A man who suffered an anaphylactic shock after hospital staff ignored a possible drug allergy flagged by his family doctor has been awarded €25,000 in damages.

The incident left the man with a permanent debility.

The incident dates back to January 2016 when the patient was referred to Mater Dei Hospital by his personal doctor for blood tests to determine the unknown cause of persistent fever. 

The doctor had flagged a possible drug allergy, filling in the relative box on the referral ticket with '? Augmentin'.

Upon admission to the hospital emergency department that afternoon, the patient was given paracetamol at the Triage 1 stage. He was later checked by a doctor and followed up with necessary tests. 

Whenever asked by doctors and nurses whether he was allergic to any drugs, the patient mentioned Augmentin, explaining that the drug made him nauseous. 

His wife had also alerted a nurse about the patient’s adverse reaction to that particular drug. 

The man was kept under further observation overnight.

The following day, at around 10.30am, he spoke to one of his daughters over the phone, reassuring her that he was feeling better. But just 30 minutes later, when the other daughter arrived at his bedside together with his wife, the patient was unresponsive.

Hospital staff promptly intervened and the man was rushed to emergency, where a team of medics administered CPR to resuscitate him.

The family was later informed that he had suffered cardiac arrest following a “sudden drop in blood pressure” after receiving an intravenous injection. His heart had stopped beating for 20 minutes. 

It later transpired he had been injected with Augmentin, which had triggered the anaphylactic shock that landed him in a coma.

His condition was deemed critical and he spent 18 days in ITU, where he was administered last rites.

When he finally emerged from the coma, the patient manifested signs of “fluctuating confusion and occasional wandering” and was kept under constant watch until he was discharged weeks later.

The then 58-year-old father, who worked as a manager at a family restaurant, never fully recovered and was subsequently certified as suffering a 40% permanent debility on account of that hospital ordeal. 

He sued the medical authorities, the Health Minister, the doctor and the nurse who took the final decision as well as all medical staff on duty that day for damages. 

When delivering judgment the First Hall, Civil Court, presided over by Mr Justice Toni Abela, declared that the minister was non-suited and also threw out the claim against curators appointed to represent unspecified members of hospital staff. 

The rest of the applicant’s claims were upheld. 

The court observed that hospital records showed that the patient’s allergy was documented neither at the Triage stage, nor on the emergency department's red admission form or the first nursing report. 

When asked by different doctors, the man said that Augmentin made him nauseous. In fact, the first doctor had jotted down ‘nauseated after co-amoxiclav but no overt allergic reaction.’ Two other doctors also put down ‘no known drug allergies (NKDA)’.

The nurse who was directed to administer the injection had asked the same question and after being told by the patient about nausea, proceeded as instructed by the doctor.

It was “uncontested and more than evident” that the harm suffered by the applicant was a direct consequence of that intravenous dose of Augmentin, said the court.

Were it not for the timely intervention by medics, the consequences could have been “far worse” or even fatal.

'Nausea not signal risk of allergy': staff

The doctors and nurses later blamed the patient himself for not explaining clearly enough his allergy to the drug, saying that nausea was considered a common side effect and did not signal risk of allergy.

But the court deemed it “incomprehensible” that doctors had “ignored and totally discarded” the query flagged by the applicant’s family doctor on the referral ticket, relying instead on what the patient told them.

The patient clearly lacked medical knowledge and could not distinguish between allergy and nausea, went on the court.

The nurse had also tried to offload responsibility by claiming that the patient had not been wearing a ‘red bracelet’ flagging such allergy. 

But a medical expert testifying in court had explained that in his long years of practice he had rarely come across patients wearing such bracelets.  

'Doctor's query was red alert': expert

The query flagged by the man’s doctor was a “red alert” and that doubt had to be checked, the expert testified.

Until proved otherwise, the patient was to be treated as allergic.

The expert’s conclusion was deemed “just and correct” by the court which declared that the decision to administer the drug, and worse still intravenously rather than orally, lacked diligence and caution.

That shortcoming brought about a “drastic worsening” of the patient’s condition and thus damages were to be borne by the Chief Medical Officer, the doctor who gave the final order and the nurse who injected the patient in 60%, 30% and 10% shares respectively, according to their level of responsibility. 

Those damages, after taking into account various factors including the applicant’s gross salary prior to the incident, his five years to pensionable age and his 40% debility, were calculated as totalling €25,557.60.

Lawyers Edward Gatt and Mark Vassallo assisted the applicant.