Saturday, November 30, 2013


HIGH COURT CASE OF ABDUL RAZAK Vs RAJA BADRUL ( 2012 ). Court of Appeal this year
The contents of this post is for the sake of discussion and analysis. The decision of the court of law is duly respected. Contents are sourced via public domain freely available on line. There is no intention to discredit anyone involved in the case.

Patient was an elderly lady admitted to Hospital Temerloh in 2010 for adhesion colic and was treated conservatively. The patient was then transferred to HKL for further treatment. Apparently the patient's husband knew the doctor at HKL and asked to be transferred there...the first RED FLAG.

"The Plaintiff spoke to the 1st Defendant and the 1st  Defendant agreed to treat the Patient. The Plaintiff had  3 specifically arranged for the 1st Defendant to treat the Patient, as he knew the 1st Defendant personally, having been previously treated by the 1st Defendant professionally. The 1st Defendant had also assessed the Patient’s condition by speaking to her doctors at the Temerloh Hospital."
After 3 days of stay at HKL, a decision was made for emergency surgery in view of investigative findings suggestive of intestinal obstruction.

“On the morning of 31.5.2010, I was at home preparing to visit my wife when I received a telephone call from her. She told me that Raja Badrul wanted to speak to me. Over the telephone, Raja Badrul informed me that he had to operate on my wife that very day. I agreed to the operation.”

One doctor informed the husband that the operation was a success while another informed him that there were complications during the surgery. The patient had aspiration pneumonia, initially attributed to failure of the patient to consent for Ryle's tube insertion. In the end, the patient passed away due to aspiration pneumonia.

1.The attending doctors should have inserted Ryle's tube prior to induction of anaesthesia
2. Negligence in providing due care to the patient
3. Failure, refusing and neglecting to advise the patient and her husband on the risk of surgery

"The Plaintiff’s counsel submits that there is no evidence of the 1st Defendant:-
i. informing the Patient that it was vitally important to have the Ryle’s tube inserted to prevent aspiration;
ii. ensuring that the Patient appreciated the importance and need for the Ryle’s tube insertion and that it could possibly save her life;
iii. assuring the Patient that he could supervise the Ryle’s tube insertion if she wished to have him present during such insertion;
iv. neither did he tell that he could make the insertion himself and that he would do so gently and as  painlessly as he reasonably could"
If I had known of such danger, I would not have allowed the operation to go on. I would have  persuaded my wife to allow the doctors to insert the tube before the operation or before she was put to sleep. I would have insisted that the doctors not perform the operation until they have exhaustively attempted to insert the tube or employed other means to remove her stomach contents. Had I known of the grave risks involved and had the hospital been unsuccessful in removing her stomach contents before the operation, I would have sought second opinion, changed doctors or hospital or sought treatment elsewhere. The fact of the matter is that I was never informed."

The court decided that the doctor failed to explain in detail to patient's husband on risk of surgery and found in favour of the plaintiff.

I have read over this case many times and looks like it is in many facebook. I thought that I will also pen my thoughts.
With all due respect to our learned judges, I believe that they did not see the case at all from the medical doctors perspective or try to understand the doctors position or medical facts.
The fact that Abdul Razak's wife died is sad and regrettable.  Dr Raja Badrul I believe had every intention to help her live, having had the case transfer over to his care despite his very busy schedule in HKL ( I am sure. HKL is a mad house ). Whether  a properly inserted Ryle's tube would have saved the patient is a mood point. It is what we do, but even with that we sometimes also have aspiration. pneumonia.
If Dr Badrul had waited for the husband, Abdul Razak to come to OT to persuade the wife to allow the Ryle's tube insertion, in HKL, it would almost certainly mean that the case will be bumped till later, pending availability of OT time and every one-elses time. Delaying the emergency surgery may bring about  a new set of problems.
So, what do doctors do? Get a proper consent, and if there are any events in between defer and re-consent. In an elective case, that may be possible. 
Thank God that Raja Badrul is in HKL where money is not an issue. Otherwise he may be accused of trying to make more money.
 How about a true emergency where a live is at stake, as we often face with an emergency angioplasty in cardiogenic shock. In the good old days, I had to make many decisions to save lives. Many turn out well, and patients are grateful. Some did not, and patients died. For which I bear responsibility and have to live with my decisions. Thank God, my patients and relatives have been very understanding. I will always insist that a relatives be outside my angiogram sute as I do a procedure, so that all are kept informed at all time.
Sometimes we are caught in a no win situation.

I believe that the issue in Abdul Razak Vs Raja Badrul, is communication. As always.
We all learn our lessons. Sometimes the hard way.
I would certainly like to take our learned judges for a weekend seminar and try and share with them, the medical mind and what we are trying to do.


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hmatter said...

Thanks for the encouragement.

Sometimes run out of time.