The Civil Court yesterday awarded Lm4,680 damages to a woman in whose abdomen hospital staff left two packs of swabs.

But Mr Justice Geoffrey Valenzia also said that the case of Maria Dolores Farrugia merited the award of moral damages because she suffered from cosmetic impairment and depression after the incident.

Local legislation, however, did not provide for the award of moral damages, the judge noted.

He heard how Farrugia, who sued gynaecologist Dr John Mamo and the chief government medical officer, underwent a delivery by Caesarean section at St Luke's Hospital in July, 1993.

The operation was carried out by Dr Mamo.

Farrugia said she did not recover after the operation and later learnt that swabs had been left in her abdomen after the surgery. An operation to remove the swabs was carried out two years later.

Farrugia requested the court to find that Dr Mamo and the CGMO were responsible and to make good the damages she had sustained.

Both defendants denied responsibility and pleaded they had exercised due care and diligence in their duties.

Mr Justice Valenzia noted that the court-appointed medical experts had concluded that two swab packs had been left in the woman's abdomen in the course of the Caesarean delivery.

The experts declared that in their opinion the primary responsibility for the counting of the swabs rested with the scrub nurse and the runner nurse and they had not carried out their duties correctly.

Neither of the nurses was sued by Farrugia.

The experts also concluded that Dr Mamo could not be totally exonerated from responsibility, for he had inserted the swabs into the woman's abdomen, and that it was his duty to ensure that these were completely removed before completing the operation.

They added that the doctor had failed to take all reasonable precautions to avoid the incident.

The experts also concluded that the Health Department was also responsible for the incident, for the authorities were bound to provide all necessary equipment in the operating theatre, including facilities for the counting of the swabs, and a swab rack.

The hospital authorities had failed to provide the equipment which might have led to the accident being avoided.

Mr Justice Valenzia referred to the conclusions of the court-appointed legal expert who had found that the doctor was to bear one-third of the responsibility, the CGMO another third and the two nurses the remainder.

The court noted that the primary responsibility for the removal of swabs lay with the doctor, for he had inserted the swabs and was therefore responsible for their removal.

The surgeon was also responsible for the operating theatre, and the team he led, and it was he who had to take decisions on the surgery.

Thus the court concluded that the doctor was responsible for the incident.

It also found the CGMO responsible for it resulted that there was a lack of appropriate theatre equipment that could have avoided this incident.

The Health Department was responsible for providing equipment to the hospital, and the failure of the CGMO to provide equipment was proven.

The nurses who were responsible for the swab counting had not been sued by Farrugia, although the court-appointed medical experts had concluded that they bore the primary responsibility for the counting of the swabs.

The fact that swabs had been left in Farrugia's abdomen was a clear sign that the counting had not been carried out properly.

Dr Mamo in fact testified that prior to suturing Farrugia's wound, he was informed by the scrub nurse that the swab count was correct, meaning that all the swabs had been accounted for.

Thus, the nurses, said the court, were also responsible for the incident, for if they had carried out their work correctly, the incident could have been avoided.

In examining the damages to be awarded, the court noted that Farrugia had sustained a permanent disability of five per cent.

The court based its calculation of actual damages sustained on the minimum wage (to which Farrugia would have been entitled to had she been in employment) and awarded her Lm4,680 damages.

Dr Mamo and the CGMO were ordered to pay this sum jointly and severally to Farrugia.

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