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xx Re: Dr. Priya Ramnath
« Reply #30 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.

Thanks
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Vijay Mehta
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xx Criminalizing Medical Errors
« Reply #31 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.


« Last Edit: Feb 3rd, 2009, 2:53pm by Vijay Mehta » User IP Logged

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xx Re: Dr. Priya Ramnath
« Reply #32 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
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xx Time for Jury to decide
« Reply #33 on: Feb 4th, 2009, 09:51am »


http://www.sundaymercury.net/news/midlands-news/2009/02/03/patient-death-trial-jury-out-66331-22846000/

Patient death trial jury out

Feb 3 2009

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.
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xx Re: Dr. Priya Ramnath
« Reply #34 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).
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xx Accessory to manslaughter
« Reply #35 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. tongue

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.
« Last Edit: Feb 4th, 2009, 5:08pm by Vijay Mehta » User IP Logged

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xx Re: Dr. Priya Ramnath
« Reply #36 on: Feb 4th, 2009, 6:34pm »

Hi

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?

Thanks
Rao


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xx Re: Dr. Priya Ramnath
« Reply #37 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...
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xx Re: Dr. Priya Ramnath
« Reply #38 on: Feb 5th, 2009, 04:11am »

helpful information from the cps website

http://www.cps.gov.uk/legal/h_to_k/homicide_murder_and_manslaughter/#_GROSS_NEGLIGENCE_MANSLAUGHTER_1

Gross Negligence Manslaughter

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 [2005] 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 [2005] 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.
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xx Re: Dr. Priya Ramnath
« Reply #39 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"
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xx Re: Dr. Priya Ramnath
« Reply #40 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:

http://news.bbc.co.uk/1/hi/england/staffordshire/7874296.stm

Doctor guilty of fatal injection

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".

'Overcome hurdles'

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."


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xx Re: Dr. Priya Ramnath
« Reply #41 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.
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xx Re: Dr. Priya Ramnath
« Reply #42 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.

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xx Re: Dr. Priya Ramnath
« Reply #43 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 you.


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xx Thank God this is over
« Reply #44 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.
« Last Edit: Feb 9th, 2009, 6:32pm by Vijay Mehta » User IP Logged

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