Murang'a County detectives investigating the death of Eric Mwaura, 17, after an operation at Kenol Hospital on May 10 want to know how the doctor doubled as the patient's guardian.
Mwaura died under anaesthesia as doctors removed an implant from his broken hand. The preliminary report compiled by the detectives indicates that the surgeon who operated on the minor (name withheld) also signed the consent form for the minor's surgery.
The form transfers the risks associated with the surgical procedure to the patient, who agrees that all possible adverse effects, including death, have been fully explained, understood and consented to in advance.
In the case of a minor or an incapacitated patient, a close relative or guardian signs on their behalf. In Mwaura's case, the hospital signed the risk form as a parent or guardian, and investigators are trying to establish the legality of this.
"This is irregular because the doctor also assumed the role of the patient's parents. It is necessary to establish how this happened and whether it's standard practice," says the report.
Mwaura, who was a Form Four student at Kanunga High in Kiambu County, died of what Dr Peter Ndegwa's post-mortem report described as "complications from anaesthesia".
Dr Ndegwa's opinion was that the anaesthesia caused the patient to secrete excess fluid into his lungs — pulmonary oedema. He said the complication could have been easily detected with careful monitoring in the postoperative period.
Mwaura's mother, Mrs Charity Kirigo, 47, has vowed to seek justice for the death of her only child, adding that the hospital told her there was no need for her to accompany her son because it was a minor operation that could be done in her absence.
She lamented that the hospital still charged her Sh80,000, which included payment for the anaesthetic that killed her son.
"The bill included Sh19,000 for the anaesthetist, Sh38,200 for the surgeon and Sh15,000 for the theatre," she lamented.
Murang'a South Deputy County Commissioner Gitonga Murungi told Nation.Africa that the death was reported to Kenol Police Station ref OB number 32/13/05/2023 as a suspicious death.
He said the case is being handled strictly within the framework of due process and in collaboration with the medical board.
Mr Murungi said the case was technical but the government, as the duty bearer, had an obligation to assist both the patient and the hospital to put the matter in its proper perspective.
"The anaesthesiologist is in the spotlight because he was quoted in the autopsy. There are patient interview notes to identify associated risks and their triggers. Diligence in these two areas will go a long way in identifying the gaps in this death," Mr Murungi said.
An official incident report from Kenol Hospital, dated May 10, states: “The patient, registered as KHL-30911, underwent the procedure to remove the implant, which had six screws holding it together, under general anaesthesia.”
The report adds that the anaesthesia was reversed and the patient was taken to the recovery room, but one hour after the operation he suddenly collapsed and resuscitation efforts were unsuccessful.
The patient was pronounced dead at 9.54am, according to the report signed by the surgeon.
Investigators have demanded written statements explaining why the patient was given a general anaesthetic rather than a local anaesthetic, "given that metal removal surgery can be done under either".
They believe that the answer to this question will answer the question of what caused the patient to develop respiratory complications to the point where he had to be placed on oxygen support.
They are also looking for evidence of post-operative monitoring, detailing how long the anaesthetist stayed after the operation, to establish whether he was present when the complication began. Detectives believe this will help them establish whether there was any abandonment of the patient, which could form the basis of a negligence claim.
The detectives also want to know whether the hospital had a competent team familiar with post-operative pulmonary oedema at the time it responded to the crisis.
In the statement, the hospital should clearly indicate whether it has dealt with a similar crisis before, to understand the competence to perform such life-threatening procedures on patients.
Once the requested information is received, the national status of hospitals will be assessed in terms of the number of anaesthesiologists with experience in post-operative pulmonary oedema, standard treatment protocols and their differences between public and private hospitals.
The 2021 Readiness to Achieve Universal Health Coverage report noted that Kenya has "a low number of anaesthetists compared to the country's needs, the few are overworked and unmotivated, leading many to commercialise services".
It was noted that in pursuit of money, they are booked in many hospitals and after surgery, most do not wait to deal with post-anaesthesia complications.
