Final Moot Question

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.