Hospitals may be held financially liable for failures in patient care even where individual doctors are cleared of negligence, after the court set precedence with a new ruling.
The High Court ordered Pandya Memorial Hospital’s operator to pay Sh6.03 million to a woman whose arm was amputated following treatment as a three-and-a-half-year-old child.
The ruling by Justice Jairus Ngaah places the responsibility for the failure to monitor, communicate and escalate a deteriorating patient on the hospital, rather than individual doctors, where the evidence shows that hospital systems and staff failed to respond to a critical warning sign.
“Pandya Memorial Society Registered Trustees, which operates Pandya Memorial Hospital, is hereby ordered to bear 100 per cent of the liability in the case brought by Uchi Mwidhin Mwarua over the loss of her right forearm in 2008,” the high court noted.
The judgment, found that neither of the two doctors sued alongside the hospital had personally acted negligently.
Instead, the court found that the hospital failed to ensure that Mwarua received timely medical review after she developed severe pain around an intravenous cannula inserted in her right wrist.
“The case therefore shifts attention from the conduct of an individual doctor during a medical procedure to the wider responsibility of hospitals to ensure that patients are properly monitored and that warning signs are acted upon,” court said.
For hospitals, the ruling highlights the potential financial consequences of gaps in nursing care, internal communication, supervision and escalation of medical emergencies.
Mwarua’s ordeal began on August 7, 2008, when she was referred from the Kenya Ports Authority Clinic to Pandya Memorial Hospital with a painful and swollen left elbow.
She was admitted with a diagnosis of cellulitis and possible septic arthritis and prescribed treatment, including the antibiotic Dalacin C.
A resident medical officer, Dr Awadh Hemed, inserted an intravenous line into her right wrist.
Her mother, Fatuma Bakari Mwasadi, told the court that blood came out forcefully when the cannula was inserted and that the child experienced severe pain whenever medication was administered through the line.
She later noticed that the right hand had become cold and changed colour. Dr Hemed disputed that account, saying the blood was dark and oozed rather than spurting. He said the radial pulse was confirmed after insertion and that the cannula flushed normally without resistance.
The court ultimately found that the evidence did not establish that Dr Hemed had negligently inserted the cannula or that it had been placed in an artery.
Justice Ngaah noted that the records showed a relatively uneventful night on August 7 and day on August 8, with the first documented complaint concerning pain at the cannula site recorded at about 8pm on August 8 about 25 hours after the line had been inserted.
At that point, Nurse Khalima Fondo took over the night shift and was informed by Mwarua’s mother that the child was experiencing severe pain at the intravenous site.
“The nurse removed the cannula. The hospital’s cardex recorded that the Resident Medical Officer “was to attend and fix the branula.” But the doctor did not attend, and Mwarua’s arm was not examined by a doctor,” the court was told.
The court also found that Dr Karega, the consultant responsible for the child, was not informed that the cannula had been removed because of the severe pain.
Instead, Mwarua was “left to sleep.” This became the critical point in the court’s assessment of the hospital’s responsibility.
Although routine vital signs were recorded at 10pm and 2am, there was no evidence that the child’s limb was examined during the seven-hour period for changes in colour, warmth, blood circulation or movement.
At about 3.20am, Mwarua’s mother raised the alarm again, reporting that the child could no longer move her fingers and that her hand was cold.
Dr Karega was called and by about 4.30am found a swollen hand with poor blood flow, clawed fingers and cyanosis extending from the wrist. He treated the condition as a surgical emergency.
Justice Ngaah said the severe pain that had prompted removal of the cannula should itself have triggered immediate medical assessment.
“Pain at an infusion site of such severity as to require removal of the cannula in a small child … is a red flag calling for medical assessment of the limb, not for the child to be ‘left to sleep’ with the matter deferred to the morning,” the judge said.
The hospital subsequently sought specialist intervention as the child’s condition deteriorated.
Dr Karega contacted senior surgeon Dr Gathua, while the intravenous route was stopped and the antibiotic changed to oral medication.
A Doppler scan conducted on August 9 showed severely reduced blood flow in the distal right radial artery but did not establish the cause of the problem.
Doctors considered several possible causes, including arterial injury, compartment syndrome, thrombosis and leakage of medication into surrounding tissue. Dr Gathua suspected a reaction caused by drug leakage rather than direct injury to the artery.
The court cleared Dr Karega of negligence, finding that his diagnosis and treatment after he was called were consistent with responsible medical practice.
The judge noted that the nurses had removed the cannula and failed to alert him about the circumstances surrounding its removal. But the child’s condition continued to worsen.
By August 12, her fingers had started turning gangrenous. A second Doppler scan on August 14 showed that the blockage had extended into larger arteries.
Dr Karega pushed for an emergency transfer to Kenyatta National Hospital instead of waiting for the gangrene to fully demarcate. Mwarua was transferred on August 16.
At KNH, Dr James Kabora Mogire found that the right arm no longer had viable blood vessels. On August 21, 2008, her right forearm was amputated below the elbow.
The injury left Mwarua with permanent physical consequences. Her mother told the court that she had lost the use of her dominant arm and that her ambition of becoming a police officer had been affected.
Dr Mogire assessed her permanent incapacity at 50 per cent and outlined the physical, psychological and social consequences of the amputation.
The legal battle began in 2009 when Mwarua was still a minor and sued through her parents. The plaint was later amended in 2023 and again in 2025. By the time judgment was delivered, she had attained adulthood and was pursuing the case in her own name.
In determining liability, Justice Ngaah drew a clear distinction between the two doctors and the hospital.
Dr Hemed was cleared because negligence in inserting the cannula was not proved. Dr Karega was also cleared because he responded appropriately once he was informed of the deteriorating condition.
Pandya Memorial Hospital, however, was found responsible for the failures that occurred after the warning sign emerged.
The judge held that the hospital had a “non-delegable” duty to ensure reasonable care was provided to the child.
The hospital’s staff knew she was suffering severe pain, removed the cannula and recorded that a doctor was expected to attend. The hospital nevertheless failed to ensure that the medical review took place.
The court identified the seven-hour period without examination of the limb as critical.
At 8pm, Mwarua could still move her fingers. By 3.20am, she could not move them and the hand was cold. By 4.30am, she had critical ischaemia.
Justice Ngaah concluded that the failure to monitor, escalate and obtain medical review “caused the progression of the plaintiff’s condition from a salvageable, threatened limb to irreversible gangrene necessitating amputation.”
The court awarded Sh4.5 million for pain, suffering and loss of amenities, including loss of use of the right forearm, and Sh1.5 million for loss of earning capacity.
It further awarded Sh34,620 in special damages, bringing the total compensation to Sh6,034,620. The hospital was ordered to meet 100 per cent of the liability.
The court rejected claims for future medical expenses and future earnings because they had not been sufficiently pleaded and proved.
