Select a region
The Royal Court will be asked to decide whether doctors at Jersey Hospital failed in their duty of care to a patient who received treatment in the UK, by failing to ensure doctors there knew he required an interpreter.
Ismael De Freitas Ramos was referred to the Royal Free Hospital to help deal with with a congenital facial vascular malformation, known as a haemangioma, affecting his left upper lip and cheek.
He says that Jersey Hospital failed to ensure he would receive adequate information on the treatment he was to receive in the UK and that an interpreter would be there to make sure he understood.
He says he would have refused the embolisation treatment, which is used to block abnormal blood vessels, if he had been warned of the risks. The Royal Court's judgment notes: "The first complaint of the plaintiff was that he was not adequately informed of the risks of the treatment by the Royal Free or the risk of ulcerations/skin necrosis which could be of such a magnitude that reconstructive or plastic surgery would be required to correct the risk materialising. The plaintiff contends he would not have undergone or continued the embolisation treatment had he understood the extent of the risks of the ulcerations/skin necrosis."
Following the first stage of treatment on 30 May, 2014, the Royal Free removed damaged tissue to Mr Ramos' face, who then underwent six operations at Jersey Hospital by way of reconstructive surgery. Mr Ramos argues that Jersey Hospital is responsible for the actions of the Royal Free because "...he was being treated and advised in Jersey and was in that context referred by the consultants at the Hospital, who were in charge of his treatment, to the Royal Free." He also says that the hospital owed him "...a non-delegable duty (...) and is therefore directly liable for the Plaintiff's (Mr Ramos) loss and injury."
Pictured: The Royal Court will be asked to decide where the Hospital's duty of care towards Mr Ramos ended.
Advocate Steve Meiklejohn, defending the Hospital, said that its employees "...were not under any duty to advise on the risks of specialist treatment." He however accepted that if there was a non-delegable duty of care owed by the defendant, in which case, if a breach of such a duty was established, the defendant would be held liable for any failure by the Royal Free to advise of the risks of the course of treatment carried out on the plaintiff.
Advocate Meiklejohn explained that for the hospital "...once a patient was referred to another hospital that patient was no longer under the care of the hospital and therefore the defendant’s obligations ceased. At that point in time the patient referred was no longer in the custody, charge or care of the defendant." He added that Jersey Hospital had no control on how the plaintiff might be treated once the referral took place.
Advocate Rui Tremoceiro, defendida Mr Ramos, said that "...for each referral of a patient, the defendant was under a duty to ensure that a patient could give informed consent. In this case, this duty meant firstly ensuring that the relevant staff at the Royal Free were aware of the plaintiff’s need for an interpreter and also taking steps to ensure that the plaintiff was provided with the services of an interpreter in relation to the risks of his treatment."
He argued that in Mr Ramos's case, treatment by the Royal Free was to reduce the size of the growth for the remainder of the growth then to be removed in Jersey. "The treatment by the Royal Free was therefore an integral part of the treatment the defendant was providing to the plaintiff in Jersey. The defendant’s commitment was to provide a hospital service to deal with medical problems. A referral to the Royal Free was simply part of that service."
Advocate Matthew John Thompson, Master of the Royal Court, refused to grant a summary judgment on the subject and said: "While there might be limits on any non-delegable duty of care, those limits were a matter for trial because they had to be worked out on a case by case basis. (...) The boundaries of what the hospital or school has undertaken to provide may not always be as clear cut as in this case and in Gold and Cassidy , but will have to be worked out on a case by case basis as they arise.”
The matter will now go to trial in the Royal Court next year at a date that has yet to be set. The Court will be asked to decided "...whether or not that the defendant owes a non-delegable duty of care to the plaintiff for the treatment the plaintiff received from the Royal Free. (...) This question matters because it goes to the extent of the obligations on the defendant to provide health care to Island residents. In particular, is there an obligation on the defendant to provide any health care or is the responsibility simply to provide such health care that can reasonably be afforded. This question requires evidence which may be complex and which it is not appropriate to determine at a summary judgment hearing."
Advocate Thompson however warned that Mr Ramos might not prevail at trial. He noted in the conclusions of his judgment: "In reaching this view, nothing in this decision should be taken to mean that either the defendant or the Royal Free have acted in breach of any duty that might be found to be owed to the plaintiff. Even if a duty of care is found to be owed, the plaintiff will still have to establish a breach of any such duty at trial."
Comments
Comments on this story express the views of the commentator only, not Bailiwick Publishing. We are unable to guarantee the accuracy of any of those comments.