VijayUncle.com - Desi Life the Good the Bad and the Ugly!
Past events >> Dr. Ramnath - Medical Error or Criminal Act? >> Dr. Priya Ramnath http://vmehta.conforums3.com/index.cgi?board=Ramnath&action=display&num=1199373151 Dr. Priya Ramnath
Post by Vijay Mehta on Jan 3rd, 2008, 08:12am
Here is the unfortunate story as I have been able to piece it to gather from the news reports.
Priya Ramnath - Healer accused to be a killer!
Priya Ramnath 39 year old Anesthesiologist, mother of two children (ages 5 & 12) was arrested at Woodland Heights Medical Center, Lufkin in the morning of Nov 30, 2007. Apparently the patient who was to undergo surgery was already sedated and US Marshalls arrested her.
Back in July 1998 Dr. Ramnath was a junior resident in England and a patient 51 year old Patricia Leighton had undergone surgery for infected bunion and went in a septic shock and was transferred to Intensive Care Unit. It is alleged that Dr. Ramnath injected 3 cc of Adrenaline to resuscitate the patient which resulted in her death.
Dr. Ramnath moved to USA in 1999 to join her husband Seshadrinathan Ramnath who was already a US Citizen. Since she has received training at University of South Florida and worked in Tampa and McAllen and now in Lufkin, TX.
4/26/2007 Extradition treaty between US and England became effective - this was signed earlier in 2003.
9/18/2007 extradition was requested.
11/30/2007 she was arrested and has been denied bail twice citing flight risk.
I do not know anyone involved in the case but it caught my attention because I am familiar with many mistakes that physicians have made and some of them resulted in death of the patient also. If we were to make all these cases involuntary manslaughter the only thing a physician in such a situation will be forced to do is to cover up.
Notice how British headlines are already calling her Dr. Death.
Criminalization of medical errors is a dangerous path. Here is Dr. Ramnath in 1998, as a junior resident, is alleged to have given a higher dose of a life saving drug (adrenaline) to the patient in crisis. Of course she could have consulted senior physicians but that is not what goes thru your mind as you see a patient collapsing in front of you. As we say in medical practice, hind sight is 20/20.
I am curious as to how she was able to get such a large dose (six times the suggested amount) anyways? All dangerous medication should only be available in the safe level of dose. And when a physician asks for much higher dose then the nurse should be able to deny that also in any good ICU.
While in training the medical errors are also responsibility of teaching physician also. That is why they are in training.
Alleged is a key word here. How do we know that she in fact gave the higher dose? Medical practice is a difficult job and physicians make critical choices for the patient all the time. With all the thoughtful and considered actions there are few who prove to be wrong and injurious to the patient.
If we make all these errors as involuntary manslaughter we can fill our already overpopulated jails with physicians.
Dr. Ramnath has not even had a chance to present her side of the story and she is being treated as hard core criminal. Here is a professional with two children who is willing to put up a bail, give up her passport and abide by the condition of house arrest and judge denies her the bail?
I think there may be a valid medial negligence case but England is making criminal charges which are excessive. Also by making it a criminal issue they are bypassing statute of limitation. I think she is entitled to defend herself against the extradition but not allowing her the bail might intimidate her into submission.
Why did the US Marshall have to take her away in the morning after the patient was sedated? Why she was not arrested at the end of the day? Did they even consider possible psychological pain caused to the patient who was already sedated for planned surgery?
I urge the judge to realize that medical errors may be infrequent but in spite of our best effort they do happen. And when they do, imprisoning a physician for extended period of time will not serve anyone but the institution needs to look it as a sentinel event and figure out a way to prevent in future.
Please let Dr Ramnath give her side of the story without intimidating her by keeping her in jail at the taxpayer’s expense. She is no criminal for God's sake she is mother of 2 and a lady who has dedicated her life to helping others.
By criminalizing the mistakes more of them are likely to go underground and the patients may never benefit in future from the lessons learned. Medical Official Support Dr. Ramnath
Post by Vijay Mehta on Jan 3rd, 2008, 08:24am
Medical officials offer support for anesthesiologist
By ANDY ADAMS The Lufkin Daily News
Monday, December 17, 2007
Two Lufkin medical officials indicated Friday that they would welcome a Lufkin anesthesiologist back to work if she is not extradited to England to face charges related to the death of a patient nine years ago.
Priya Ramnath was jailed Nov. 30 and remains in custody. Her attorney has asked a federal judge to set her bail at a hearing expected to take place Tuesday in federal court in Lufkin.
Dr. J.S. Chandra, a heart physician who has worked in Lufkin for 23 years, called Ramnath "one of the best trained anesthesiologists we've ever had in Lufkin." He said she was trained at the Cleveland Clinic, which he called "probably the No. 1 or No. 2 hospital" in the United States. Ramnath has done quite a bit of cardiac work in the six months he has worked with her, Chandra said.
"She has assisted a lot of heart patients, and the outcomes have been excellent," he said. "I have no problems with her professional abilities at all. She has a lot of confidence in a specialized field. She is a very competent physician."
Lance Jones, CEO of Woodland Heights Medical Center, said that, if Ramnath is released on bail, his hospital will reconsider her privileges at his hospital, which were suspended when she was arrested. He said she still has an active Texas license and that the state's Board of Medical Examiners is one of the strictest licensing authorities in the country.
"Depending on the outcome of Tuesday's case, her status will be immediately reviewed at the hospital," Jones said.
Ramnath is accused of killing patient Patricia Leighton, 51, of Burntwood, England, on July 22, 1998, after allegedly administering a lethal dose of adrenaline.
In 2003, the British government filed an involuntary manslaughter charge against Ramnath — five years after Leighton's death.
Ramnath's attorney, Al Charanza of Lufkin, has said his client did not know about the charge until she was arrested.
Staff writer Jessica Savage contributed to this story. Why should Dr. Priya Ramnath be released on bail
Post by Vijay Mehta on Jan 3rd, 2008, 08:44am
Attorney cites special factors in requesting bail for doctor Legal counsel says he plans to fight extradition of client
By JESSICA SAVAGE The Lufkin Daily News
Sunday, December 16, 2007
The attorney of a Lufkin doctor being held in custody for the death of a patient in England nine years ago has re-filed a motion asking a federal judge to set bail at a hearing expected Tuesday.
In an amended motion filed Friday, Lufkin attorney Al Charanza stated Dr. Priya Ramnath, an anesthesiologist jailed Nov. 30, should be given bail because the British government's alleged delay of its investigation and Ramnath's extradition in 2003. Charanza has said he will fight the extradition process.
Ramnath is accused of killing patient Patricia Leighton, 51, of Burntwood, England July 22, 1998, after allegedly administering a lethal dose of adrenaline.
In 2003, the British government filed an involuntary manslaughter charge against Ramanth — five years after Leighton's death. By that time, Ramnath had been living in the United States for about four years where she completed her residency and was practicing medicine at a Florida hospital. In 2004, the British government issued a statement, apologizing to Leighton's family after it missed an important deadline, virtually eliminating chances of extraditing her to England.
An extradition treaty signed in 2003 by the United States and United Kingdom did not take effect until April 26, 2007, Charanza stated in his amended motion. The British Embassy in Washington, D.C. did not request the extradition of Ramnath until Sept. 18.
The U.S. Marshals Service arrested Ramnath Nov. 30 at Woodland Heights Medical Center in Lufkin where she had been practicing for six months.
At a status hearing Dec. 4 in Lufkin, U.S. Magistrate Judge Earl S. Hines said Ramnath will likely remain in custody until an extradition hearing.
"This is the type of procedure that almost certainly will result in Dr. Ramnath remaining in custody until she is extradited" Hines said. "And there's not a person in this room that is happy about that."
Hines said for him to consider Ramnath's bail at a detention hearing Tuesday, Charanza would have to prove a "special circumstance" for her release.
Charanza stated in an amended detention motion filed Friday that Ramanth is likely to "succeed" at an upcoming extradition hearing "since the United Kingdom has failed to establish probable cause with reliable evidence." He is asking a federal judge to set bail under those special circumstances. A detention hearing is expected to be held 9 a.m. Tuesday in Lufkin.
A complaint filed by the U.S. Attorney's Office Nov. 29, and made public Dec. 6, stated Ramnath left England days after Leighton's death. Charanza said Ramnath did not flee the country, but decided to move to the United States then to be with her husband, who is a U.S. citizen.
Leighton had undergone surgery the day before she died for an infected bunion, stated the complaint. The next morning Leighton's health declined. She was diagnosed with septic shock and then transferred to the intensive care unit at Stafford General Hospital where she was placed under the care of a team of doctors, including Ramnath, the report stated. There Ramnath allegedly gave Leighton a three-milliliter dose of adrenaline after other doctors had advised against it, the report stated.
"Mrs. Leighton reacted immediately by becoming agitated, sitting upright and shouting. She fell back onto the bed and became unresponsive and stopped breathing with cardiac arrest ensuing. Attempts to resuscitate her were unsuccessful," the report stated.
The director of the hospital's ICU spoke with Ramnath about the incident. Ramnath told the director "in hindsight she had been wrong to proceed in the manner which she had" and that she should have called the consultant anesthesiologist for the hospital, the report stated.
The hospital completed its investigation in 2001 and turned it over to authorities. The British government filed a charge in 2003.
Charanza said Ramnath knew nothing about the charge until she was arrested.
In an interview with the Tampa Tribune in 2004, Ramnath told a reporter who asked her to comment on the charge that she knew nothing about an investigation into Leighton's death.
"I don't know anything about this," she told the Tribune in an article published Sept. 2, 2004. "This is the first time I'm hearing about this."
Ramnath has two children, ages 12 and 5. She completed her residency at the University of South Florida and has worked in hospitals in Tampa and McAllen, Texas, prior to moving to Lufkin. Her Texas medical license was approved in 2004. Woodland Heights Medical Center and Memorial Health System of East Texas have both suspended her privileges, pending the outcome of the case.
Dr. Ramnath Released on Bail
Post by Vijay Mehta on Jan 12th, 2008, 1:41pm
Lufkin Doctor Out On Bail
by Tashun Chism
Lufkin doctor Priya Ramnath was arrested in late November on an involuntary manslaughter charge related to the death of a patient in the United Kingdom. After several weeks of hearings where Ramnath and her lawyer asked a judge to allow her to post bail, the judge ruled in her favor Friday. There were plenty of happy family members and friends there to celebrate.
"I felt that we had done a very good job documenting the clear and convincing evidence that she is not a flight risk, that this case has problems in the United Kingdom and those problems in the United Kingdom are a special circumstance of why she should be released," Ramnath's attorney, Al Charanza, said.
The judge agreed, even though bail is very rarely granted in most extradition cases. Ramanth's good work record in the U.S., and her strong family and community ties also influenced his decision. Ramnath's attorney says there's one thing in particular that made the judge rule in her favor.
"The judge granted bail in this case because he found a special circumstance and he believes based on the evidence we've been able to present him so far, she has a very likely chance of succeeding in the United Kingdom," Charanza said.
But Ramnath's release doesn't come without special conditions.
"She will be under house arrest so she won't be able to leave her home, and we've already surrendered the passports for herself and her immediate family," Charanza told KTRE.
Ramnath's extradition hearing is set for February 15th at the federal courthouse in Lufkin. We thank the judge for using commonsense and letting Dr. Ramnath be with her family pending extradition hearing. We wish Dr Ramnath well in her fight against extradition. - Vijay Mehta Re: Dr. Priya Ramnath
Post by Vijay Mehta on Jan 27th, 2008, 2:12pm
American judge backs British doctor fighting extradition over death of patient 9 years ago Last updated at 20:52pm on 27.01.08
A doctor faces extradition from America to Britain, accused of killing a female patient being treated for an infected bunion nine years ago.
But a judge in Texas has taken the unusual step of granting bail to anaesthetist Dr Priya Ramnath, 39, saying a British jury was bound to clear her.
Indian-born Dr Ramnath is alleged to have injected Mrs Patricia Leighton with adrenaline, against the advice of more senior medical staff, when she went into septic shock at Staffordshire General Hospital, Stafford, in July 1998.
Mrs Leighton, of Burntwood, suffered a heart attack and died. Dr Ramnath moved to America just days later and has worked there as an anaesthetist ever since.
In 2003, an extradition case failed because the Crown Prosecution Service just missed a five-year deadline. Now, new laws make extradition possible again – and mother-of-two Dr Ramnath has been charged with involuntary manslaughter.
But on January 11, Judge Earl S. Hines granted her bail in Lufkin, Texas, where she was arrested in December at the hospital where she works. The extradition hearing is set for February 15.
In the bail document, Judge Hines said: "All the evidence points to the conclusion that Dr Ramnath's actions were taken with the intention of saving a life, not taking one. A jury might or might not conclude that Dr Ramnath made a very serious mistake based on a very serious error in judgment.
"However, such evidence is nowhere near enough for a crime as serious as the United Kingdom's version of involuntary manslaughter to be committed."
He authorised bail under house arrest because Dr Ramnath was not a "flight risk" and a jury would not find her guilty. He said there was no reason to keep her "confined with the customary contingent of crackheads, crazies and miscreants", adding:
Dr Priya Ramnath was arrested at an American hospital
"Every rational concern augurs for her release. Her husband and children need their wife and mother. Critically ill patients could benefit were she available."
In 2004, a coroner ruled that Mrs Leighton, 51, had been unlawfully killed. Now the Texas judge's comments have angered Mrs Leighton's family, who have vowed to keep fighting for justice.
Her daughter Debbie, 38, who lives at the family home with her father Brian and sister Nikki, said: 'The death was very difficult for us in 1998 and it's still difficult now. The anaesthetist was lucky she can go back to her family because my mum can't.
"Our mum has missed so much in all our lives. Dad has since retired, something they dreamed of doing together and they had planned how their days would be. We'll fight this case for ever."
Dr Ramnath's lawyer Ben Rose said: 'She treated an apparently dying patient at 3am.
"She did everything she could to save the patient's life. Ten years later, the CPS accuses her of manslaughter.
As a result, she spent Christmas and New Year in custody.
"Having carefully reviewed the evidence, a senior US federal judge has expressed grave concerns regarding the case and granted bail. In spite of all of this, the CPS refuses to justify their inexplicable decision to continue with this case."
A CPS spokeswoman said: "We would not seek extradition if we didn't feel we had sufficient evidence."
Thank God for some common sense. Dr. Ramnath was faced with a critical patient and she did what she thought was the best in patient's interest. I am not sure what they are trying to achieve by charging her for manslaughter except for intimidation. I agree with the judge no impartial jury or judge will convict her. Good luck to Dr Ramnath.
- Vijay Mehta Case is not what they have made out to be
Post by Nicky F on Feb 2nd, 2008, 3:33pm
I know a lot about this case and I find it very annoying that people are being mis-led by the press and commenting on a case study they know nothing about. The said adreneline was given by Doctor Ramnath against the advice of all other colleagues, it was NOT given to rescusitate at all, it was given in the wrong circumstances and top pofessionals, doctors and nurses have stated this. There was no operation, the problems were due to low blood pressure readings. Doctor Ramnath left Britain following a meeting with hospital officials a couple of days afterwards, after stating that she was wrong to do what she did. Her husband was not a US citizen at this time, he only became one in 2005 and she is still not one. The hospital led its own investigations and called in Police in 2001. As the case is a first of its kind, the Police had to investigate fully prior to speaking with Doctor Ramnath. In 2004 the charge was brought following the inquest verdict of unlawful killing. However following extradition rules the Police were unable to bring her back to Britain. Doctor Ramnath has known about this case all along, not just in 2004 upon speaking to American newspapers and definitey not in 2007 upon her arrest. When people are wishing Doctor Ramnath well, lets remember that a 51 year old woman died, leaving behind a husband and 2 children...People are commenting on press speculation not facts, i.e., if the Judge believes she is so innocent, why was she kept in Custody over Christmas and New Year, eventually given bail of $300,000, put under house arrest and family's passports surrendered?
Thank you for sharing with us.
My biggest concern is that I believe the whole exercise is meant to intimidate Dr Ramnath rather than seek justice. Medical practice requires critical choices. Many a times people do not agree on what is the right choice. Now if we start accusing physicians and nurses of involuntary manslaughter every time there is an adverse outcome, it would have terrible effect on the morale of hardworking well meaning physicians and nurses.
All errors like that should be considered as professional negligence to be evaluated by professional standard board. There is a huge difference between professional negligence and involuntary manslaughter.
You are right a 51 year old woman is dead. But that does not mean Dr Ramnath killed her. Whatever condition caused her blood pressure to drop could have lead to her death. When a physician admits that he or she should have not done certain things does not mean they are guilty of manslaughter.
How do they plan to prove anything after these many years is beyond me. They can succeed in ruining Dr Ramnath financially.
Remember, it is one thing to accuse someone of involuntary manslaughter and totally different thing to prove it beyond reasonable doubts in a court of law.
I hope British authority reconsider it again.
If you have specific information please feel free to post it here.
I agree with you Dr. Ramnath had known about the case every single moment of the day since it happened back in 1998.
- Vijay Mehta Dr. Priya Ramnath
Post by Nicky F on Feb 4th, 2008, 3:23pm
Hi, I do not understand what you mean by "intimidation rather than justice"...and I don't believe that the UK Police Force or Crown Prosecution Service would be still attempting to seek extradition after all this time if they did not feel that the case was strong enough...I hope justice prevails...
1. If every time a patient dies in UK if they charge the physician for involuntary manslaughter there would be lot more physicians serving the life sentences. 2. Why did they took so much time after the incidence to charge her? 3. UK Police may be charging her for political reasons to make it look like they are doing something. They have already bungled the case by filing late. 4. Charges in criminal case have to be proven beyond doubg to all the jurors not just a majority. This makes it very hard after all these years to prove anything.
I hope justice prevails too. - Vijay Mehta
Dr. Priya Ramnath waives extradition fight
Post by Vijay Mehta on Feb 16th, 2008, 7:55pm
Today Priya Ramnath did something she'd never done before. She walked out of the federal court in Lufkin without having to wear shackles or an orange jump suit.
"I'm pleased to have Judge Hines allow her to stay out one more week," said Ramnath's US attorney, Al Charanza.
One more week before United Kingdom authorities come to Lufkin to extradite Ramnath. She and her attorney had originally planned to fight extradition. But to the court's surprise, Ramnath decided to waive today's extradition hearing.
"She's hoping by agreeing to go back and working with the United Kingdom's judicial system that the family will have closure and she can get this closure for her as well so she can return to her family here in the United States," Chazanza told us.
An extradition treaty has been made between the the US, the UK and Ramnath and her attorneys. For voluntarily turning herself in, Ramnath expects bail to be set at her next hearing in the UK. Charanza tells us Ramnath's bail here in the US gave her much needed to time to be with friends and family, not to mention plan her next steps.
"It's given her an opportunity to work with me and her attorneys in the United Kingdom to address this case and decide what the best course of action is. And we believe our best course of action is going back to the United Kingdom and adressing it there in the courts of the united kingdom," said Charanza.
Ramnath is scheduled to turn herself in for extradition Friday, February 15, 2008. If UK authorities decide to come before the set extradition date, Ramnath must turn herself in one hour prior to their arrival. Smiling up beat Dr. Ramnath arrives
Post by Vijay Mehta on May 16th, 2008, 4:41pm
Ramnath, aged 39, is facing a charge of manslaughter following the death of 51-year-old Patricia Leighton, of Dewsbury Drive, Burntwood in 1998.
Mrs Leighton was at Stafford Hospital to undergo a routine procedure to have an infected bunion removed. It is alleged Ramnath injected Mrs Leighton with a lethal dose of adrenalin ï¿½ against the advice of more senior medical staff at the hospital.
Mrs Leighton suffered a heart attack and died.
Ramnath appeared at Wolverhampton Crown Court yesterday, where the case was adjourned until later in the year. She was not invited to enter a plea.
The hearing, in front of Mr Justice Goldring, lasted around an hour while administrative and legal matters were dealt with.
The 39-year-old doctor, a mother- of-two, was further remanded on conditional bail by The Honourable Mr Justice Goldring. The next hearing is scheduled for a date in October.
October Hearing - when exactly?
Post by Srini Rao on Oct 10th, 2008, 7:13pm
Hi is there any update on Dr Priya Ramnath in UK courts? Her case was supposed to be in October. Thanks
No news yet on her hearing. This may mean her hearing may be in later part of October or later. We are monitoring the situation and will post any new news. - Vijay Mehta
Re: Dr. Priya Ramnath
Post by satish d on Oct 17th, 2008, 12:53pm
i appreciate what Dr. Mehta is doing. Dr.ramnath 's intention was to save pt's life, there can not be any dobt about it. It is unfortunate that a person died , but if pt was in septic shock nobody can prove beyond doubt that she died of adrenaline and not because of septic shock. I feel sorry for pt's family but i do believe she was misguided by hospital officials. The way dr. ramnath was treated initially when arrested it was embarrasing for all practicing physicians in usa or any where in world. It is not fair. she should not have been treated like any criminal. where is american medical aasosiation or texas medical assosiation? we pray for her and we believe justice will prevail and she will be free soon. and will join her family who has been suffering since it all started. No jury or judge in his or her right mind can possibly convict her. thank you.
Tiral for Dr Priya Ramnath begins
Post by Vijay Mehta on Jan 14th, 2009, 11:14am
Trial begins for Dr. Priya Ramnath. It is turning into "he said - she said" trial.
Prosecutors are going to say that Dr. Ramnath injected the adrenaline prior to cardiac arrest therefore not indicated while the defense will content that pt had a cardiac arrest, therefore the adrenaline was indicated.
Prosecutors are claiming that Dr. Ramnath ignored the advise of her colleagues and did not seek the guidance of the consultant. However in case of emergency if a physician feels that patient needs life saving drug in moments are they expected to have a conference all to decide the merits of treatment?
This case may have a far reaching impact on physicians caught in emergency situation. You are darned if you do and darned if you don't.
I hope the judge and the jury will use their common sense and throw away this case. It is time support the physicians who have to confront the difficult choices day in and day out.
Our prayers are with Dr. Ramnath and the family.
- Vijay Meha Priya Ramnath trial 1/5/2009
Post by Vijay Mehta on Jan 15th, 2009, 09:48am
Burntwood woman died after doctor ignored hospital staff warnings, court told
Jan 15 2009 by Ross McCarthy, Birmingham Post
A doctor treating a woman for rheumatoid arthritis had no reason to believe she might suddenly die when she was sent to a Staffordshire hospital.
Dr Thomas Shearan said when he learnt of Patricia Leighton’s death he realised something “catastrophic” had happened.
It is alleged the 51-year-old’s death was caused after a doctor gave her a large injection of adrenaline after having ignored the warnings of other doctors and medical staff.
Dr Priya Ramnath, aged 40, has denied the manslaughter by gross negligence of Mrs Leighton from Burntwood, Staffordshire.
Dr Shearan told Birmingham Crown Court that there were problems treating Mrs Leighton’s condition and that in April 1998 she was enrolled in a controlled drug trial.
He said as a result she said she felt better but on July 20 she reported to be in a lot of pain and suffering from a wound on a bunion.
There was concern about her low blood count, he said, and it was arranged for her to be taken to the hospital the following morning to have the bunion cleaned out.
Asked about her condition, Dr Shearan said: “She was in quite a lot of pain, despite being on opiates. Otherwise she was not bad.”
Mr Michael Burrows QC, prosecuting, asked the doctor: “Did you have any cause to suppose she was so seriously ill she might die?”
The doctor said he did not and that Mrs Leighton was conscious, knew where she was and what her condition was.
Dr Shearan said when he learnt about her death two days later his immediate concern was the ten other patients who were on the drug trial.
Mr Burrows said after Mrs Leighton was taken to Stafford District General Hospital, Dr Ramnath administered the adrenaline despite the fact that two doctors present told her not to do it and without referring to the consultant in charge.
He said the doctor later resigned from her post at the hospital before moving to the United States.
The case continues.
Mrs Leighton was suffering from Rheumatoid arthritis she was not responding to usual medication so she was enrolled in an experimental drug trial. On July 20, 1998 she reported to be in a lot of pain from a wound on a bunion. There was a concern about low blood count (?wbc). She was in septic shock she had reaction to antibiotics given to her. Could the experimental drug be responsible for her death? Could she have died of septic shock that failed to respond to the treatment?
How are they going to prove beyond a reasonable doubt that it was adrenaline that killed the patient? Colleagues of Dr. Ramnath recommended her to ask the attending but it is a judgment call of a physician in case of emergency. At the most Dr. Ramnath may be faulted for making a wrong judgment call but no a manslaughter. - Vijay Mehta Re: Dr. Priya Ramnath
Post by solicitor on Jan 20th, 2009, 3:55pm
my mother gave evidence against Dr Ramnath on Monday (18th January 2009).
whilst it was exceptionally stressfull for all concerned, it was clear that her evidence, like the other doctors who were witnesses and have been called to give evidence, was that Dr Ramnath gave the injection against their judgment. the patient was not in crisis as she had blood pressure - she was alert, sitting upright and talking.
the evidence of 4/5 doctors is suggestive that dr ramnath disregarded, "arrogantly", their advice. this was despite one of the doctors physically putting his hand over dr ramnath's and telling her not to give the injection.
dr ramnath's evidence conflicts with 4/5 independant witnesses who put the patient's death at her door.
it is unclear at the moment whether she herself will give evidence, or what forensic evidence will state.
what is clear is that, come conviction or aqcuittal, there are no winners in this case. nothing can bring mrs leighton back. and if dr ramnath escapes conviction, the family's 10 year quest for justice is in vain.
now the outcome is in the hands of the jury....
Re: Dr. Priya Ramnath
Post by solicitor on Jan 20th, 2009, 4:05pm
also, it is clear that within seconds of the injection being given, mrs leighton suffered a reaction to the adrenalin and collapsed. coincidence? maybe. but inferences can be drawn from the timings of the injection to the reaction. and of her conduct in the immediate moments once the patien had collapsed.
furthermore, inferences can be drawn of dr ramnath's resignation and departure within days of mrs leighton's death.
personally, my feellings as a legal practitioner are that she did act negligently and that as a result the patient died. i even feel that it was so negligent that it could be classed as gross negligence, and that therefore it is possible that the Judge will direct the jury to convict her.
however, i understand the notion that, politically, there may be reservations about doing so, thereby potentially criminalising drs actions.
but the point to distinguish is that, in an emergency situation, people make calls and can make mistakes. but was this a mistake, or was it something more than that? a mistake so terrible and negligent that criminal sanctions are necessary?
i think both medical and legal practitioners everywhere are watching this case with interest.
To the solicitor
Post by Vijay Mehta on Jan 20th, 2009, 6:03pm
Well there are problems with the scenario those witness are trying to create. Suppose the patient was sitting up and had blood pressure and Dr. Ramnath asks for adrenaline the nurse did not have to give it to Dr. Ramnath. She could have simply called the attending. Also why would Dr. Ramnath give adrenaline to the patient who is sitting up and talking - did she want to hurt the patient?
It is also possible that someone very powerful wanted to cover up his/her mistake and found Dr. Ramnath to be an easy scapegoat.
Do not discount several white people testifying against one brown doctor. Racism can also play a part.
Her leaving the country was a logical thing to do. A doctor feels horrible when a patient dies specially immediately after administering the medicine. Once patient died they needed someone to pin the blame on and the witness easily change their story.
If the patient dies due to error in judgment, that calls for professional discipline and not a jail term.
If you were to place all the physicians in the jail who prescribe or administer some medication and patient either suffers grave consequences or dies, you will have to build many jails. As they say 20/20 hindsight. Once such event occurs in majority of events we the medical profession are able to come up with, what could have been done to prevent such occurrences.
To me the whole story just does not make sense. And it will come down to who the jury believes. But in criminal case the bar of proving guilt is much higher on the prosecution. Let us see what happens.
Re: Dr. Priya Ramnath
Post by solicitor on Jan 21st, 2009, 12:04pm
whilst i agree that the matter is now in the hands of the jury, i believe that your comments are unhelpful and misguided.
you talking of racism and dr ramnath being a scapegoat, which is absurd. her actions are the cause of her being on trial, no one elses. and racism is not a part of this case, as a black doctor nd a chinese doctor gave evidence on behalf of the crown. there is no evidence of these issues being evident and have certainly not been raised in court.
you also discuss possibilities - what if, if she did this, etc... when these are not the case. the evidence is clear - she gave an injection of indrenalin against her colleagues advice. this is what she will be tried for, and nothing else.
i understand why, as a practitioner of medicine, you would feel strongly about this case. but you have to set aside all feelings and emotions when considering this - did her actions amount, in UK law, to gross negligent manslaughter (which is a different standard to UK manslaughter, and completely different to the US's crime of involuntary manslaughter)? a coroner concluded that mrs leighton was unlawfully killed. that indicates the seriousness of dr ramnath's actions. now she is being tested by the UK legal system to see whether she should be accountable for her actions.
thanks for listening.
783,936 deaths may be iartogenic in US per year!
Post by Vijay Mehta on Jan 21st, 2009, 8:35pm
You can check out the detailed article but here are some noteworthy quotes. "As shown in the following table, the estimated total number of iatrogenic deaths–that is, deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures– in the US annually is 783,936. It is evident that the American medical system is itself the leading cause of death and injury in the US . By comparison, approximately 699,697 Americans died of heart in 2001, while 553,251 died of cancer. "
If we charge one out of a thousands physicians for homicide that would be 783 physicians per year! Criminalizing medical errors could have profound effect on honest reporting and solving the errors. It is estimated that vast majority of errors are not reported due to fear of adverse action or malpractice litigation.
You have not paid attention to the other important fact, which is this. The hospital could have charged her with a civil offense but for that the statute of limitation had expired. So they had to elevate it to a criminal charge. 4/26/2007 Extradition treaty between US and England became effective - this was signed earlier in 2003. 9/18/2007 Extradition was requested by England. 11/30/2007 She was arrested.
Re: Dr. Priya Ramnath
Post by solicitor on Jan 22nd, 2009, 01:41am
you are incorrect.
under uk, the family alone can bring a civil case against her, not the hospital. the family potentially may still be able to bring a case, outside of limitation, but it will be at a court's discretion whether to allow it.
also, the hospital nor the General Medical Council could not bring disciplinary procedures against her because she resigned following the patient's death and fled to America.
the cps sought to extradite dr ramnath but were prevented due to an administrative error which meant that the extradition timelimit had elapsed. once the extradition treaty legislation was amended, the cps submitted the extradtion papers and dr ramnath was arrested and processed.
with respect, you do not understand how uk law operates, and seek to muddy the waters by using arguments that are not based either on uk law or the relevant facts of the case. whilst you are entitled to your opinion which I respect, you should only seek to comment on elements of the case which have been raised in court, and keep theories such as racism and scapegoat-ism out of any discussion.
sorry for the rant - i need coffee!
Re: Dr. Priya Ramnath
Post by satishd on Jan 23rd, 2009, 05:15am
I am confident Dr. Ramnath would not have given adrenaline if patient were talking and sitting in chair. Why would she? our solicitor friend has no idea about what runs through physician's mind when there is an emergency. you don't have luxury to call consultant. and yes, you may disagree with your colleagues. that is not a crime. She acted in good faith, she truely believed adrenaline had to be given under circumstances. It was unforunate that outcome was fatal. I am sure dr. Ramnath was sorry for patient's loss. we all feel for patient's family., but fact is Mrs Leighton was suffering from septic shock, and Dr. Ramnath gave adrenaline in patient's best interest. One thing I don't understand is that if patient was alraedy sitting in chair and talking, why they are saying that after she received injection sat bolt upright in her bed and shouted. I hope jury will use common sense-physician did act in good faith, her intention was to save life, never to take one, if we all could look in future, we would never do thousands of things we did. i feel sorry for solicitor, he will never be able to think from physicians perspective, no matter what. let us just pray for Mrs Leighton's soul. but also dr. ramnath has suffered enough for past year. may be that is her punishment. but she should be acquitted at this point and her two young children finally should meet their mom.
Dr. Priya Ramnath
Post by solictor on Jan 23rd, 2009, 06:49am
the evidence of 4 individuals is that she gave the patient adrenaline when she was sitting and talking in bed. those are the facts of the case. the jury must consider whether they agree with those testimonys.
your personal confidence that dr ramnath would not have administered adrenaline is based upon a premise that you or a reasonable doctor would not have done so.
the crown's case is that ramnath's actions were in conflict with other colleagues, and those actions had consequences so dire that criminal charges were brought.
i agree that i have no comparable knowledge about what a physician may consider at any given moment. but, from an evidential perspective, 4 other doctors and nurses who were there deemed it unnescessary to give adrenalin, and tried to prevent dr ramnath from administer it. she may have acted in "good faith" but her more senior colleagues attempted to warn her off from acting.
with regards to the sitting query you raise, the patient was lying on a bed in a raised position ie: not flat and not sitting upright at 90 degrees. she then surged forwards. hope that clears that up. I was in court when evidence was given.
with respect, your sympathy for me being unable to "think from physicians perspective, no matter what" is not not necessary. you are unable to objectively look at the evidence and weigh that up, which is what must be done in any legal proceedings, whether in the US or UK.
personally, i dont believe she intended to kill mrs leighton. dr ramnath is not a murderer. but it is clear that her actions went against the opinions of everyone else in that room. it is also clear from the witness evidence in court that dr ramnath was a very arrogant doctor who did not take well to being told what to do.
from a legal perspective, i honestly dont know which way it will turn. i agree that common sense could prevail and dr ramnath could be acquitted. but ultimately there IS a triable case and dr ramnath needs to be tested by the courts.
mrs leighton and her family deserve that.
Solicitor thank you very much for providing the information. We are unable to find detailed information about the testimonies etc. Is there anyway for us to get it? The testimonies are supposed to be a public knowledge, do they post it on the web? Please keep us posted with details of proceedings. Thank you. -Vijay Mehta
Let us look from other point of view
Post by Vijay Mehta on Jan 23rd, 2009, 08:22am
Let us look the incidence from Dr. Ramnath's point of view:
You are a registrar in charge of the patient with Septic shock and you feel that patient is sinking, her blood pressure is falling and in your best judgment adrenaline injection can save her life. You have two colleagues and a nurse who tells you that adrenaline is not indicated. You being a Crown's loyal physician do not give her adrenaline. The patient proceeds to die. Now can you live with your self for rest of the life saying that I felt that patient could be saved but my colleagues and one smart nurse told me not to do it. The patient died what else can I do? Can you stand in front of jury and tell them, "ladies and gentlemen, I felt that patient needed but I had to go by the advise of two colleagues and one smart nurse, so I did not give her the adrenaline. Too bad patient died. I am not culpable!! I am sure solicitor & company would be happily defend her as long as she listened to her colleagues.
If the judge and Jury do decide to convict her may be they need to guide us as to how to manage patient in times of crisis. Do we call the meeting to order and get a vote?
It is darned if you do and darned if you don't situation. Let us hope the Judge and Jury has common sense to figure this out. She is a physician and she has dedicated her life to serve the humanity. She had no ill intentions. She did what at that point in time she felt was in the best interest of her patient. I urge British Medical Association and physicians to speak up. May be to day it is Dr. Ramnath's turn, to morrow it could be yours.
Civil vs criminal neglience
Post by solicitor on Jan 23rd, 2009, 10:38am
I understand the "d**n ed if you do/don't" view. Under the UK civil standard of medical negligence, the Bolam test would apply - would three reasonable doctors have done the same actions. It is an objective test. It is not a subjective one - ie: "I was acting in the best interests of the patient." If the three reasonable doctors disagree with those actions, the doctor is liable.
True, they weren't all doctors there at the scene, but the prinicple applies, and that is what is being tested effectively, albeit in a criminal context where the burden of proof is higher.
I will do my best to report as much as I can from the court for you
Thanks. Well in that case, based on the outcome, no one is going to argue that reasonable doctors would not have given the adrenaline. However, what legal test in UK law makes it criminal offense, rather than medical negligence? -Vijay Mehta
Expert testifies that patient died of septic shock
Post by Vijay Mehta on Jan 27th, 2009, 7:36pm
Doctor on trial over death of patient opts out of giving evidence
Jan 28 2009 Birmingham Post
A hospital registrar accused of killing a patient by injecting her with adrenaline opted not to give evidence at her trial.
A jury at Birmingham Crown Court was told by counsel acting for Dr Priya Ramnath, who is accused of killing Patricia Leighton in 1998, that she would not be called as a witness.
Ramnath, 40, is alleged to have gone against the advice of three colleagues at Stafford District General Hospital before injecting adrenaline into Mrs Leighton.
The defendant, who returned from the United States to the UK to face trial last year, denies the manslaughter of Mrs Leighton by gross negligence.
Jonathan Caplan QC, began Ramnath’s defence case by informing the trial judge that his client would not be called as a witness.
The lawyer then called Dr John Coakley, an expert in intensive care medicine who works at London’s Homerton Hospital, to give evidence.
Dr Coakley told the court that he believed Mrs Leighton died as a result of septic shock rather than the injection of adrenaline. He told the jury Mrs Leighton’s condition was critical when she was admitted to Stafford District General in July 1998 and that she had about a 50 per cent chance of survival.
Dr Coakley said: “I don’t envy any of the doctors that were present - this was a critically ill patient. If you believe that the situation is becoming out of control then you have to do something.”
Mr Caplan asked the witness what he believed the cause of Mrs Leighton’s death to be.
Dr Coakley, who said he himself had used adrenaline to “buy time” for other treatments, replied: “I think she died of septic shock.”
The expert also said that although adrenaline was dangerous, he would not have expected the dose given to Mrs Leighton to have resulted in death.
Ramnath is alleged to have acted against the express instructions and advice of colleagues when she administered the adrenaline.
The court has heard that moments after the injection Mrs Leighton lost consciousness and her heart stopped.
Jurors have been told that she suffered from arthritis and had been admitted to hospital in Cannock on July 20 after a wound on a bunion on her left foot became infected.
She then suffered side-effects from antibiotics and was transferred to Stafford, where she was admitted to intensive care with septic shock.
Ramnath, whose address cannot be published for legal reasons, came back to Britain in February last year after dropping her opposition to extradition proceedings.
The case continue
The crown had to prove the cause and effect relationship between the injection of adrenaline and the death of the patient. It seems that they have failed to do it so far. How do they know that patient did not die of septic shock as testified by the expert witness for the defense. Where is the evidence beyond a reasonable doubt that Dr. Ramnath killed the patient? How do we know that patient died due to Adrenaline instead of in spite of Adrenaline? - Vijay Mehta
Re: Dr. Priya Ramnath
Post by solicitor on Jan 28th, 2009, 1:05pm
because a coroner ruled that she was unlawfully killed by an overdose of adrenaline, not by septic shock
from a legal perspective, please remember that the defence expert witnesses CHARGE and are PAID fees to give their evidence in support of the defence, whereas the crown will only reimburse their expert witnesses for travel expenses.
as regards proof, it was seconds between the dose being given and mrs leighton collapsing and dying. the evidence of the crown paints a completely different picture that mrs leighton was ill and not critically ill, as indicated by the defence.
finally, inferences can and will be drawn by the jury upon dr ramnath chosing not to give evidence.
the case continues...
Coroner may be over his head
Post by Vijay Mehta on Jan 28th, 2009, 3:45pm
Thank you solicitor.
With all due respect to the coroner the fact is that no one can testify with certainty if a person died of overdose of adrenaline. Adrenaline is destroyed by the body.
Adrenaline might have killed by induction of ventricular fibrillation - a condition where the heart beats at 300-400 times per minute in stead of 80 per minute. In process the heart is not able to pump any blood resulting in the death. The process could have been reversed with proper defibrillation. The effect of adrenaline is very short lived so the patient need to be resuccited for few minutes.
If the adrenaline was the only culprit heart would have come back in few minutes but if toxicity for sepsis had made the heart too weak to return to normal, she could not come back, as it happened in this case.
Scientifically no one can be certain that it was the adrenaline. Sepsis also makes heart more vulnerable to fibrillation - so a coroner can not be hundred person sure that sepsis did not play a part in her death.
The amount of Adrenaline was not a fatal dose. We generally give 1 cc and repeat two to three times. Why would anyone give her 3 cc of adrenaline in the first place? All emergency cardiac drugs come on single does to prevent such errors. So hospital can also be liable.
I am much more positive now than when he case started. Let us see what jury decides.
where can I find the testimony of the coroner? Re: Dr. Priya Ramnath
Post by solicitor on Jan 29th, 2009, 07:02am
Thank you Vijay
The coroner's verdict is a matter of public record and im certain that audio recordings of the hearing were taken, but these are not "public documents" if you will - requests can be made to obtain them via the courts, but at a price. also, because this happened over 10 years ago, i think they have probably been destroyed by now. I could be wrong though!
I do not profess to understand the medical side of things so I will not comment on them. However, I do not believe that ventricular fibrillation played a part in mrs leighton's death as there is no evidence of the same.
Your comments are interesting -"The amount of Adrenaline was not a fatal dose. We generally give 1 cc and repeat two to three times. Why would anyone give her 3 cc of adrenaline in the first place? All emergency cardiac drugs come on single does to prevent such errors. So hospital can also be liable." The crowns case, I understand, is that a 3cc dose is fatal when delivered in that quantity and undiluted. If it is infused with saline over hours, then it would not be lethal. This is what the crowns experts and witnesses testified. Clearly, I am not a doctor so do not know whether this is accurate, but this is the evidence before the court.
Interestingly, the Judge commented during arguments with the barristers and experts that she was satisfied that the quantity given was a lethal dose. unfortunately this has not been accurately reported in the press. we are being fed mere snippets from what they deem to be relevant, which is a shame.
All emergency drugs may nowadays come in 1cc doses, but this may not have happened at the time of the incident. Again, I am only hypothocising on that point.
If you are questioning why she would give that quantity of drug, then do you personally consider her actions to be incorrect? Especially if senior colleagues and nurses are all telling her not to? Would you personally have done the same in an identical situation? Or would you have been one of those trying to stop the injection?
Thanks for your time. Re: Dr. Priya Ramnath
Post by GUEST on Feb 3rd, 2009, 10:10am
What about the septic shock that the patient was admitted with and the low WBC count. Could it have any connection with the experimental drug that she was on. Nobody seems to be discussing the reason why she went into septic shock in the first place which does have high mortality rate of almost 50%
Professional Neglience vs Homicide
Post by Vijay Mehta on Feb 3rd, 2009, 10:21am
Guest, You are correct. It is the job of prosecution to prove that the patient died only due to Adrenaline. And the Adrenaline was given with criminal neglect. There is a higher bar for the proof in criminal charges compared to civil ones.
So far I have seen so many accusation but nothing that would amount to justify anything more than professional negligence.
Re: Dr. Priya Ramnath
Post by solicitor on Feb 3rd, 2009, 11:35am
"If you are questioning why she would give that quantity of drug, then do you personally consider her actions to be incorrect? Especially if senior colleagues and nurses are all telling her not to? Would you personally have done the same in an identical situation? Or would you have been one of those trying to stop the injection?"
I would appreciate a response to my point, if you will? A reasoned discussion on the evidence is a positive thing, instead of soley focusing on one side of a case and dismissing everything else.
Criminalizing Medical Errors
Post by Vijay Mehta on Feb 3rd, 2009, 2:47pm
"If you are questioning why she would give that quantity of drug, then do you personally consider her actions to be incorrect? Her actions were incorrect.
Especially if senior colleagues and nurses are all telling her not to? This is the first time that colleagues are identified as being senior to her. Nurses are not in the charge of patient care but a physician is. Buck stops with the physician.
Would you personally have done the same in an identical situation? It depends. I would have not given her the adrenaline if I were in the situation that prosecution witness are trying to portray. However, if I was convinced in my mind that the patient needed adrenaline to save her life, I would not hesitate to administer it, specially in an emergency situation. If I was convinced that a patient needs given treatment I have gone over the advise of others to do what I believe to be the right thing to do. I do not know any physician who will practice by consensus in emergency situation. There is always time later on to discuss and reflect upon what was the right thing to do, but an urgent clinical situation demands urgent action. She is being accused of manslaughter for her actions that she undertook firmly believing that it was needed to save the life of the patient.
Next we may try some physician for manslaughter when he/she fails to provide a given treatment in time when a nurse of colleague told them not to do so.
I think we are missing the point. No one is denying that given treatment was wrong. The issue is, whether her professional negligence rose to the level of criminal conduct? If we start criminalizing medical errors the jails will be full of well meaning physicians.
Re: Dr. Priya Ramnath
Post by solicitor on Feb 3rd, 2009, 3:18pm
Thank you for your comments.
I completly understand your view point - at the end of the day, doctors like yourself and dr ramnath have to make decisions all the time that could impact upon a patients mortality. If we criminalise each action, then more and more doctors would face prosecution.
But the crowns case is that her actions were so negligent that she should be tried with a criminal offence and she should be tested by a jury. This is what is meant by gross negligent manslaughter - a crime that the UK but not the US has. It will be interesting to see what precedents are set by this case in this country.
Thanks for your time, vijay. I will try and keep you updated as best I can
Time for Jury to decide
Post by Vijay Mehta on Feb 4th, 2009, 09:51am
Jurors deciding the case of a Stafford hospital registrar accused of killing a patient by injecting her with adrenaline 10 years ago have retired to consider their verdict.
Dr Priya Ramnath, 40, is alleged to have gone against the advice of three colleagues at Stafford District General Hospital before injecting the drug into Patricia Leighton, who was suffering from septic shock.
The trial at Birmingham Crown Court was told that Mrs Leighton was being treated in an intensive therapy unit when she died in the early hours of July 22, 1998.
Ramnath, whose address cannot be published for legal reasons, returned from the United States to the UK to face trial last year.
She denies the manslaughter of Mrs Leighton by gross negligence.
Re: Dr. Priya Ramnath
Post by guest on Feb 4th, 2009, 4:26pm
For your information, the one fact that has not been mentioned, and I stress this point, is that Dr Ramnath was the most junior doctor that was in the team that night and was not a registrar that has been quoted. She was in fact a second year junior house officer, and the other members of the team were : A medical registrar, Third year senior house officer, two senior Intensive care nurses with over 20 years experience in critical care.(not smart nurses).
Accessory to manslaughter
Post by Vijay Mehta on Feb 4th, 2009, 5:03pm
Thanks for the clarification. So Dr. Ramnath gave a lethal dose of medicine while two senior nurses and one senior physician just watched? In that case they are guilty of being accessory to the manslaughter.
If they (the nurses and other physician) truly believed that the medication will harm the patient it was their duty to do everything possible to stop Dr. Ramnath from giving it. Is there any evidence of physical attempt to stop Dr. Ramnath? If a physician asks for a harmful medicine the nurse's ethical and legal responsibility was to not give her and do everything possible to stop her from giving it. Dr Ramnath did not go to medicine cabinet and prepare the dose herself. Re: Dr. Priya Ramnath
Post by Rao on Feb 4th, 2009, 6:34pm
Pardon my ignorance I see updates about the case only once a week. Don't they work on the case daily till its over?
How come there's only one defense witness called to testify?
What is the penalty if the jury says Dr Ramnath is guilty?
Re: Dr. Priya Ramnath
Post by solicitor on Feb 5th, 2009, 02:28am
"Dr Ramnath did not go to medicine cabinet and prepare the dose herself."
the evidence was that she did prepare it herself, and that her colleaguies couldn't stop her. hence why dr ramnath is on trial, and not her colleagues.
plus, there is no charge under uk criminal law as accessory to gross negligent manslaughter.
punishment-wise, imprisonment is a possibility. i wouldnt be suprised though if it were to be suspended and she were to be allowed to return to the states. or alternatively, she could live out a jail term in the states.
lots of possibilities for the judge to impose *IF* she is found guilty...
Re: Dr. Priya Ramnath
Post by solicitor on Feb 5th, 2009, 04:11am
51. This is where the death is a result of a grossly negligent (though otherwise lawful) act or omission on the part of the defendant. In R v Bateman (1925) 19 Cr App R 8 the judge described the circumstances in which mere civil liability could become criminal liability in these terms:
"...the facts must be such that, in the opinion of the jury, the negligence of the accused went beyond a mere matter of compensation between subjects and showed such disregard for the life and safety of others, as to amount to a crime against the State and conduct deserving punishment."
52. Some of the words used in Bateman to describe the nature of "grossness" demonstrate how difficult it is to identify: culpable; criminal; gross; wicked; clear and complete.
53. In R v Adomako (1994) 3 All ER 79 the law was clarified by the House of Lords, who affirmed the Court of Appeal's decision, but amended the principles.
54. The case introduced a 4 stage test of gross negligence manslaughter, known as the 'Adomako Test' which involves:
a) The existence of a duty of care to the deceased;
b) a breach of that duty of care which;
c) causes (or significantly contributes) to the death of the victim; and
d) the breach should be characterised as gross negligence, and therefore a crime.
There is no manslaughter by "Lawrence Recklessness", overruling R v Seymour (1983) 2 AC 493. The Duty of Care
56. There is no "general" duty of care owed by one citizen to another (No 'good Samaritan rule')
57. A duty of care will arise from an ACT of a person where the requirements of foreseeability, proximity, fairness, justice and reasonableness establish such a duty (R v Donohue v Stevenson (1932) AC 582)
58. In Caparo Industries PLC v Dickman (1990) 2 AC 605 the House of Lords set out a 3 stage test if a duty existed:
a. Was the damage foreseeable;
b. Was the defendant in an appropriate position of proximity and;
c. It is fair and just to impose liability on the claimant
59. The duty can exist even where the deceased and the defendant were engaged in an unlawful activity together (R v Wacker (2003) 1 Cr App R 329; R v Willoughby (2004) ECWA Crim 3365.
60. The duty can arise from a contract of employment (R v Pittwood (1902) 19 TLR 37)
61. In addition there is the case of R (Rowley) v DPP (2003) EWHC Admin 693 where the Administrative Court referred to a fifth test, that 'criminal' involved an element of 'badness' - but note that the Adomako test is objective and the Crown need not prove the defendant's state of mind. The risk must be a serious and obvious risk of death, not merely serious injury - R v Misra & Srivastava  1 Cr App R 328. The Breach of the Duty of Care
62. The ordinary law of negligence applies to these case, in that those with an established duty of care, must act as a "reasonable person would do in their position". If they fail to do so they will have breached that duty. This is an objective test and will be based upon the defendant's position at the time of the breach.
63. Therefore, if the defendant has acted within the range of what was generally accepted as being the standard practice (even if it is at the lower end) it will be difficult to describe such behaviour as falling far below the standard of a reasonable person in his position.
64. An unqualified person is not to be judged at a lower standard than a qualified person. Therefore the lack of skill will not be a defence if the conduct is deemed negligent. If however, the defendant has particular skills and knowledge of a danger that the reasonable person would not have, his actions should be judged in the light of those skills or knowledge. This test is an objective test.
65. It does not matter that the defendant did not appreciate the risk only that the risk would have been obvious to a reasonable person in the defendant's position. (R v DPP ex Parte Jones 2000 CLR 858 and AG ref No:2 of 1999 3 All ER 182) Causation
66. in R v HM Coroner for Inner London, ex parte Douglas-Williams (1999) 1 All ER 344 Lord Woolf put forward the following test:
"For gross negligence manslaughter so far as the facts we are considering are concerned there must be:
(i) negligence consisting of an act or failure to act;
(ii) that negligence must have caused the death in the sense that it more than minimally, negligibly or trivially contributed to the death; and
(iii) the degree of negligence has to be such that it can be characterised as gross in the sense that it was of an order that merits criminal sanctions rather than a duty merely to compensate the victim.
"It is an essential ingredient that the unlawful or negligent act must have caused the death at least in the manner described. If there is a situation where, on examination of the evidence, it cannot be said that the death in question was caused by an act which was unlawful or negligent as I have described, then a critical link in the chain of causation is not established. That being so, a verdict of unlawful killing would not be appropriate and should not be left to the jury."
The Grossness of the Breach
67. The risk (which has to be the foreseeable risk of death) must be serious and it must have been one which would have been obvious to a reasonable person.
68. It is for a jury to decide whether the defendant's conduct was so bad, in all the circumstances, as to amount to a criminal act or omission. In R v Misra & Srivastava  1 Cr App R 328, the court agreed with the direction by the judge that the term 'reprehensible' would be apt to describe the nature of the conduct. "Medical Manslaughter"
69. Medical manslaughter is legally no different from Gross Negligence manslaughter. The term refers to medically qualified individuals who are performing acts within the terms of their duty of care, when the act or omission occurs.
Re: Dr. Priya Ramnath
Post by SatishD on Feb 5th, 2009, 9:35pm
Well, I feel some what better after long time. I am really glad that Dr. Coakley gave expert opinion for defence. And, yes as I had said before Mrs. Leighton, was in septic shock. And Dr. Ramnath gave adrenaline as a last resort as patient was going in to cardiac arrest. No physician in world would give adrenaline to patient if patient were sitting and talking.May be Dr. Ramnath was just registrar there but she already had full training in INDIA. She was qualified physician already . There is absolutely no question of gross negligence. She did what she believed was tv only way to save pt's life. Dr. Coakley's testimony proves that. That coronor should actually learn lesson from Dr. Coakley before coming to conclusion about "unlawfull death". Also I hope our solicitor friend will have different perspective now.- She gave injection to save her, adrenaline is one of such medicines. It is not negligence at all. It was just everybody's bad luck that it did not help. Yes, she did not listen to others, if that is crime, than she should be punished for that. I would listen to nurse with 20 years of experience, still I would do what I would think would be best for patient. I am now much more optimistic than ever after Dr. Coakley's testimony . Hope jury will take him seriously and disregard the that she did not listen to others. Justice should prevail. Innocent should not be punished. No one in world can ever prove beyond doubt that death was caused by adrenaline and not by septic shock or other causes. That is all. Once again, I hope soon she will be with her 2 children and husband. Dr. Vijay Mehta deserves "thanks a lot"
Re: Dr. Priya Ramnath
Post by solicitor on Feb 6th, 2009, 05:30am
I am currently at work and will respond to any points raised later, but the breaking news is this:
Dr Priya Ramnath had denied manslaughter by gross negligence A doctor has been found guilty of killing a patient by giving her a fatal injection of adrenalin against the advice of three colleagues.
Patricia Leighton, 51, had been taken into Staffordshire District General Hospital suffering from septic shock. She died there in July 1998.
Dr Priya Ramnath, 40, had denied manslaughter by gross negligence.
She was given a suspended six-month jail sentence after being convicted at Birmingham Crown Court.
Staffordshire Police revealed after the case that Ramnath, who was due to take annual leave, resigned from her post at the hospital on 28 July - six days after Mrs Leighton's death.
She arrived in Orlando, Florida, a day later.
They have faced agonising times to see justice brought and we hope that they can now find some form of closure
An inquest in August 2004 recorded a verdict of unlawful killing on Mrs Leighton and police then took steps to extradite Ramnath.
The four-week hearing was previously told by Ramnath's colleague, Dr Doris Ng, that she was "horrified" the injection had been given.
Mrs Leighton, from Burntwood, Staffordshire, was admitted to hospital in Cannock on 20 July 1998 for treatment for rheumatoid arthritis and an infected bunion.
She suffered side-effects to antibiotics and was transferred to the intensive care unit in Stafford with septic shock.
It was there that Ramnath gave her adrenaline, she said, in an effort to raise Mrs Leighton's blood pressure.
Patricia Leighton died at the hospital in July 1998
Michael Burrows, prosecuting, had told the court that within moments of receiving the jab, Mrs Leighton had "jerked forward and sat bolt upright in her bed".
He said she had shouted out: "What's happening to me? I am going to die."
Shortly afterwards, Mrs Leighton lost consciousness and her heart stopped.
Ramnath and other colleagues tried to resuscitate Mrs Leighton but failed.
Mother-of-two Ramnath declined to give evidence during her trial.
However, Dr John Coakley, an expert in intensive care medicine who works at London's Homerton Hospital, told the trial Mrs Leighton probably died of septic shock - not the injection.
He said he "did not envy" any of the doctors who dealt with her as he said her condition had been critical when she was admitted to hospital.
It doesn't matter how long ago a crime happened, you just can't let it go, you have to fight for justice
Dr Coakley said Mrs Leighton had only been given about a 50% chance of survival at that time.
Mrs Justice Rafferty said the doctor had panicked in the "pressure cooker" of the intensive care unit.
The judge told Ramnath: "The jury has found that Mrs Leighton would have lived longer, perhaps days, but for your gross negligence."
Mrs Justice Rafferty added that Ramnath's biggest mistake was refusing to listen to her colleagues.
The jury convicted her with a 10-to-two verdict after three days of deliberations.
A statement from Mrs Leighton's family after the case described her as a "very loyal and family-orientated person with a lovely, gentle nature".
The statement said: "A lot of lives got wrecked the day she was taken from us."
It continued: "We have overcome many hurdles to get this case to trial.
"It doesn't matter how long ago a crime happened, you just can't let it go, you have to fight for justice.
"We are happy that the jury have returned a guilty verdict and that justice has at last been served, and hope that she will never be able to wreck another family's life."
Det Ch Insp Phil Bladen said it had been a "complicated and highly unusual" case.
He added: "Our thoughts have been very much with Mrs Leighton's family, who have waited more than 10 years to see someone made culpable.
"They have faced agonising times to see justice brought and we hope that they can now find some form of closure."
Re: Dr. Priya Ramnath
Post by SatishD on Feb 6th, 2009, 05:31am
It is over. Thank God. I am disappointed little bit., but it could have been worse. All witnesses, I believe had testified against her. Thanks to Dr. Coakley. Now, she will be with her children soon. I think deep down in her heart judge did have some sympathy for her. This brings an end to long standing battle and agony of Dr. Ramnath's family. Good work Dr. Mehta. Bye everybody.
Re: Dr. Priya Ramnath
Post by solicitor on Feb 6th, 2009, 06:12am
Indeed. Justice has been done.
I feel that this case will set a very strong legal precedent that doctors cannot rely on the defence that that "I was simply doing what I thought was best for the patient".
Doctors, like all other individuals/companies, are never outside of the law. Perhaps this will serve as a reminder to those who arrogantly continue to practice medicine in that false belief.
Many thanks to all for the informed discussion we have partaken in. All the best for the future.
Re: Dr. Priya Ramnath
Post by solicitor on Feb 6th, 2009, 06:16am
However, the important point to note here SatishD, is that this was about bringing justice to the Leighton family for the death of their mother which Ramnath caused.
Nothing will bring Mrs Leighton back, but maybe the family will have closure from this. I sincerely hope they do.
Thank God this is over
Post by Vijay Mehta on Feb 6th, 2009, 06:28am
Guilty verdict. light sentence. It was not an unanimous verdict but majority verdict.
six months of suspended sentence. She can be home with her family. In a way I am sure she will be more relieved. Had she known the sentence would be so reasonable she would have turned herself years ago to avoid all the pain and suffering she might have undergone over the years.
All these years of worrying and hiding was probably more of a punishment than six months of suspended sentence. So this also brings a closure to Ramnath family.
If this is what prosecutors were looking for I am sure the plaintiff would have agreed long time ago, just to move on with their lives. All the drama of extradition and trial. But what do I know, I am just a surgeon and not a lawyer!
Special thanks to solicitor for keeping us informed. By the way I would have no hesitation to be treated by Dr. Ramnath. Dr. Priya Ramnath
Post by Vijay Mehta on Feb 6th, 2009, 06:42am
Doctor given suspended prison sentence
Feb 6 2009 by Ross McCarthy
A HOSPITAL registrar who killed a patient at a Midlands hospital by injecting her with adrenaline against the advice of three colleagues has been given a suspended prison sentence.
Dr Priya Ramnath, who was found guilty of the manslaughter of Patricia Leighton, by gross negligence by a jury at Birmingham Crown Court, was sentenced to six months imprisonment suspended for two years.
Passing sentence Mrs Justice Rafferty said: "The jury has found that Mrs Leighton would have lived longer, perhaps days, but for your gross negligence.
"Her family's grief is the more complex as a result.
"In my view the defining error was that you chose not to listen to Sister. She had a world of experience to offer you and she offered it. Arrogance is not attractive and it has cost you your reputation."
However she said she had taken into account that the ITU at Stafford District General Hospital had been "wholly unprepared" for what it had to cope with when Mrs Leighton arrived and that no one had taken control or worked to a consistent system.
She said: "The result was that you panicked in the pressure cooker of the ITU."
Michael Burrows QC prosecuting said that Mrs Leighton, 51, from Burntwood, near Cannock, Staffordshire, had attended a clinic in June 1998 complaining of a wound on a bunion on her left foot which had failed to heal.
The wound was resistant to antibiotics, her condition deteriorated and she was transferred to the Stafford hospital where she was placed in the ITU suffering from septic shock.
Mr Burrows said although Mrs Leighton was very ill she was not about to die and against the express instructions and advice from her colleagues and without reference to the consultant in charge of Mrs Leighton, 40-year-old Dr Ramnath injected Mrs Leighton with a dose of adrenaline.
He said the patient's condition further deteriorated and she could not be resuscitated.
Jonathan Caplan QC, for Dr Ramnath, said the doctor had already suffered considerably having been uprooted from her children and family in the United States where she had been living for a number of years.
He also said there was a real risk that having returned to this country without a visa she would not be able to go back to the US and that she would have to return to the country of her birth, India.
Mr Caplan said that there had been "extreme difficulties" in assessing this critically ill patient.
Afterwards in a statement made by Mrs Leighton's family, they paid tribute to her.
They said: "We have overcome many hurdles to get this case to trial. It doesn't matter how long ago a crime happened, you just can't let it go, you have to fight for justice. And that is what we have done over the last 10 years - it's the least we could do.
"We are happy that the jury have returned a guilty verdict and that justice has at least been served and hope that she will never be able to wreck another family's life."
I am not sure what the judge meant by, "hope that she will never be able to wreck another family's life." Dr. Ramnath has already demonstrated to help thousands of patients over past several years. I am sure she will be allowed to practice medicine, may be with some restriction in US. - Vijay Mehta Re: Dr. Priya Ramnath
Post by NF on Feb 6th, 2009, 08:05am
Doctor Priya Ramnath has been found guilty of gross negligent manslaughter today - justice has finally been served!!
Re: Dr. Priya Ramnath
Post by kaur on Feb 6th, 2009, 09:58am
Justice have finally been done, she is a disgrace to medical profession and must not practice this profession at all.
Why did she leave UK after killing that patient? Dr Kaur To Dr. Kaur
Post by Vijay Mehta on Feb 6th, 2009, 10:47am
Dear Dr. Kaur,
It is so easy to be high and mighty and pronounce Dr Ramnath as being disgrace to her profession.
Even the judge who gave her the sentence taken into account that the ITU at Stafford District General Hospital had been "wholly unprepared" for what it had to cope with when Mrs Leighton arrived and that no one had taken control or worked to a consistent system.
She said: "The result was that you panicked in the pressure cooker of the ITU."
Her husband was already in US and she was planning to join him. She was already scheduled to visit him the week of the incidence. Once this happened she simply decided to not go back to UK but stayed with her husband. I am sure you might do the same thing.
Why don't you give us your true identity and may be some others who have grudges against you or who have been recipient of your care can come and post how much grace to your profession you are?
Only doctors who have no morbidity or mortality are the ones who never practice medicine.
Re: Dr. Priya Ramnath
Post by guest2 on Feb 6th, 2009, 12:13pm
Another international medical graduate goes down the drain!
75% of GMC litigation is against the IMGs. Even GMC itself is investigating why IMGs are prosecuted more and get the toughtest punishment available.
Fact is England is the most racist place on earth, IMGs are used as slaves (staff grade and associate specialists) and when any thing goes wrong they are easliy made scape goats.
I feel extreemly sorry for the doctor and congratulations to the deceasesd family, they just hit a jack pot! Millions of £s on their way in civil litigation claims. As they say in Hindi "haathi zinda laakh ka, murda sawa lakh ka"
Re: Dr. Priya Ramnath
Post by solicitor on Feb 6th, 2009, 5:44pm
your comments are wholly incorrect and inappropriate. the family can no longer pursue a civil case against Dr Ramnath or the hospital as the Limitation Act applies to all UK civil cases and as such there is a time limit of 6 years within which to bring a civil case. They of course had the choice to do so years ago.
However, they have consistently made it clear that this has never been about money. It has been about the family fighting for justice for their mother/sister. Something which has taken over ten years to achieve and something which they have finally attained. Your comments can be considered insulting to the family, their dead mother, and also to Dr Ramnath as well.
As regards racism, I believe that the jury consisted of other ethnic groups including white and hindu, so your comments in this regard are also not founded. Dr Ramnath's conviction was the result of her own actions. Nothing else.
Re: Dr. Priya Ramnath
Post by solicitor on Feb 6th, 2009, 5:54pm
re your comment: "Her husband was already in US and she was planning to join him. She was already scheduled to visit him the week of the incidence. Once this happened she simply decided to not go back to UK but stayed with her husband. I am sure you might do the same thing."
Unfortunately, you are only hypothocising on this point as Dr Ramnath did not give evidence at all throughout her trial. As I explained in a previous post, the jury were allowed to draw inferences from this, in addition to the fact that she handed in her resignation and fled/left for the US within 6 days of Mrs Leighton's death.
Whether the jury took this view is irrelevant for these purposes as they could have decided to convict her on different facts and points of evidence. But it is possible for a reasonable man/woman (ie: juror) to view her actions as fleeing. Conversely, they could well have believed her explanation and thought nothing else of it.
All hypothetical points and now merely historical points. Dr Ramnath has been convicted of gross negligent manslaughter by a jury of her peers.
Hopefully other doctors will now take note that their conduct will be scrutinised and tested in court, both civil and criminal, should they arrogantly and flagrantly make decisions concerning patient care without considering the rammifications of those actions.
Thank you once again for the informed discussions during the past few weeks.
Re: Dr. Priya Ramnath
Post by Jericho Morton on Feb 6th, 2009, 7:58pm
Well, it looks like the great healer, who skipped the UK within hours dumping a job and training after killing a woman, was nothing more than a prima donna who couldn't care less about a patient, other doctor's opinions or pharmacology or medical practice, and just gave the woman what she 'thought' was best. For those who are hard of thinking, she is a pointless waist of space. If she must work in medicine, perhaps in teaching anatomy of cadavers? What about 'homeopathy' which is big in the NHS, harmless enough. In fact anywhere is doesn't have access to a PDF and a script pad would be best. And, she isn't a healer, she is a 'nearly kill them for 3 hours but keep them hanging on' arrogant slimebag. When you meet her you would agree.
Re: Dr. Priya Ramnath
Post by ann on Feb 7th, 2009, 04:35am
how the f@#$ did they prove that death was caused by adrenaline and not septic shock , since septic shock by itself has a very high mortality and adrenaline is one of the treatment for septic shock-and even if this patient had not received adrenaline ,if she was really in septic shock requiring any amount of pressors there is a very low chance that she would have survived.Fu@#$&^ racist brits just because it was img she is targetted
Re: Dr. Priya Ramnath
Post by NF on Feb 7th, 2009, 3:33pm
Ann Have you not read all the quotes relating to this as this is most certainly not anything to do with race or colour. What you need to remember is that someone died due to "Dr" Ramnath's actions - now albeit 10.5 years later, justice has been done. Re: Dr. Priya Ramnath
Post by NF on Feb 7th, 2009, 3:35pm
Adam - Solicitor Many thanks for your comments and updates on this case - you have been right all the way!! Re: Dr. Priya Ramnath
Post by rb on Feb 7th, 2009, 4:53pm
A review by the Journal of the Royal Society of Medicine found the number of doctors charged with manslaughter in the UK to have risen substantially since the 1990s. The authors comments perfectly sum the situation up to my mind. (Taken from BBC web page). Dr Robin Ferner, who led the study, said: "The number of doctors charged with manslaughter has risen steeply since the beginning of the 1990s. "However, the rate of conviction remains low. "The evidence suggests that doctors are being charged for reasons of vengeance or retribution rather than to protect patients. "Charging doctors with manslaughter following a medical error may be an emotionally satisfying way to exact retribution, but if individual doctors are singled out for punishment it will become much harder to foster an open culture." Dr Ferner added: "In the case of doctor error there are two choices; either we continue to perpetuate the myth of perfection or we examine the systems in which they work. "Threats or fears of prosecution do not result in better health systems. "Rather, they lead to cover up where faults remain hidden and more patients die." Bias against overseas Doctors in UK
Post by Vijay Mehta on Feb 7th, 2009, 9:53pm
LONDON: Britain's medical regulatory body has begun an urgent inquiry into the alarming and disproportionate rise in the number of Indian and other overseas-trained doctors facing disciplinary action here, compared to their UK-qualified peers, nearly six months after TOI first revealed that one in three doctors erased from the medical register are from India.
The General Medical Council (GMC) inquiry into why overseas doctors are more likely to be disciplined, comes as this paper established that one in six doctors facing disciplinary action today are Indian.
This is in stark and disproportionate contrast to the actual number of Indian doctors in the UK. Indians account for just 25,000 of the 220,000 doctors registered with the GMC, of whom only 148,000 are in active practice.
But, Umesh Prabhu, a consultant paediatrician who serves as clinical adviser to the UK-wide Patients Safety Agency and has been lobbying the GMC to investigate the disproportionate disciplinary action against Indians and others, said: "60% of the 45 doctors charged with manslaughter at the moment are Indian." Prabhu, who combines his advisory role with the UK's Healthcare Commission with vice-chairmanship of the British Association of Physicians of Indian Origin (BAPIO) and is executive chair of the British International Doctors Association (BIDA), told TOI that the GMC's newly-launched inquiry was the welcome outcome of "at least four meetings I have had with them, to ask them to explore why Indian and overseas doctors face more disciplinary action. Is it institutional racism or is it something to do with the training they receive in their home countries?"
Prabhu said that TOI's February revelation that nearly 60% of all doctors disciplined by the GMC belong to Britain's ethnic minority communities and one in three were trained in India had spurred the GMC into action, "with the (Indian) High Commissioner getting involved as well." He said the Indian media interest in the alarming rise in the number of Indian and other non-UK doctors facing disciplinary charges had forced the GMC to examine the "cultural difference" or other reasons which get foreign-trained doctors regularly into trouble more oftener than their UK-qualified peers. The GMC admitted that of the 54 doctors struck off the medical register last year, 35 had trained abroad. Myth of perfection
Post by Vijay Mehta on Feb 7th, 2009, 9:59pm
EMBARGOED UNTIL GMT 00:01HRS THURSDAY 1 JUNE 2006 Number of doctors charged with manslaughter rising in the UK
The number of doctors charged with manslaughter in the UK has risen substantially since the 1990s; however, the rate of conviction remains low.
The comprehensive review, which is published in the June issue of the Journal of the Royal Society of Medicine, examined cases from 1795 to December 2005.
The study identified 85 doctors in the UK charged with manslaughter since 1795.1 Sixty doctors have been acquitted compared to 22 recorded convictions and three pleas of guilty. Thirty-eight doctors have been charged since 1990.
“The number of doctors charged with manslaughter has risen steeply since the beginning of the 1990s,”
said Dr Robin Ferner of Birmingham’s City Hospital.
“However, the rate of conviction remains low. The evidence suggests that doctors are being charged for reasons of vengeance or retribution rather than to protect patients,”
The study by Dr Ferner and Sarah McDowell categorised all manslaughter cases according to a recognised classification of human error – mistakes, slips or lapses, and violations.
The authors found most doctors were charged as a consequence of mistakes (37) or slips (17) and a minority of alleged violations (16).
“Criminal prosecution of doctors is appropriate when there is clear evidence of violation; however, human error is unavoidable,”
said Dr Ferner.
“Prosecuting doctors who make errors increases the number of doctors with ruined careers, but vilification of individuals does not lead to safer health systems,”
The study calls for an open culture to help identify areas of weakness and foster improvements in health care systems.
“In the case of doctor error there are two choices, either we continue to perpetuate the myth of perfection or we examine the systems in which they work. Threats or fears of prosecution do not result in better health systems rather they lead to cover up where faults remain hidden and more patients die,” said Dr Ferner.
Doctors charged with manslaughter in the course of medical practice, 1795 – 2005: a literature review [PDF 300k]
‘Doctors charged with manslaughter in the course of medical practice, 1795 – 2005: a literature review’ by RE Ferner and SE McDowell is published in the June issue (Vol. 99) of the Journal of the Royal Society of Medicine.
1This figure excludes 47 individuals who were not medically qualified, three medical students and 31 practitioners who were accused of manslaughter associated with criminal abortion rather than errors during legitimate practice.
JRSM is the flagship journal of the Royal Society of Medicine. It has been published continuously since 1809. Its Editor is Dr Kamran Abbasi. Criminalizing errors will not improve care
Post by Vijay Mehta on Feb 7th, 2009, 10:06pm
Doctor manslaughter charges rise
Surgeon Steven Walker was convicted of manslaughter in 2004 The number of doctors charged with manslaughter in the UK has risen substantially since the 1990s, a study has shown.
But the review, in the Journal of the Royal Society of Medicine, found the rate of conviction remains low.
Birmingham City Hospital researchers examined cases found 85 doctors had been charged with manslaughter since 1795, 38 of them since 1990.
They said the rise in charging was due to "vengeance and retribution".
1859: A woman died several days after her baby was delivered using instruments as a result of a large vaginal wound. It was alleged the doctor was drunk and was therefore unfit. He was charged with manslaughter and found guilty.
The earliest case discovered by the team involved a Dr Raeburn who was charged with manslaughter in 1831 following the death of a woman after childbirth.
There was a surge in the number of cases seen in the mid-19th century, the majority linked to obstetrics, which researchers say is probably due to the increased medicalisation of childbirth at that time.
Twentieth century cases tended to involve drugs, probably because of the introduction of more powerful - and therefore more dangerous - medications.
'Emotionally satisfying' Over the 200 years studied by the researchers, 60 doctors have been acquitted compared to 22 recorded convictions and three guilty pleas.
In 37 of the cases, doctors were charged with manslaughter as a consequence of mistakes in planning a procedure - 10 were convicted.
Another 17 cases involved errors caused by being distracted, or having a lapse in concentration. Four of these doctors were convicted.
It is difficult to see how bringing manslaughter charges against an individual doctor rather than investigating and resolving the underlying system failures that led to death is helpful
Sixteen cases were deemed to involve a "deliberate deviation from safe practices". Ten of these doctors were convicted.
In the remaining cases, which involved 12 doctors, there was insufficient information to classify the case.
Dr Robin Ferner, who led the study, said: "The number of doctors charged with manslaughter has risen steeply since the beginning of the 1990s.
"However, the rate of conviction remains low.
"The evidence suggests that doctors are being charged for reasons of vengeance or retribution rather than to protect patients. "Charging doctors with manslaughter following a medical error may be an emotionally satisfying way to exact retribution, but if individual doctors are singled out for punishment it will become much harder to foster an open culture."
Dr Ferner added: "In the case of doctor error there are two choices; either we continue to perpetuate the myth of perfection or we examine the systems in which they work.
2004 Surgeon Steven Walker was found guilty of the manslaughter of Dorothy McPhee who suffered catastrophic blood loss during an operation to remove a liver tumour in 1995. He admitted he should have stopped the operation after finding the tumour was double the expected size and close to key blood vessels. He was also alleged to have had his picture taken with the organ during the procedure. Mr Walker received a 21-month suspended jail sentence.
"Threats or fears of prosecution do not result in better health systems. Rather, they lead to cover up where faults remain hidden and more patients die."
Ian Barker, a solicitor with the Medical Defence Union, which provides medico-legal assistance to doctors, says the study echoes the MDU's experience.
"We have seen an increase in investigations in the past few years, but many more doctors are investigated for manslaughter than are prosecuted and even fewer are convicted.
"One of the reasons for this is that there are greater complexities involved in cases where there has been a medical accident than in ordinary manslaughter cases, for example the actual cause of the death.
"Many cases involve system failures as well as individual error.
"In such cases, it is difficult to see how bringing manslaughter charges against an individual doctor rather than investigating and resolving the underlying system failures that led to death is helpful."
He said being involved in a manslaughter investigation could be extremely traumatic for the doctor involved, and called for a recognition that medics carry out dangerous procedures and use powerful drugs on people who are sometimes extremely ill.
A spokeswoman for the Patients Association said such cases, whether they involved individual doctors or wider NHS failures, were rare. Medical Manslaughter
Post by Vijay Mehta on Feb 7th, 2009, 10:14pm
Doctors face trial for manslaughter as criminal charges against doctors continue to rise BMJ July 13, 2002 Clare Dyer, legal correspondent, BMJ
Two UK junior doctors are to stand trial for manslaughter over the death of a 31 year old patient who developed staphylococcal toxic shock syndrome following a routine knee operation.
Rajeev Srivastava and Amit Mizra, both senior house officers at the time, have been charged with causing the death of Sean Phillips, who died in June 2000 following surgery at Southampton General Hospital. A trial date has been set for March 2003 at Winchester crown court in Hampshire.
The case follows the acquittal last month of consultant urologist John Roberts and locum registrar Mahesh Goel, who were charged with manslaughter after Dr Goel removed a patient's healthy kidney by mistake instead of the diseased one. They were acquitted on the direction of the judge after a prosecution pathologist said he could not be sure of the cause of death.
Medical manslaughter cases are a development of the 1990s, following a policy decision by the Crown Prosecution Service to pursue prosecutions for gross negligence or recklessness at work.
A paper published two years ago in the BMJ by consultant physician Dr Robin Ferner of the City Hospital NHS Trust, Birmingham, showed that whereas only four doctors were charged with manslaughter during the 1970s and '80s, 17 were charged during the 1990s (2000;321:1212). In the two and a half years since the completion of that research, another six doctors have been tried for manslaughter.
Although the Crown Prosecution Service's decision to pursue prosecutions for negligence at work has affected mainly doctors, the service did prosecute a plumber for causing death by electrocution while working on a kitchen.
The success rate for medical manslaughter prosecutions is much lower than for manslaughter generally. The reason is simply that for a manslaughter charge to stick, it must be proved that the defendant caused the death. The cause of death is much harder to state with certainty in medical cases than in more ordinary manslaughters, such as a death after a fight got out of hand.
Of the 21 doctors charged between 1970 and 1999, 10 were convicted, but three of them had their conviction quashed on appeal. Of the six doctors charged with manslaughter between the beginning of 2000 and mid-2002, only one, an anaesthetist, was found guilty. At least three of the remaining five were acquitted on the direction of the judge, after the prosecution case collapsed. In another, the judge had nudged the jury towards its decision by summing up for an acquittal.
By comparison, Home Office figures for manslaughter cases generally in 2001 show that of 278 defendants who stood trial, 238 were convicted and only 40 acquitted. Dr. Mitra Nikkhah charged with manslaughter
Post by Vijay Mehta on Feb 7th, 2009, 10:18pm
Dubai doctor faces manslaughter charge in UK by Andy SambidgeTuesday, 18 November 2008
MANSLAUGHTER CHARGE: Dr Mitra Nikkhah denies gross negligence following the death of a patient in England in 2006.
A doctor now working and living in Dubai is on trial in the UK charged with the manslaughter of an elderly patient when she allegedly ignored instructions that he was allergic to penicillin and insisted he took the drug.
Dr Mitra Nikkhah is accused of manslaughter through gross negligence after David Townsend went into anaphylactic shock and died after taking medication she had prescribed.
A court in Plymouth, south west England, heard that Townsend and his wife Joan both told Nikkhah that he was allergic but she could not find any information on the surgery's computer about his condition and so prescribed the medication anyway.
Nikkhah, 41, who now lives and works in Dubai, was working as a locum doctor at the St Budeaux Health Centre in Plymouth, Devon, reported the Plymouth Evening Herald.
The court heard Nikkhah told police she does not remember any conversation about penicillin other than when she asked if Mr Townsend suffered any allergies and the couple looking "confused".
She has pleaded not guilty to one count of manslaughter through gross negligence.
Townsend, 73, died at his home in Antony Gardens, Plymouth, on May 25, 2006.
Phillip Mott QC, prosecuting, told the court the case hinged on the conversation in the surgery.
The court heard Nikkhah was trained in Romania in 1995 before coming to the UK in 2001 and in 2004 qualified as a locum GP.Dr. Visnjevac charged with manslaughter
Post by Vijay Mehta on Feb 7th, 2009, 10:22pm
DOCTOR CHARGED WITH MANSLAUGHTER OF BABY STILL AT LARGE
The baby girl died after a forceps delivery
Monday April 21,2008 By Emily Garnham for express.co.uk
A BOSNIAN DOCTOR charged with manslaughter after allegedly using “excessive force” to deliver a baby is still at large, a disciplinary tribunal was told today.
Vladan Visnjevac is thought to have fled to Bosnia after he allegedly made three unsuccessful attempts to effect a forceps delivery on a baby girl in 2002.
The obstetric registrar, who worked at St Peter’s Hospital in Chertsey, fled whilst on bail after he was arrested on suspicion of manslaughter of the baby.
A case against Visnjevac began in his absence before the General Medical Council in London today.
It heard how at about 1am on May 24, 2002, a woman who was 37 weeks pregnant, known only as Mrs W, was admitted to the hospital in labour.
That evening, Visnjevac allegedly made three unsuccessful attempts to effect a forceps delivery, removing and reapplying the forceps to the baby’s head, eventually delivering a girl at 10.26pm.
The child later died at 2.10am on May 26, the hearing was told.
It is alleged that during the childbirth procedure, Visnjevac did not properly assess or record the level and position of the head before forceps delivery.
Furthermore he is accused of not reassessing the clinical situation after the failure of the baby’s head to descend with the first episode of traction.
He allegedly used excessive force in the three unsuccessful attempts at delivery, and again when he did achieve delivery on the fourth episode of traction.
His actions are accused of being "inappropriate" and "irresponsible" and not of a standard expected of a registered medical practitioner.
In a statement Surrey Police said it is believed that Visnjevac is no longer in the UK.
They added: “Officers have liaised with the Foreign and Commonwealth Office about extradition from the country in which he is believed to be living.
“The authorities in that country advised the FCO that they were not prepared to allow the extradition to proceed.”Medical Manslaughter - full article
Post by Vijay Mehta on Feb 7th, 2009, 10:45pm
Re: Dr. Priya Ramnath
Post by RB on Feb 8th, 2009, 07:48am
Since coming across this case in the Times yesterday I have been concerned. Although I am not an anaesthetist I am currently doing ITU at a large teaching hospital in London. Adrenaline boluses are used in some septic patients. As a medical registrar I am not familiar with using adrenaline for this indication and rely on anaesthetic colleagues to guide me. The patients who I have seen being given adrenaline really have overwhelming sepsis and generally die no matter what interventions are done on ITU. Coming to the Dr Ramnath case there are a number of worrying features. The patient clearly must have had severe sepsis to be admitted to ITU in the first place. Such patients are inherently unstable and the majority of drugs used in such settings can have unpredictable effects. It is difficult to understand how the coroner could differentiate the effects of sepsis from drug effects. (However I cannot find exactly how many mg's of adrenaline were given in this case - if it were a massive overdose then clearly that is different) The other aspect to the case relates to going against senior colleagues. From my understanding the most senior colleague present was Dr Ng a medical registrar in gastroenterology - being a medical registrar myself I can tell you we do not use inotropes or vasopressors on a routine basis. When medical opinions are sought on ITU we give advice in our speciality field not on general aspects of ITU care. Again I obviously would stand corrected if Dr Ng turns out to have years of anaesthetic or ITU experience. As for not listening to the senior sister I think you would be hard pressed to find a doctor who has not gone against a senior nurse at some point in their career. Looking at the postings on doctors net ( a major UK doctors forum) I am not the only one to have serious misgivings about this case. If there are other aspects to the Dr Ramnath case then please let them come out into the open so that we can all understand what has happened. For example if Dr Ramnath had a history of poor performance. From the information I have read so far this case is much less clear cut then those doctors who have previously been found guilty of manslaughter. Surely this will go to appeal?
Re: Dr. Priya Ramnath
Post by D Grundy on Feb 8th, 2009, 5:12pm
Dear Sir, I have read your interest your various posts on the topic of Dr Ramnath and I have to tell you that you are misinformed on many issues, which is not surprising given the distance and the natural distortion that becomes endemic when perceived truths are divulged as Chinese whispers. I have been involved in the case since the night of the incident, when the patient was admitted into ITU under false pretenses. I do, however, concede that the medical profession carries the burden of decision at times of crisis and sometimes the outcome can be less than desirable, but the key thing here is whether the doctor acts in the best interest of the patient. In this instance, Dr Ramnath ignored the advice of all the professionals around her and in the confusion of the admission, and without anyone noticing, she helped herself to an ampule of Adrenaline which, to the dismay of her colleagues, she swiftly administered to the patient. She wrongly believed that the patient was in respiratory distress and delivered a bolus of the drug. She did so because she would not accept anyone's advice or opinion - something that and been a source of discord in the past. When the patient finally passed away, in considerable distress, Dr Ramnath proceeded to put the empty ampule in her pocket and walked out of the unit. A few short days later Dr Ramnath finished her allocation early and left the country after a conversation with her consultant and mentor. Dr Ramnath's failing was her arrogance and lack of humility - something she demonstrated throughout her working career as well as during her court appearance, and is something the judge felt compelled to highlight by saying "arrogance is not attractive". Should there be anything else you would need clarification on, please do not hesitate to contact me again. I understand that this sort of forum is useful but only if the truth as whittled from hearsay and gossip.
Questions and Observations
Post by Vijay Mehta on Feb 8th, 2009, 9:48pm
Thank you D Grundy. May be you or Solicitor can answer some of key questions.
Can you tell us what was you involvement in the case? Were you present at the time of incidence?
Who exactly was present at the time of incidence. If there were other physician what was their level of training and specialty?
Was Dr. Ramnath working as a capacity of a consulting service?
Who was the primary service responsible for the patient?
Was adrenaline available in open space for Dr. Ramnath to reach out take it her self?
How much adrenaline was injected and what dilution was it?
What do you mean by "the patient was admitted into ITU under false pretenses?"
What time of the day did this incidence happened?
Was there any thing in Dr. Ramnath's record to prove that she did not follow the instructions of her superiors?
Is it possible that instead of subcutaneous she gave the adrenal intravenous?
You are saying that she gave one ampule but some other reports indicate 3 cc. How much adrenaline did the ampule contain?
If she took the ampule with her how did they figure out exactly what she administered?
By the way not testifying in your own defense does not mean you are arrogent. This is done by the counsel of your attorney who basically decides that putting a witness on the stand may open up for cross examination.
And if she does not appeal to superior court, that does not mean she is guilty but simply may indicate that they may decide it is far cheaper to spend six months in jail than to spend large sum of money to challenge the court rulings. ( I have a feeling that she probably would not challenge the decision, unless her attorney can come up with some legal technicality.)
When judge said, "arrogance is not attractive" she was simply referring to the allegation that Dr. Ramnath refused to listen to those who were present and advised her against administration of adrenaline. I am not sure how Dr. Ramnath could come across arrogant and lacking humility, while sitting next to her attorney?
But at the end of the day this seems like three peoples word against one.
Re: Dr. Priya Ramnath
Post by Surgical Trainee on Feb 9th, 2009, 04:01am
I have been following this thread with interest. There is a healthy discussion about this issue in the BAPIO (British Association of Physicians of Indian Origin in UK) forum Indi_go. BAPIO won a landmark court case last year against Department of Health UK.
Though I am surgical trainee, I have some recent ITU experience from a leading University Hospital in UK. I was baffled why Dr Ramnath was found guilty of manslaughter for giving adrenaline. I do not know about the competence of her colleagues who were with her at that time and why they objected.
In my ITU we give Noradrenaline, Adrenaline, Metaraminol etc... in larger doses than was administered in this case.
I think the end result of this court case will be that doctors will have to let more people die form septic shock and taking the risk of being found guilty of manslaughter.
Will it not be ironic if one of these patients on the receiving end happened to be a solicitor, a witness or a family member from the prosecution....!
Re: Dr. Priya Ramnath
Post by solicitor on Feb 9th, 2009, 06:50am
vjay, in relation to the following questions you raised
"By the way not testifying in your own defense does not mean you are arrogent. This is done by the counsel of your attorney who basically decides that putting a witness on the stand may open up for cross examination" - I agree, but the family and witnesses may take a different view. The decision not to give evidence is a higly risky one, and one which dr ramnath would have been properly advised about at court. The risk is that inferences can be drawn by the jury about her not giving evidence, as what may or may not have happened when the jury were deliberating.
"And if she does not appeal to superior court, that does not mean she is guilty but simply may indicate that they may decide it is far cheaper to spend six months in jail than to spend large sum of money to challenge the court rulings. ( I have a feeling that she probably would not challenge the decision, unless her attorney can come up with some legal technicality.)" With respect, she has been found guilty and convicted of gross negligent manslaughter. This is irrefutable. The choice would be hers should wish to appeal it, though she would be hard pressed to find grounds and legal standing to do so.
When judge said, "arrogance is not attractive" she was simply referring to the allegation that Dr. Ramnath refused to listen to those who were present and advised her against administration of adrenaline. I am not sure how Dr. Ramnath could come across arrogant and lacking humility, while sitting next to her attorney? Dr Ramnath's arrogance was proven in court, and the Judge referred to this, calling it her "defining failure" to arrogantly refuse to listen to colleagues. "Your arrogance has ruined your reputation."
"But at the end of the day this seems like three peoples word against one." This view is incorrect - it was 12 people. The jury. The jury ruled on three independant witnesses who testified at court. Adding to that forensic evidence of the quantity given, and the unlawful killing verdict by the coroner, and the evidence against Dr Ramnath was overwhelming.
Thank you again.
Re: Dr. Priya Ramnath
Post by Dr Kaur on Feb 9th, 2009, 07:43am
Dr Priya was arrogant and ignorant she didn’t take notice from experience nurse, this kind of behavior is totally not acceptable in modern medicine.
“Another goes down the drain! Fact is England is the most racist place on earth, IMGs are used as slaves (staff grade and associate specialists) and when any thing goes wrong they are easliy made scape goats.”
Maybe The GMC need to carefully assess which medical institute dished out the qualification. Some apart of the world medical training establishments can be very corrupt. International medical graduate most comply with highest ethics and rules of UK.
Dr Kaur Re: Dr. Priya Ramnath
Post by RB on Feb 9th, 2009, 08:14am
I would have thought that Dr Ramnath should be covered by a medical defence union who would pay for legal expenses. In such an important case they should pay for an appeal. If not then she should explore other avenues of financial support such as doctor based organisations. D grundy - I am sorry if you had personal involvement in what is a tragic event. In the last few years the NHS has made massive strides in trying to understand why medical errors happen and in attempting to minimise risks of reoccurrence. The best units I have worked in make a point of analysing any near misses or actual patient adverse events on a regular basis and try to work out what went wrong and how to change things. This can only be effective in an open culture where people are not afraid to admit to their mistakes. Individuals would be more likely to cover things up if they fear criminal proceedings. This would be a serious backward step. Every single doctor makes mistakes at some point - luckily most of these do not result in serious patient harm. Where harm is caused hospital/GMC and legal proceedings may all result, the doctor may lose their licence and the hospital will have to demonstrate how to change their policies for the better. However a manslaughter charge is only justifiable in only the most exceptional and indisputable of cases. Although I have not heard the evidence of the Dr Ramnath case - Dr Coakely a highly regarded intensivist from a London ITU did review the evidence. He did not believe the adrenaline bolus to have killed the patient. From an earlier posting I understand that Dr Coakely would have been paid for acting as a defence expert witnesses however to imply that this would have influenced his decision is ridiculous. No-one would put decades of professional training on the line in this way, furthermore he would not benefit from giving any opinion other than that which he truly believed to be correct. In medicine an individual doctor will never have all the answers, we generally only train in one or two specialties. When something falls outside of our scope of medicine or experience we rely on a specialist senior review/opinion for guidance. That is why Dr Coakely's opinion is more useful then the opinion of the doctors who attended on the day of Mrs Leighton's death (particularly as the junior doctors giving evidence against Dr Ramnath do not appear to be ITU or anaesthetic trainees). I realise that Mrs Leighton’s family must have gone through unimaginable stress over the last decade and need ‘closure’ but I am not clear that this was the right way of obtaining it. Everyone who works or uses the NHS has an interest in making it fit for purpose, no-one wants bad, or arrogant doctors who do not listen to reason. It would be a real step backward if instead of identifying these individuals early we find that they are buried because we have stopped actively looking for and tackling our mistakes head on. Re: Dr. Priya Ramnath
Post by RB on Feb 9th, 2009, 08:26am
Re With respect, she has been found guilty and convicted of gross negligent manslaughter. This is irrefutable. The choice would be hers should wish to appeal it, though she would be hard pressed to find grounds and legal standing to do so.
No system is infallible - neither medicine nor the legal profession. At least with errors in the legal system there is the possibility of appeal.
Clarification from Solicitor
Post by solicitor on Feb 9th, 2009, 10:26am
RB - "particularly as the junior doctors giving evidence against Dr Ramnath do not appear to be ITU or anaesthetic trainees".
Forgive me, but you are incorrect on this point - the witnesses who gave evidence were all highly experienced individuals - three doctors with seniority over Dr Ramnath and one senior ITU nurse with over 40 years experience. Plus the Crown's expert witness is also highly regarded, altho his name escapes me for the moment.
Ultimately, it will always come down to who a jury believes - whether there is enough supportive evidence to tip the scales one way or the other. The Defence called one expert witness, against the Crown's five witnesses of fact and one expert witness. In my eyes, the amount of evidence presented to the jury was overwhelming, but that is not to say that it could have gone the other way - I honestly couldn't say which way it would have gone, as my previous posts indicate. All I know is that there was an arguable case for Dr Ramnath to answer, and she was subsequently tested by the court and found guilty.
In relation to Dr Coakley's evidence, I understand that the jury had to ask for both Dr Coakely's and the Crown's evidence to be restated as they could not believe that the difference of opinion to be that great - one saying that adrenalin did not cause the patient's death, the other saying it did. Counsel for the Crown and Defence had to sum the evidence up fro the jury once again.
With respect to Dr Coakely, whilst it was his professional opinion that Mrs Leighton did not die from an overdose of adrenalin, the coroner ruled that it was and presented a verdict of unlawful killing. The coroner , I understand, had access to pathology reports and toxicolgy reports which confirmed it. Dr Coakely was called by the Defence to call into doubt that finding, so as to attempt to introduce doubt into the jury's mind.
Ultimately, the jury convicted her, whether the medical evidence was their sole rationale or not. These comments are now purely academic.
Finally, my understanding is the Dr Ramnath has now returned to the States to continue her medical profession there. She will never be allowed to practice medicine in the UK, but will continue to do so in the States. Therefore, why bother appealing when nothing rests on it in this country? Her life is now in the States. She of course is entitled to appeal against her conviction here, but I believe she would struggle to find the legal grounds to do so. To appeal against a jury's conviction is the hardest thing to do.
Thank you Adam, your insightful remarks have helped many of us understand the event and the process. In incidence such as this there are no winners but may be this will give everyone involved an opportunity to put this behind us. What do you mean by Dr Ramnath is back in USA? She was sentenced to "six months imprisonment suspended for two years." Is she not already serving the sentence? - Vijay Mehta
Clarification from D Grundy
Post by D Grundy on Feb 9th, 2009, 12:00pm
Dear Dr Vijay Melita,
First of all I would like to make perfectly clear that the comment regarding Dr Ramnath's arrogance is not exclusively due to her not wishing to testify in her own defence. From your statement it is clear to me that you have never met the lady in question otherwise your opinion would undoubtedly be different.
Dr Ramnath administered 3ml out of a 10ml 1/10000 minijet. This was delivered by her intravenously after removing the ampule directly from the Cardiac Arrest trolley. Other concentrations were kept in the drugs cabinet safely under lock and key.
Regarding the admission under false pretenses, this is a key issue. On the night in question ITU was working to capacity when Sally Carter, the hospital bed manager, called looking for a bed for her patient who was on the move from Cannock Hospital to Stafford. She was told that there was no ITU capacity but Sally clearly stated that all the patient needed was "babysitting" until the morning. The patient could have equally ended up in the Maternity Unit. When patient finally arrived, her condition was far more serious than had been indicated. It was during the process of taking base-line readings by connecting leads to the various monitors that Dr Ramnath acted believing that what she was seeing was respiratory distress instead of static, even though she had been told by the very experienced nursing staff, to wait. The rest you know. What isn't generally known is that the senior management of the hospital had done a good job of covering the events of the night, even the incident forms that had been written by the nursing staff had been deleted by person or persons unknown. However, because Mrs Leighton was at the time of her death undergoing a drug trial, it was the drug company who instigated their own investigation and this resulted in them contacting the police. Had it not been for that, it is likely that nobody would have been any the wiser. I have to say, Dr Melita, that this happens far too often.
Dr Ramnath did not act in the best interest of the patient. She reacted because her judgment was questioned and she did not like it in the slightest which, knowing the doctor, I can assure you she was not an easy person at all to deal with. She did not like it in the slightest that, being a junior doctor she was in fact out of her depth and that the nursing staff had far more experience than her.
Dr Melita, these are the facts. You may chose to believe them or you may prefer to search for a different truth that you may find more palatable, but let it be stated that after 11 years of police investigation, a Coroner returning a verdict of unlawful killing and a subsequent trial (where I was present) that lasted 3 weeks all resulted in Dr Ramnath being found guilty of manslaughter. Nobody who has had any direct involvement in the case will have any doubt as to the appropriateness of the ruling.
She was irresponsible and did not act in the best interest of the patient. I don't doubt that she didn't mean to kill Mrs Leighton but her hubris resulted in Mrs Leighton's death. This was not an accident, it was an irresponsible act carried out by a very unstable individual in the absence of common sense and advice from her colleagues. She acted alone and she paid the price - even though she walked free from the court room.
As to your question of who I am, if you have been following the case closely you will know the answer to that question.
Thank you D Grundy for the information. - Vijay Mehta
Re: Dr. Priya Ramnath
Post by RB on Feb 9th, 2009, 12:30pm
Thanks – solicitor. Forgive me, but you are incorrect on this point - the witnesses who gave evidence were all highly experienced individuals - three doctors with seniority over Dr Ramnath and one senior ITU nurse with over 40 years experience. To agree with the above point the highly experienced trainees who gave evidence would specifically need appropriate training in ITU or anaesthetics to be credible in disputing the correct treatment of an apparently critically ill septic patient on ITU. Anaesthetics and ITU are different specialties to general medicine. Patients who require circulatory support are not cared for on general wards but on ITU and high dependency units where specialist staff administer drugs to support their circulation (this may include adrenaline and related medications). Anaesthetic and ITU trainees specifically pass examinations and train in how to use these medications. Trainees in general medicine sit completely different exams and tend only to use adrenaline in the settings such as cardiac arrest or severe allergic reactions. For example I am training in general medicine and have MRCP. I have completed 6 months of ITU where I was supervised by more senior trainees. I do not have the experience to know when to use adrenaline boluses in a septic patient. On the other hand if I either extend my ITU training or do a stint of anaesthetics then I am likely to become proficient in uses of adrenaline in non arrest situations. I am labouring this point because it potentially a vital problem with the Dr Ramnath case. Look at it this way - you don’t expect a gastroenterologist/ medical specialist to give you your anaesthetic. The doctor may be highly experienced but they are training in completely a different field and they would likely kill you. For the same reasons to be critical of another doctors actions you must at least have had substantial training in the specific area that you are disputing. Coming to the senior nurse present, she will have trained solely in ITU. I have the greatest of respect for senior nurses and have often bowed to their judgement particularly when I was starting my training. However I reserve my judgement to decide when I will go against their advice. The roles of doctors and nurses are complimentary but are clearly not the same and the training and responsibilities are obviously different. With regard to the rest of the posting – is it possible that the toxicology reports, expert statements etc. will come into the public domain? It is very interesting that the two medical experts gave conflicting advice regarding whether the adrenaline was the cause of death. Surely the medical experts would both have had access to the toxicology and pathology reports. If so then one could surmise that the toxicology/pathology reports could not have been that damning otherwise Dr Coakley would have also have come to the conclusion that adrenaline caused the death of the patient. (For example in the case of Colin Norris the nurse who killed patients – the dosage of insulin found in blood samples was massive and could not be accounted for by anything other than murder.) If the reports were kept from Dr Coakely and could potentially have altered his opinion to adrenaline causing the death – then there seems to have been a serious error in the legal proceedings. I agree that if the doctor has left the UK and does not intend to practice here again then she would be unlikely to appeal. Overall I am still not convinced yet regarding this conviction. Doctors posting on UK anaesthetic forums also seem puzzled. The evidence seems to support arrogance and (without knowing the adrenaline dose given) ?overdosage of a drug. Not necessarily manslaughter. As for it all being academic now – it is not! Generally serious untoward incidents in the NHS form the basis of changes in medical practice to minimise risk towards other patients. Cases like this are dissected by the medical defence unions and reported with learning points for us all. There may be many learning points to take away – an important one might be that ambiguous cases are better kept out of the criminal courts. Suspended sentence
Post by solicitor on Feb 9th, 2009, 1:15pm
Vijay - "What do you mean by Dr Ramnath is back in USA? She was sentenced to "six months imprisonment suspended for two years." Is she not already serving the sentence?"
The sentence is suspended for two years: ie: if she stays out of trouble and doesn't get arrested in the uk for ANY offence in the next two years, she will not have to go to prison. If she commits another crime in the UK, she will be sent to prison for 6 months. Hence why really the sentence is mere lip service as Dr Ramnath is back home in the States where the sentence does not apply to her, although the conviction may have bearing on her eligibility for a visa.
RB - the case of R v Ramnath is purely academic now as it is historical. People can argue that they dont believe the evidence showed x, y and z but the fact is that there was enough evidence to try Dr Ramnath for gross negligent manslaughter. The CPS would not have brought a prosecution if they did not consider the evidence would not have brought them a reasonable chance of obtaining a conviction.
For both legal and medical practitioners alike, however, the case does set a strong precedent for both professions. Out of this, let us hope that lessons can be learnt.
With regards to the tox reports, etc, these will have been held on the court file. Although considered "public documents", a person has to specifically request the documents and show grounding to retrieve them (as well as pay a fee). However, I fear that since a substantial period of time has now passed, there is the potential that these files will have been shredded as is custom in relation to file retention.
Once again, many thanks.
Thank you solicitor. - Vijay Mehta
Re: Dr. Priya Ramnath
Post by G on Feb 9th, 2009, 2:23pm
The message this sends out is to practice defensively. Do not take risks, and definitely stick with the "consensus view". Do not stick your neck out even though you may be sure that those around you may be incorrect or wrong. Just be "safe".
For the lawyers, who are not medically trained, I dont blame you for not truly understanding the dilemma and difficulties in this case. The coroner is not "all knowing", and even the pathologist is only giving his "opinion" of the facts. The case is most definitely in the grey area. Nobody will ever know what the patient ultimately died of.
We are breeding a generation of "defensive practitioners", to the great detriment of the patients.
My thoughts and My concerns
Post by Vijay Mehta on Feb 9th, 2009, 2:28pm
Now that it is all over, jury and judge has spoken and Dr. Ramnath (convicted) returns home. This may be over for many people but there are several issues that we as a society has to pay attention to.
1. Criminalizing medical practice in long run would be very detrimental. In every case where a medical practitioner is charged with manslaughter all the records should be published on internet for everyone to see and learn from it.
2. It may encourage a culture of cover up and discourage voluntary reporting of incidence because of the fear. In long run this may hamper medical progress.
3. Global Village: in Global economy if one nation takes much harsher view of medical errors compared to others it may influence the movement of physicians. Australia noted a significant decrease of supply of overseas physician after two Indian physician were ostracized.
4. Medical career is already a long and difficult road - a reason why western countries are not able to entice enough of local young men and women to the profession, and have to rely heavily on graduate from overseas schools. Now add the possibility that after all the hard work you may be defending your self against some large medical malpractice or criminal charges.
5. Medical practice is too complex. Just as in this case two prominent medical experts had opposite views on the cause of death. It is not uncommon in clinical practice for two well qualified physicians to disagree.
6. I think giving her a suspended sentence, the judge was fair to Dr. Ramnath in view of majority of jurors finding her guilty.
7. Bias based no race, religion or national origin is always a possibility. There is no way to judge if witness who go to the same church or have closer social identity may see things in different ways. While it may not be in this case but one has to accept this as a possibility.
8. I think all the overseas physicians in UK as well as those interested in long term integrity of medical care in UK need to use this incidence to develop definite guide lines and make sure enough protection exist for well meaning physicians who also make errors.
I like to thank everyone specially the solicitor and D Grundy for their input.
Re: Dr. Priya Ramnath
Post by cp on Feb 19th, 2009, 02:30am
I knew Priya; she was a warm and loving friend and devoted mother,wife and doctor.
I worked with her husband, who, long before all this happened, planned his move to the USA, so whatever people's opinions are about Priya's medical practice and general attitude to taking advice, please don't think she was in some way either running away, or devious in her return to America- I expect she wanted to be with her husband and children.I knew her eldest child- he was adorable, and 2 of my children are of a similar age- I can understand her children needing her near too.
It seems she made a mistake, a big mistake perhaps( I didn't know her at the time of the incident), but the trouble with the medical profession is that mistakes can have disastrous consequences. I think everyone( being human) has made mistakes at work.
I also really feel for the family of the lady who died- it must be hideously shocking to lose someone in this way.
I am concerned that ordinary people/society expects Drs to be perfect, in modern western society people go to the Dr expect a cure or fix for everything...but medicine is not all curing and Drs are real people.
I worked as a healthcare professional and often disagreed with colleagues- disciplines differ hugely in their approach- that is what forms rounded healthcare provision surely?
I wonder if this whole case is partly to do with society's expectations or society's litigiousness?
A saddening case all round.
Re: Dr. Priya Ramnath
Post by NF on Jun 5th, 2009, 3:00pm
Just so that you are all aware, Priya Ramnath is now back in India as she was not granted entry back into America or allowed to stay here.
Re: Dr. Priya Ramnath
Post by satishd on Jun 15th, 2009, 1:22pm
I hope it is not true. why she would not she be allowed back in to USA? I don't know much about laws., Does not make sense. Is it reliable information? Is it because she got suspended sentence? Her husband is us citizen, probably does not matter if that's how law is ! Any how, I wish her and her family best. They have gone through a lot. They do need fresh start. There is no perfect place. Living anywhere USA or INDIA, there always would be some advnatages and some disadvantages. sd
Re: Dr. Priya Ramnath
Post by tk on Sep 4th, 2009, 05:31am
Its really difficult to know what is real in this case, not having been right there and seen what has happened.
On one count, it would be terribly tragic to accuse someone who is a medical professional of killing a patient when I'm sure very few would ever have such intentions. Mistakes happen and can lead to dreadful consequences. On the other hand, if strict laws are not applied, how would we control medical neglect which seem on the increase all the time?
Difficult fine line to be partial on. She probably chose to go
Post by Vijay Mehta on Mar 12th, 2010, 2:44pm
Just so that you are all aware, Priya Ramnath is now back in India as she was not granted entry back into America or allowed to stay here.
I doubt if that is true. Is she wanted to come here and practice back she would have been allowed to do so. If the Texas Medical Board felt after receiving the information from England they could hold a hearing to decide. The same way immigration can not simply cancel your visa but give you and opportunity to present your side of the story. I believe she felt with all the publicity she and her family may be better off and chose to go to India rather than forced to go. Re: Dr. Priya Ramnath
Post by SR on Apr 28th, 2010, 9:55pm
I know her very well.We lost in touch since she left Rockledge, Florida. I feel very sad about the whole thing.I hope they are doing ok now....