Alder v Khoo: When One Test Can Signify the Difference Between Medical Negligence and Genetic Abnormality
I haven't written for a while, and the reason for this is that I have been trying - to no avail - to find arguments or debates or similar cases to the 2010 Queensland case of Alder v Khoo.[1] I’m going to provide a quick summary of the facts here, and hopefully this will elicit some form of discussion or debate.
The plaintiff was a baby who was diagnosed as having cerebral palsy after a hypoxic event while his mother was giving birth to him. The respondents contended that the plaintiff (Trent Ashley Alder) did not have cerebral palsy, but instead had Angelman’s syndrome. This is relevant to the determination of liability because cerebral palsy is a condition often brought on by birth hypoxia as a result of negligence on the medical professional’s part, whereas Angelman’s syndrome is a preexisting genetic condition. That is to say, if the child had Angelman’s syndrome, the respondents would be absolved from liability.
In Para [8] of Chesterman JA’s judgement, it is stated: ‘… The Queensland Angelman’s Association also notes that some individuals with Angelman’s Syndrome are misdiagnosed as having autism, pervasive developmental disorder or cerebral palsy. In the majority of cases, Angelman’s Syndrome can be diagnosed through a DNA test.’[2]
Several tests were carried out on Trent Alder, only one of which returned positive for Angelman’s syndrome. Nevertheless, this single positive test was sufficient for the court to stay proceedings until the appellant undergo further tests.
Why I’m so interested in this case is that I’m wondering whether any similar cases have occurred elsewhere. While it is true that the majority of cases can be diagnosed via a DNA test, what is contentious is that the minority of those children may have been misdiagnosed as having cerebral palsy, when indeed they had Angelman’s syndrome. I’m wondering what the degree of research into Angelman’s is in Malaysia, particularly. I’m wondering how many doctors have been made liable to pay damages for something that wasn’t their fault. If any one of you out there is familiar with the facts of this case or any similar cases or studies done on this, I’d love to talk. Feel free to comment here or drop me an email.
Medical negligence is professional carelessness committed by a physician or any relating staff members that does not conform to the accepted standards of medical practise and causes injury or even death to the patient.Most cases involve registered medical practitioners, doctors and surgeons, but similar principles are applied to relating staff members such as dentists, midwives, nurses, physiotherapists, psychologists and psychiatrists.
ReplyDeleteI came across your blog whilst looking for Malaysia specific material to teach my medical students. I thought it was worth pointing out that there are many causes of cerebral palsy and that it is not only caused by birth hypoxia. For example, infections in the mother when she was pregnant (intrauterine infections) or a structural defect when the brain was forming can also cause cerebral palsy. Cerebral palsy is an umbrella term for a group of conditions where the child has a problem with the brain causing problems with movement, posture and coordination. Hypoxia is not always a result of medical negligence as this can also occur whilst the child is in the womb.
ReplyDeleteThe Medical Directorate Queensland Spastic Welfare League diagnosed Trent Alder with hypotonic spastic quadriplegia in April 1990. Trent Alder suffered foetal distress and foetal bradycardia (hypoxia) prior to his birth. According to the CTG tracing his foetal heart rate plummeted to as low as 65 beats per minute for prolonged periods of time during the tracing that lasted for 3 hours and 20 minutes. According to RANZCOG guidelines this CTG tracing is completely abnormal and ominous. The correct response is a caesarian section. Unfortunately Dr Khoo was not at the Rockhampton Hospital when these episodes of foetal bradycardia occurred. The nursing staff informed me on that day of Trent Alder’s birth that they are sick do death of delivering Dr Paul Khoo’s babies.
Delete