments to the plaintiff as part of the amount sought to be recovered.

Because the defendant had not admitted liability – a Defence had not even been filed – Justice Cavanagh needed to be satisfied that, if the proceedings went to trial, the plaintiff would obtain judgment for substantial damages against the defendant.

In the absence of any submission in opposition to Professor Butt’s views, the judge was comfortably satisfied from the “liability” point of view.

He went on to add: “In circumstances in which the [child] originally presented to the hospital with symptoms of fever but was otherwise suffering from no disablement and is now left with permanent spastic quadriplegia and a hypoxic brain injury, the damages that the first plaintiff will recover will be very substantial”.

After the hospital voiced its opposition to the amount sought, the parties agreed on the sum of $200,000 being allowed as an interim payment to cover living expenses now that both parents are providing full time care to Meki and their other children.

“The family’s situation is extremely difficult,” Justice Cavanagh observed. “I am satisfied that the interim payment I will allow for a better standard of care, some better accommodation, and proper transportation of the first plaintiff at this most difficult stage”.

Puletua bht Puletua v Sydney Children’s Hospital Network [2022] NSWSC 1795 Cavanagh J, 21/12/2022, Published 28 August 2023 Read case

Categories: Medical Negligence

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