Barbara Gayle, Staff ReporterEight years ago a young woman went to the Cornwall Regional Hospital for treatment because she was suffering from a sore throat. She was given two injections and shortly after complications set in.
Coleen Burrell said she felt numb in the lower limbs after she got the injections on December 4, 1994. The nurse assured her that that was the normal side effect of penicillin and the feeling would soon disappear.
When she went home her condition became worse and she had to return to the hospital where she was admitted from December 5 to 19, 1994. She was then diagnosed as suffering from the rare disease - Stephen Johnson's Syndrome (SJS) which can lead to blindness and death. There is no known cure for SJS. The long-lasting and debilitating effect of SJS is that it can leave the victim totally blind.
Miss Burrell was transferred to the Kingston Public Hospital where she was admitted from December 19 to April 5. Miss Burrell, a store clerk now has a 70 to 90 per cent loss of vision.
She filed a negligence suit against the Cornwall Regional Hospital Board of Management and the Attorney General, contending that it was the penicillin administered on December 4, 1994 which led to an attack of SJS. She said she developed an allergic reaction that precipitated the attack of SJS, leaving her with very poor vision.
Mr. Justice Bryan Sykes heard the suit in the Supreme Court last month and although he found that the doctor and nurse were negligent in their failure to give Miss Burrell a penicillin test, the judge threw out her case on the ground that the injection did not cause the disease as later tests proved that she was not allergic to penicillin.
Allergic reaction
In reviewing the evidence, the judge pointed out that Miss Burrell, the plaintiff and her witnesses said that Dr. Wright did not ask her if she were allergic to penicillin. When the plaintiff woke up on the morning of December 5, 1994, she noticed that her eyes were not opening and they were feeling sticky. She struggled to the bathroom to wash her face and "the more she washed her face the more the stickiness kept coming."
She looked in the mirror and noticed that her eyes were not just oozing the sticky substance but there were also dark bumps on her forehead, ears and around the eyes.
The judge said that from the medical evidence, that was clearly the early stage of SJS. The judge pointed out that from December 19 to April 1995 while she was at the Kingston Public Hospital her eyes were closed.
Dr Manolina Malenova, senior medical resident at the Cornwall Regional Hospital who was part of the medical team treating Miss Burrell, disclosed that Miss Burrell was in great pain and discomfort as her body was covered with lesions. "This must have been quite traumatic and frightening for a 16-year-old girl," the judge remarked.
Dr. Malenova said that the disease was a mucocutaneous disorder that affected areas of the body that had mucuous membranes such as the eyes, mouth, anogenital region and the skin.
The doctor said that she would not expect a doctor exercising ordinary skill and competence to diagnose SJS if a patient had sore throat, temperature, inflammation of the eyes and rash. She said those symptoms and signs could be the beginning of any bacterial or viral infections.
Dr. Valens Jordan, an ophthalmologist, said the disease attacks the moist areas of the body including the eyes. He said the areas developed swellings called vesticules some of which have blood in them.
Ruptures
The vesticules rupture and the rupture leads to the formation of adhesions. He said when the vesticules ruptured in the eyes, adhesions were formed between the eyeball and eyelid.
The eyelid is pasted to the eyeball and that leads to scarring and damage of the eyeball with the consequential loss of vision. Dr. Jordan said that Miss Burrell suffered loss of vision between 70 per cent to 90 per cent. He said spectacles would not help because the cornea of the eye was too scarred .
He said contact lens could not be worn because the eyes lacked moisture. Miss Burrell has been given medication to moisten the eyes and have to use the medication for the rest of her life. She has 20/200 vision which means that she has to be within 20 feet of an object to see it while a person with normal vision can see the same object from 200 feet.
The judge said it was common ground that Miss Burrell suffered an attack of SJS. The hospital came to the conclusion in 1994. "The issue in this case is whether Dr. Wright and the nurse who administered the penicillin were negligent in how they treated the patient and if they were, did their negligence precipitate the plaintiff's SJS?" the judge said.
"There is no evidence in the records that she was asked about penicillin on December 4, 1994 and neither does it show that any test dose was done on December 4, 1994," the judge said. He pointed out that both doctors had said that any doctor of ordinary skill and competence should comply with the procedure already prescribed whenever they were going to prescribe or administer drugs.
Negligent
"I find that Dr. Wright and the nurse were negligent. Dr. Wright and the nurse breached their duty of care to the plaintiff. Dr. Wright should have taken the necessary precautions himself or he should have seen to it that it was done by the nurse if he could not have done it himself. The clear evidence is that the nurse herself did not make any of the enquires outlined by Dr. Jordan and Dr. Malenova."
The judge said the next question to ask was did that act of negligence precipitated or cause the development of SJS. He said the relevant entry in the docket indicated that a penicillin test was done on December 6, 1999 and the test was negative.
The judge said that although SJS may follow an allergic reaction, it would not be true to say according to both doctors that allergies cause SJS. The judge said he accepted that the penicillin test was done on December 6, 1994 which meant that Miss Burrell was not on a balance of probability, allergic to penicillin on December 4, 1994. He said that the symptoms which Miss Burrell presented on December 4, 1994 were in fact the early stages of SJS and were not caused by the penicillin administered by the nurse.
The judge further added that although SJS may follow an allergic reaction it would not be true to say according to both doctors that allergies cause SJS. The allergy seems to act as a trigger. The trigger can also be viral, bacterial or fungal infections.
There is no particular type of viral infection or fungal infection that triggers the illness. Drugs referring to prescription drugs have been known to precipitate SJS. The most common drugs being dilantin and penicillin, the judge said.
