Medical negligence has become a growing area of concern in Sri Lanka’s healthcare and legal landscape. In this article, we explore a landmark case on medical negligence in Sri Lanka that has significantly influenced Sri Lankan case law and patient rights. This high-profile court decision sets a crucial precedent on how medical professionals are held legally accountable for malpractice, misdiagnosis, and treatment-related errors. Whether you’re a legal practitioner, a law student, or a healthcare professional, this case offers valuable insight into how the Sri Lankan legal system addresses negligence in the medical field. Dive in to understand the facts, the legal arguments, and the judgment that shaped the contours of medical negligence law in Sri Lanka.
Priyani E. Soysa v. Rienzie Arsecularatne
Case Title: Priyani E. Soysa v. Rienzie Arsecularatne
Court: Supreme Court of Sri Lanka | SC SPL LA APPLICATION NO. 141/98
Citation: 1999 2 SLR 179
Before: Amerasinghe, J., Wijetunga, J. and Bandaranayake, J.
Decided on: March 25, 1999
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Introduction
The Priyani Soysa v. Arseculeratne case is a landmark case in Sri Lanka Delict law, and that is medical negligence to be specific. The case looked at the malpractice of a well-known child specialist and landmark legal developments on establishing causation as well as awarding damages in medical malpractice cases. In this article, I shall deal with the facts of the case as also highlighting the legal battle and its importance to Sri Lankan delict law and medicine
Facts of the case
Rienzie Arseculeratne’s daughter, Suhani, who was 3 years old, was seen dragging her legs and showing involuntary movement of her upper limbs in April 1992. Suhani was then taken into a well-known Professor of Paediatrics, Professor Priyani Soysa.
After a clinical examination, Professor Soysa provisionally diagnosed Suhani with rheumatic chorea and admitted her to Nawaloka Hospital for further management. The prescribed treatment included medications such as valium, penicillin, and multivitamins.
But a few days after hospitalization, there was not much improvement in her condition. Seeing this lack of progress, Suhani’s parents decided to get a second opinion. Hence, Professor Sanath Lamabadusuriya was consulted too. Prof. Sanath diagnosied rheumatic chorea but noted atypical symptoms, including brisk tendon reflexes, which were inconsistent with the initial diagnosis.
This observation led him to order a CT scan, which revealed a brain stem glioma (BSG), a highly aggressive and inoperable tumor. Subsequent consultations with neurosurgeons, both locally and in the United Kingdom, confirmed the grim prognosis. Tragically, Suhani passed away shortly after returning to Sri Lanka.
Legal Issues
- Was there negligence in the diagnosis or treatment?
- Did the conduct of Prof. Soysa fall below the standard of care expected from a reasonable medical professional?
- Can prof. Sriyani Soysa held liable under medical negligence ?
Legal Proceedings
Arseculeratne filed a suit against Professor Soysa for using medical negligence on Suhani by not timely diagnosing the BSG and claiming negligence.
The plaintiff is claiming that the intervention of timely diagnosis would aid in prolonging Suhani’s life leading to far more significant benefits. This case went through several stages of the legal system in Sri Lanka:
- District Court of Colombo: The first hearing was ruled in favor of the plaintiff and granted a total of five million rupees, in reparations. The court stated that Professor Soysa was negligent in not ordering a CT scan earlier, which could have led to a timely diagnosis
- Court of Appeal: On appeal, they accepted the finding of negligence but also lowered the amount of damages. There was a strong emphasis placed that ‘under roman-dutch law, compensation should only be given in terms of loss of estate.’ which means compensation is limited to patrimonial loss.
- Supreme Court: The highest court overruled all prior decisions concluding that the plaintiff failed to establish causation on a balance of probabilities. The court reasoned that even if negligence were established, the inoperable nature of the BSG meant that an earlier diagnosis would not have altered the fatal outcome.
Legal Reasoning
- The court reiterated the principle that a medical professional is not liable merely because a patient dies or the treatment fails.
- Liability arises only if the conduct falls below the accepted standard of care of a competent medical professional in that field.
- In medical negligence cases, the court places high value on expert medical testimony to determine whether the standard of care was breached.
- The Supreme Court found no negligence on the part of Prof. Priyani Soysa.
- It was held that her decisions were in line with accepted medical practice, and she acted reasonably given the symptoms and available information.
Obiter Dicta
Justice Amerasinghe, has extracted a quotation from Aristotle (Rhetoric, 1.1) when delivering this judgment which states,
“It is best, as we may observe, where the laws are enacted upon right principles, that everything should, as far as possible, be determined absolutely by the laws, and as little as possible left to the discretion of judges.”
Broader Impact on the Medical Community
The case has a huge impact throughout the medical community in Sri Lanka:
- Medical Recording : Careful recording has come to the fore, ensuring that all clinical findings, diagnoses, and treatment plans are documented properly.
- Continuing Medical Education : Keeping up with advances in diagnostic technology and treatment methods has been reinforced, encouraging practitioners to seek continuing education.
- Patient Communication : The case highlighted the importance of transparent and compassionate communication with patients and their families, especially when faced with complex or terminal diagnoses.
Conclusion
The Priyani Soysa v. Arseculeratne case is a cornerstone in Sri Lankan law in the area of medical negligence, highlighting the balance between medical findings and delictual liability. It highlights the challenge of establishing causation in medical negligence.
The case has provoked reflection in the medical community on issues of diagnostic care, communication with patients, and the importance of comprehensive medical documentation.
And most importantly this case affirms the high threshold for proving medical negligence and underscores the protection given to medical professionals who follow accepted practices, even if the outcome is unfortunate.
Cases referred to
Following are the cases the judges have referred to when delivering this judgment.
- Rasheed Ali v. Khan Mohamed Ali (1981) 2 Sri LR 29 (C.A).
- Gangodagedera v. Mercantile Credit Ltd. (1988) 2 Sri LR 253
- Leelananda v. Mercantile Credit Ltd. (1988) 2 Sri LR 417, 419 (CA).
- Paramanathan v. Kodituwakkuarachchi (1988) 1 ‘Sri LR 315, 337 (CA).
- Brown & Co., Ltd. v. Ratnayake (1990) 1 Sri LR 92, 95-96 (CA).
- Ibrahim v. Nadaraja, (1991) 1 Sri LR 131 (SC).
- Kiriwanthe and Another v. Navaratne and Another (1990) 2 Sri LR 393.
- Rasheed Ali v. Khan Mohamed AH (1981) 1 Sri LR 262 (SC).
- Mary Nona v. Fransina (1988) 2 Sri LR 250.
- Karunawathi v. Kusumaseeii (1990) 1 Sri LR 127.
- Fernando v. Sybil Fernando (1997) 3 Sri LR 1.
- Read v. Samusudin (1895) 1 NLR 292, 294.
- Velupillai v. Chairman UDC (1936) 39 NLR 464, 465.
- Dulfa Umma et al v. UDC Matale (1939) 40 NLR 474, 478.
- All Ceylon Match Workers’ Union v. Jauffer Hassan and Others (1990) 2 Sri LR 420.
- Jayasuriya v. Sri Lanka State Plantations Corporation (1995) 2 Sri LR 379.
- Piyadasa and Others v. Land Reform Commission SC Appeal No. 30/97 SC Minutes 8 July, 1998.
- Chelliah v. Ponnambalam (1986) Sriskantha’s Law Reports vol. IV 61, 64.
- Caldera v. John Keells Holdings Ltd. (1986) Colombo Appellate Law Reports vol. I 575, 585.
- Collins v. Blantern 2 Wils KB 341.
- Master v. Miller 4 TR 320, 344.
- R. v. Wilks 4 Burr 2527, 2539.
- Duport Steels Ltd. v. Sirs (1980) ICR 161, 189.
- Alice Kotelawala v. W. H. Perera and Another (1937) 1 CLJ 58; VII CLW 61.
- Rasiah v. Sittamparapillai (1920) VII CWR 116.