Dear students,
The following attached are the final moot question. Please take note that if you are representing appellant during the preliminary round, you are going to represent the same party which is appellant during the final round and same goes to respondent.
Law Moot Director.
English
IN THE COURT OF APPEAL, MALAYSIA
AT PUTRAJAYA
[APPELLATE
JURISDICTION]
MOOT NO. OF 2013
BETWEEN
DR. ERIK ANAKIN LAU & ANO …APPELLANTS
AND
LUNA RAIM
KARIN (A MINOR)
(THROUGH ELISABETH
ZIRYAB, HER MOTHER
AND
LITIGATION REPRESENTATIVE) …RESPONDENT
Background of the case
The Plaintiff (the Respondent) a minor suing through her
Mother and Litigation Representative had sued the Defendants (the Appellants)
for medical negligence resulting in her blindness. The first Defendant is Dr.
Raven Sparks, the medical consultant. The
second Defendant is Dr. Erik Anakin Lau
while the third Defendant is Pantai Medical Centre, Ayer Keroh, Melaka i.e the
Hospital.
The infant Plaintiff, Luna Raim Karin was born at 3.25 am on
24/12/2010 at the Hospital (the ‘Second Appellant’). She was born at about 30
weeks gestation i.e premature, having been born about 10 weeks before her
estimated date of delivery on 25/02/2011.
At birth, the Plaintiff had slight generalized blueness with chest
recession respiration indicating that she had problems with breathing. She was
thus placed in an incubator and given oxygen at the rate of 5 liters per minute
(1/min) into a hood around her head and a further 5 liters 1/min into the
incubator. Due to her illness, she was referred to Dr. Raven Sparks, who was an
Honorary Consultant Visiting Pediatrician for the Hospital, by the obstetrician
who delivered her. The First Defendant saw the Plaintiff later that day and
from the records, she found her to be a premature infant. By then, the blueness
or cyanosis had improved. Although the Plaintiff’s breathing was still with
minimal chest recession, nevertheless, she was not grunting and was not in
distress. After being satisfied that the Plaintiff’s condition was stable, she
reduced the oxygen level to 3 liters 1/min and thus stopped the incubator
oxygen. She passed the management of the Plaintiff to the Second Defendant (the
‘First Appellant’) care i.e. Dr. Erik Anakin Lau as she was going on leave and
in effect saw the Plaintiff only on that occasion.
At all material times, the Plaintiff was attended to by
nurses in the employment of the hospital and although various nursing notes
were produced on the agreed bundle, none of the nurses gave evidence.
The Second Defendant saw the Plaintiff on 25/12/2010 at 9.00
am. According to the Second Defendant's medical report, on that day the Plaintiff
was in a critical condition and was suffering from peripheral cyanosis and
minimal chest recession with evidence of respiratory distress. The Plaintiff
had been given antibiotics to cover the infection.
The Second Defendant also stated that the nurses had noted
'can afford incubator' implying that the matter of transferring the Plaintiff
to the Malacca Hospital was discussed with the parents but they chose to remain
at the hospital. This was because it was expensive to keep the plaintiff in the
incubator and to administer oxygen as well.
On the third day, the Plaintiff suffered an intraventricular
haemorrhage which was spontaneous and unavoidable. She turned blue four times
that day and in fact at 1.35pm the Plaintiff stopped breathing for one minute.
However, she responded to external cardiac massage and began to breathe again.
Because of this, the Second Defendant started the incubator oxygen at the same
rate while at the same time the hood oxygen was maintained. An umbilical vein
drip was also set up.
On the fourth day, the Plaintiff had a tinge of jaundice but
the second defendant noted that the incubator oxygen was taken off that day. On
the fifth day, her jaundice was satisfactory but she suffered several outs of
fits. On the sixth day, the Plaintiff's condition was satisfactory and the drip
was removed. Although her respiration was irregular and she had mild jaundice,
was no more suffering from fits.
On the seventh day, her condition was satisfactory. On the
eight day, the Plaintiff was well and active but still had some jaundice.
Oxygen into the hood was reduced to 3 litres per minute. On the ninth day, it
was further reduced to 2 litres per minute. On the tenth day, it was stopped.
At the same time, the incubator oxygen was restarted and maintained at two
litres per minute.
On the 11th day, the oxygen was stopped. The plaintiff still
had some jaundice and weighed for the first time at two pounds and eleven ounces.
On the 21st day, having progressed well, he was taken out of the incubator. It
is pertinent to observe at this juncture that the day by day report indicate
that the plaintiff progressed well with the amount of oxygen administered and
the result was that he survived the ordeal.
The Plaintiff was discharged on 07/02/2011 weighing five
pounds and four ounces. The Second Defendant had asked the Plaintiff's parents
to bring her back in a month's time for a follow-up at the Third Defendant's
clinic. Upon discharge, the Plaintiff’s parents were not informed of the complications she had suffered
or possible risks that she could face due to the
oxygen therapy.
The Plaintiff’s mother started to notice something different
about her infant when the Plaintiff’s eyes did not move or respond to any objects in front of her. This happened when the Plaintiff was about
five months old. The Plaintiff’s parents then
brought her to an Ophthalmologist, Dr. Serena Song who confirmed that the Plaintiff was suffering from retrolental fibroplasia
(RLF) or Retinopathy of Prematurity (ROP) due to excessive oxygen. The Plaintiff is blind in both eyes till today.
The Plaintiff’s claim against the First and Second
Defendants is for inter alia damages for pain
and suffering due to their negligence resulting in her blindness when the Plaintiff was under their care. Her claim
against the Third Defendant is also for inter alia damages negligent medical
care and vicarious liability for the negligence of the First and Second
Defendants by virtue of being the employer and/or principal of the First and
Second Defendants since the negligence occurred during the course of the First
and Second Defendants’ employment and/or consultancy with the Third Defendant.
The High Court Judge awarded the Plaintiff RM700,000.00 as general damages. The First Defendant has not been negligent
in this case as the Plaintiff was under her care for only a short period and
that during that time she had, used her clinical judgment to administer
adequate oxygen required by the baby. Furthermore, there is no causal link
between her acts and the blindness which the Plaintiff has unfortunately
suffered. Thus, claim against her was dismissed. The Second Defendant however,
the Judge had categorically stated that the he was only negligent in not
alerting the Plaintiff's parents at the time of discharge of the possible onset
of RLF. In this respect, the Second Defendant had categorically stated in his
report that it was his practice to advise routine ophthalmic examination for premature
babies at the follow-up stage. As for the Third Defendant, the Judge has held
that the Hospital has failed to equip their nursery with the basic equipment as
recommended by the prescribed texts and the experts.
The Second and Third Defendants now appeal to the Court of
Appeal. The grounds of appeal from the appellants are:-
a)
The Second Defendant (the ‘First
Appellant) has no duty to alert the Plaintiff’s
parents at the time of discharge of the
possible onset of RLF and/or ROP; and
b)
The Third Defendant (the ‘Second
Appellant) had not failed in equip the nursery with basic equipment as
recommended by the prescribed texts and experts.
BM
DALAM MAHKAMAH RAYUAN, MALAYSIA
DI PUTRAJAYA
[BIDANGKUASA
RAYUAN]
NO. MOOT TAHUN
2013
DI ANTARA
DR. ERIK ANAKIN LAU DAN LAIN-LAIN PERAYU
DAN
LUNA RAIM
KARIN (SEORANG KANAK-KANAK)
(MELALUI ELISABETH
ZIRYAB,
IBU DAN
WAKIL LITIGASINYA) RESPONDEN
Latar belakang kes
Tuntutan Plaintif (‘Responden’) (melalui ibu dan wakil
litigasinya), yang merupakan seorang kanak-kanak terhadap Defendan-Defendan
(‘Perayu-Perayu’), masing-masing sebagai pakar perubatan dan pihak hospital, antara
lain adalah, gantirugi kerana kecuaian
Defendan-Defendan yang mengakibatkan cacat penglihatan dan/atau buta terhadap
Plaintif. Defendan Pertama adalah Dr.Raven Sparks, seorang Perunding Pelawat Pediatrik.
Defendan Kedua adalah Dr.Erik Anakin Lau dan Defendan Ketiga adalah Pantai
Medical Centre, Ayer Keroh, Melaka.
Plaintif adalah seorang kanak-kanak, Luna Raim Karin
dilahirkan pada 3.25 pagi pada 24/12/2010 di Defendan Ketiga (‘Perayu Kedua’). Beliau
dilahirkan kira-kira 30 minggu kehamilan iaitu pra-matang, kira-kira 10 minggu
sebelum tarikh jangkaan dilahirkan iaitu pada 25/02/2011. Di awal kelahirannya,
kulit Plainitf bertukar sedikit biru serta menunjukkan bahawa dia mempunyai
masalah dengan pernafasan. Oleh itu, dia telah diletakkan dalam inkubator dan
diberi oksigen pada kadar 5 liter seminit (1/min) ke dalam hud sekitar
kepalanya dan lagi 5 liter 1/min ke dalam incubator tersebut.
Oleh yang demikian, Plaintif telah dirujuk kepada Dr. Raven
Sparks ('Defendan Pertama') yang merupakan seorang Perunding Pelawat Pediatrik
bagi Defendan Ketiga, oleh Obstetrik Plaintif. Apabila Defendan Pertama memeriksa
Plaintif berdasarkan dari rekod-rekod kesihatannya, beliau mendapati Plaintif adalah
seorang bayi yang tidak matang. Namun demikian, keadaan Plaintif beransur baik
dan tiada terdapat usur sianosis atau kulit bertukar biru. Walaupun pernafasan Plaintif
masih dalam keadaan minimum, namun, keadaan Plaintif adalah stabil dan tidak mengalami
masalah pernafasan yang kritikal. Setelah berpuas hati bahawa keadaan Plaintif
stabil, dia mengurangkan tahap oksigen ke 3 liter 1/min dan menghentikan oksigen
di inkubator. Oleh kerana beliau hendak bercuti, beliau kemudiannya menyerahkan
Plaintif di bawah jagaan Defendan Kedua (‘Perayu Pertama’) iaitu Dr.Erik Anakin
Lau. Malah Defendan Pertama hanya merawat dan/atau melihat Plaintif hanya pada
dan waktu ketika itu sahaja.
Didalam semua keadaan, Plaintif dibawah pemerhatian
jururawat-jururawat yang bertugas di Defendan Ketiga dan walaupun terdapat nota
dan/atau catitan rawatan daripada jururawat ditandakan sebagai dokumen yang
dipersetujui, tiada seorang pun jururawat dipanggil untuk memberikan
keterangan.
Defendan Kedua memeriksa Plaintif pada 25/12/2010 jam 9.00
pagi. Berdasarkan laporan kesihatan daripada Defendan Kedua, pada hari itu,
keadaan Plaintif adalah kritikal dan mengalami peripheral cyanosis dan minimal
chest recession berpunca daripada masalah pernafasan. Plaintif kemdiannya
diberikan suntikan antibodi untuk merawat jangkitan.
Defendan Kedua juga menyatakan bahawa, jururawat ada
mencatatkan nota yang menyatakan 'can afford incubator' (‘mampu menggunakan
rawatan inkubator’) untuk menandakan bahawa terdapat perbincangan untuk
memindahkan Plaintif ke Hospital Melaka kerana kos rawatan untuk merawat
Plaintif menggunakan inkubator serta oksigen adalah sangat tinggi.
Pada hari ketiga, Plaintif mengalamai intraventricular haemorrhage yang berlaku secara spontan dan tidak
boleh dielakkan. Keadaan Plaintif telah bertukar biru sebanyak 4 kali dan pada
1.35 pm Plaintif didapati berhenti bernafas selama satu minit. Namun, Plaintif
memberikan respon terhadap external
cardiac massage dan mula bernafas semula. Oleh yang demikian, Defendan
Kedua meyambung semula penggunaan oksigen ke incubator di paras yang sama
manakala penggunaan oksigen ke hud diteruskan. Satu umbilical vein drip juga disediakan.
Pada hari keempat, Plaintif mengalami sedikit jaundis tetapi
Defendan Kedua uga mencatatkan yang oksigen ke incubator telah dihentikan. Pada
hari kelima, jaundis Plaintif beransur pulih tetapi Plaintif mengalami beberapa
serangan fits. Pada hari keenam,
keadaan Plaintif amat memuaskan dan umbilican
vein drip telah dihentikan. Walaupun Plaintif mempunyai pernafasan yang
tidak sempurna dan sedikit jaundis, Plaintif tidak mengalami serangan fits lagi.
Pada hari ketujuh, keadaan Plaintif sangat memuaskan. Pada
hari kelapan, keadaan Plaintif sangat baik dan mula aktif walaupun terdapat
sedikit jaundis. Paras oksigen ke hud telah dikurangkan ke 3 liter 1/min. Seterusnya dikurang kepada 2 liter
1/min pada hari kesembilan dan pada hari kesepuluh ianya terus dihentikan.
Dalam pada masa yang sama, paras oksigen ke inkubator disambung semula dan
diteruskan pada paras 2 liter 1/min.
Pada hari kesebelas, penggunaan oksigen dihentikan. Plaintif
masih lagi mempunyai sedikit jaundis dan pertama kali diambil berat badannya
iaitu seberat 2 kilogram dan 11 auns. Pada hari yang kedua puluh satu, Plaintif
menunjukkan peningkatan kesihatan yang baik dan telah dikeluarkan dari
inkubator. Penting untuk dinyatakan disini bahawa, setiap laporan harian kesihatan
Plaintif menunjukkan kemajuan peningkatan kesihatan Plaintif serta paras
oksigen yang telah dijaga rapi merupakan fakor yang menyelamatkan Plaintif.
Plaintif kemudiannya dibenarkan pulang pada 07/02/2011
dengan berat badan seberat 5 kilogram dan 4 auns. Defendan Kedua telah meminta
ibubapa Plaintif untuk membawa Plaintif menjalankan rawatan susulan dalam masa
sebulan ke klinik Defendan Ketiga. Semasa kebenaran pulang, ibubapa Plaintif
tidak dimaklumkan akan sebarang komplikasi atau risiko yang berkemungkinan akan
dialami Plaintif akibat daripada penggunaan terapi oksigen.
Ibu Plaintif mulai mengesyaki sesuatu yang ganjil terhadap
Plaintif apabila kedua belah mata Plaintif tidak memberikan sebarang reaksi terhadap
apa jua benda di hadapannya Waktu itu, Plaintif berumur sekitar 2 bulan. Ibubapa
Plaintif kemudiannya, membawa Plaintif berjumpa dengan seorang Ophthalmologist, Dr Serena Song yang mengesahkan
bahawa Plaintif mengidap retrolental
fibroplasia (RLF) atau retinopathy of
prematurity (ROP) akibat daripada bantuan oksigen yang berlebihan. Kedua
mata Plaintif buta sehingga ke hari ini.
Plaintif kemudiannya menuntut terhadap Defendan Pertama dan
Kedua ganti rugi ke atas rasa sakit dan penderitaan (pain and suffering) dan menyebabkan kebutaan pada mata Plaintif
akibat daripada kelalaian merawat Plaintif.
Tuntutan Plaintif terhadap Defendan Ketiga pula adalah ke atas kerosakan (damages) kerana Defendan Ketiga
bertanggungjawab ke atas kelalaian Defendan Pertama dan Kedua berdasarkan
majikan-pekerja dan / atau sebagai perunding Defendan Ketiga semasa kejadian. Plaintif
juga secara khusus menuntut terhadap Defendan Ketiga di bawah vicarious liability.
Hakim Mahkamah Tinggi telah memutuskan bahawa Plaintif dibayar
ganti rugi am sebanyak RM700,000.00. Defendan Pertama pula didapati tidak cuai
didalam kes ini kerana Plaintif hanya berada dibawah jagaanya untuk satu tempoh
yang singkat dan dalam tempoh yang sesingkat itu, beliau telah mengaplikasikan
penilaian klinikalnya dalam penggunaan paras oksigen yang cukup untuk seorang
bayi. Malah, tidak terdapat kaitan diantara tindakan beliau dan kebutaan ang
dialami Plaintif. Oleh yang demikian, dakwaan terhadap Defendan Pertama adalah
ditolak. Namun demikian, Hakim memutuskan bahawa, Defendan Kedua hanya cuai
untuk tidak memaklumkan ibubapa Plaintif, semasa kebenaran pulang, akan
sebarang risiko RLF terhadap Plaintif. Dalam hal ini, Defendan Kedua telah
menyatakan dalam laporannya bahawa ia adalah amalannya untuk menasihati
pemeriksaan rutin ophthalmic untuk
bayi pra-matang di peringkat rawatan susulan. Bagi Defendan Ketiga, Hakim telah
memutuskan bahawa Hospital telah gagal untuk melengkapkan nurseri mereka dengan
peralatan asas seperti yang disyorkan oleh teks-teks yang ditetapkan dan
pakar-pakar.
Defendan Kedua dan Ketiga kini merayu ke Mahkamah Rayuan.
Alasan rayuan daripada perayu-perayu adalah: -
a) Defendan
Kedua ('Perayu Pertama) tidak mempunyai kewajipan untuk memberi amaran kepada
ibu bapa Plaintif akan berkemunkinan berlaku RLF dan/atau ROP sewaktu kebenaran
pulang; dan
b) Defendan
Ketiga (yang 'Perayu Kedua) tidak gagal dalam melengkapkan nurseri dengan
peralatan seperti yang disyorkan oleh teks-teks yang ditetapkan oleh
pakar-pakar.
