https://new.kenyalaw.org/akn/ke/judgment/kehc/2026/7782

Onchiri (Legal & personal representative of the Estate of Pauline Kasesya Mwinzi) v Endere & another (Civil Case 4 of 2020) [2026] KEHC 7782 (KLR) (Civ) (2 June 2026) (Judgment) Neutral citation: [2026] KEHC 7782 (KLR) Republic of Kenya In the High Court at Nairobi (Milimani Law Courts) Civil Civil Case 4 of 2020 AN Ongeri, J June 2, 2026 FORMERLY CMCC 2836 OF 2016 Between John Kenyatta Onchiri (Legal & personal representative of the Estate Of Pauline Kasesya Mwinzi) Plaintiff and Dr Frank Endere 1st Defendant St Marys Mission Hospital Langata 2nd Defendant Judgment 1.The plaintiff in this case, John Kenyatta Onchiri sued the two defendants, Frank Endere And St. Mary’s Mission Hospital seeking the following remedies;a.Special damages of kshs.570,405.00b.General damages fori.Pain and sufferingii.Loss of dependencyiii.Loss of expectation of lifeiv.Loss of consortiumc.General damages for emotional distress and loss of longitude expectation.d.General damages for upkeep p and care of children as orphans.e.Costs of the suit. 2.The cause of action arose as a result of the demise of the plaintiff’s wife Pauline Kasesya Mwinzi (deceased) at the 2nd defendant hospital due to the alleged negligence of the 1st defendant. 3.The plaintiff, John Kenyatta Onchiri, acting as the legal and personal representative of the estate of Pauline Kasesya Mwinzi, filed the plaint dated 9th May 2016 amended on 24th February 2020. 4.He averred in the said amended plaint that on or about 18th May 2014, the deceased was rushed and admitted to the 2nd Defendant’s hospital after going into premature labour. 5.The 1st Defendant performed a caesarean section on the deceased on 20th May 2014 at 12.30 am, resulting in the birth of twin baby girls. 6.The deceased then experienced post-partum haemorrhage, and the 1st Defendant performed a second surgery on her at 3.00 am, a third at 5.00 am, and a fourth at 8.00 am on the same day, but failed to control the bleeding. 7.The 1st Defendant then referred the deceased to Kenyatta National Hospital, where upon arrival she was diagnosed with acute renal failure secondary to post-partum haemorrhage, caused by negligent handling. 8.The deceased died on 20th May 2014 at Kenyatta National Hospital due to massive intra-abdominal haemorrhage from the numerous surgeries. 9.The plaintiff particularizes the 1st Defendant’s negligence as failing to prevent or control bleeding by conducting more surgeries, operating without consultation with other experienced medical personnel, failing to obtain consent from the family before the second to fourth operations, handling the delivery negligently, administering procedures that aggravated her condition, failing to refer her earlier to a more advanced facility, failing to prepare a comprehensive referral report, and delaying in making critical decisions. 10.The 2nd Defendant’s negligence is particularized as permitting and condoning the negligent actions of its medical personnel and failing to refer the patient in good time to a more advanced facility. 11.The plaintiff incurred hospital bills at Kenyatta National Hospital and St. Mary’s Mission Hospital Langata, miscellaneous expenses, and funeral expenses including an advertisement fee. 12.The plaintiff filed a complaint with the Medical Practitioners and Dentists Board on 24th July 2014, sent further documents on 5th September 2014, and lodged a complaint on 30th September 2014. 13.The Board delivered a ruling on 11th March 2016 holding the Defendants liable for professional negligence. 14.After the Defendants filed Judicial Review Civil Application No. 229 of 2016, the parties filed a consent on 31st January 2016 dispensing with the judicial review and allowing the Defendants to be heard afresh by the Council. 15.The Council heard the Defendants and on 30th October 2019 delivered a ruling finding them liable for negligence. 16.The plaintiff maintains that both rulings confirm the Defendants’ negligence. 17.Despite demand and notice of intention to sue, the Defendants failed to admit liability or compensate the plaintiff. 18.The plaintiff sues on his own behalf and on behalf of his three children, P M, R K and L P. 19.The plaintiff prays for judgment against the Defendants jointly and severally for special damages comprising hospital bills (Kshs. 61,850), miscellaneous expenses (Kshs. 2,055), funeral expenses (Kshs. 156,500), costs before the Medical Practitioners and Dentists Council (Kshs. 300,000), and costs for obtaining letters of administration (Kshs. 50,000), totaling Kshs. 570,405; general damages for pain and suffering, loss of dependency, loss of expectation of life, loss of consortium; general damages for emotional distress and loss of legitimate expectation; general damages for the upkeep and care of the children as orphans; and costs of the suit with interests at court rates 20.The defendants filed statements of defence which they amended on 2/10/2020 and 19/10/2023 respectively denying the plaintiff’s claim. 21.The case proceeded by viva voce evidence. The plaintiff testified as PW 1. He produced his witness statements dated 9/5/2016 and a supplementary statement dated 17/8/2020 as his evidence in chief. 22.PW 1 stated in the said statements in summary that he is the legal and personal representative of the estate of his late wife, Pauline Kasesya Mwinzi. 23.He stated that on May 19, 2014, his wife was rushed to St. Mary’s Mission Hospital in Langata after going into premature labour. 24.He said she was admitted for observation on the advice of the 1st Defendant, Dr. Frank Endere. On May 20, 2014, at around 12:25 a.m., her labour pains became severe, and Dr. Endere recommended an emergency caesarean section. 25.He confirmed that Dr. Endere performed that procedure at approximately 12:30 a.m. on the 2nd Defendant’s premises, following which two baby girls, R K and L P, were born. 26.He further stated that after the caesarean section, his wife began bleeding profusely. Without informing him or seeking his consent, Dr. Endere performed a second surgery at around 2:50 a.m. on the same day. 27.He added that his wife’s condition worsened, and at about 5:00 a.m., Dr. Endere performed a third surgery, again unilaterally and without his knowledge or consent. 28.When her condition continued to deteriorate, Dr. Endere performed a fourth surgery at around 8:00 a.m. instead of referring her for specialized care. 29.He testified that throughout these events, both Defendants kept him in the dark about his wife’s condition. It was only after the fourth surgery that someone from the hospital called him to say her condition had deteriorated and that she was being referred to Kenyatta National Hospital. 30.At Kenyatta National Hospital, the attending doctor informed him that his wife had died at 7:35 p.m. on May 20, 2014, due to a massive intra-abdominal haemorrhage or post-partum haemorrhage. 31.The doctor confirmed to him that her death was caused by the four operations performed by the 1st Defendant at the 2nd Defendant’s premises, and that by the time she was referred, her condition was already beyond salvation. 32.The Plaintiff asserted that his wife’s death resulted solely from the negligence of the 1st and 2nd Defendants. 33.He particularized that negligence as follows;i.Failing to prevent or control bleeding while performing more surgeries that increased blood loss;ii.Conducting surgeries without consulting other experienced medical personnel;iii.Failing to obtain his consent for the second, third, and fourth operations;iv.Administering procedures that aggravated her condition;v.Failing to refer her early to a more advanced facility; and failing to prepare a comprehensive referral report. 34.He also contended that the 2nd Defendant was vicariously liable because it permitted and condoned those negligent actions, failed to refer the patient in good time, failed to maintain proper records and a referral system, permitted multiple surgeries without proper decision-making, and allowed a doctor who had not obtained necessary consultations to perform repeated surgeries. 35.As a result of the alleged negligence, the Plaintiff stated that he filed a complaint (PIC No. 31 of 2014) with the Kenya Medical Practitioners and Dentists Board on July 24, 2014. 36.He recalled that on March 11, 2016, the Preliminary Inquiry Committee found both Defendants liable for medical negligence. 37.Although the Defendants filed a Judicial Review Application (No. 229 of 2016), the matter was compromised by consent, and a fresh inquiry was conducted. 38.He further stated that on October 30, 2019, the Disciplinary and Ethics Committee of the Medical Practitioners and Dentists Board found the 1st Defendant liable for negligence in handling his late wife. 39.The Plaintiff testified that he lost his wife and incurred financial expenses totaling Kshs. 570,405, comprising of Kenyatta National Hospital bills of Kshs. 15,350; St. Mary’s Mission Hospital bills of Kshs. 46,500; miscellaneous costs of Kshs. 2,055; funeral expenses of Kshs. 156,500; costs of proceedings before the Medical Practitioners and Dentists Council of Kshs. 300,000; and costs for obtaining letters of administration in Probate and Administration Cause No. 2979 of 2015 of Kshs. 50,000. 40.He stated that he is now the sole caregiver of his three children, P M, R K, and L P, and that they will never experience their biological mother’s love and care due to the Defendants’ negligence. 41.Despite demand and notice of intention to sue, the Defendants refused to admit liability or compensate him. 42.He therefore sued on his own behalf and on behalf of his three children. 43.The plaintiff called three witnesses. PW2, an assistant director, Legal services at the Kenya Medical Practitioners and Dentists Council(KMPDC) a ruling and minutes from the Ethics and Disciplinary Committee at the KMPDC. 44.The plaintiff also called Dr Innocent Maranga(PW3) from Kenyatta National Hospital who produced a report dated 11/6/2015. 45.In that report, PW3 stated that the patient was admitted to Kenyatta National Hospital on 20th May 2014 with acute renal failure secondary to postpartum haemorrhage and possible disseminated intravascular coagulation (DIC) following emergency Caesarean section, multiple laparotomies, and a subtotal hysterectomy. 46.On arrival she was in hypovolaemic shock with severe pallor, low blood pressure, no urine output, and abdominal distension with non-clotting blood. 47.Despite resuscitation, blood products, medications, and involvement of renal, ICU, and haematology teams, her condition deteriorated rapidly. 48.She suffered cardiac and respiratory arrest at 6.45pm and was pronounced dead at 7.35pm on the same day. 49.PW4, Professor Grace Omoni also produced a report dated 18/7/2014. 50.PW4 stated in her expert midwifery report dated July 18, 2024, that the critical clinical failures that led to the death of Pauline Kasesya Mwinzi at St. Mary’s Mission Hospital Langata were that the patient, who was 37 weeks pregnant with twins and had two previous caesarean scars, was highly vulnerable, yet multiple red flags were ignored. 51.Prof. Omoni noted that the patient should never have been allowed to enter labor, and that her sweating and abdominal pain pointed to an unaddressed placental abruption. 52.Following a caesarean delivery of twin girls, the patient suffered severe hemorrhaging. 53.Rather than organizing an immediate referral to Kenyatta National Hospital (KNH), the attending obstetrician, Dr. Frank Endere, performed four consecutive surgeries within six hours, during which the patient developed Disseminated Intravascular Coagulation (DIC) and acute renal failure. 54.The transfer to KNH was further delayed by administrative demands for the family to clear bills and replace blood, and the patient was ultimately sent via a private ambulance with inadequate medical documentation. 55.She went into cardiac arrest and died shortly after arrival. 56.A post-mortem determined the cause of death to be a massive intra-abdominal hemorrhage resulting from a vascular injury inflicted during the initial caesarean section. 57.Prof. Omoni concluded that Dr. Endere was grossly negligent for failing to seek senior consultation or execute a timely transfer, findings mirrored by the Medical Practitioners and Dentists Council, which stripped Dr. Endere of his license and found both defendants liable. 58.She also censures the hospital for lacking emergency protocols and urges compensation for the grieving family. 59.The 1st defendant, DR. FRANK ENDERE, testified as DW1. He produced his written witness statement dated 1/7/2016 as his evidence in chief. 60.DW 1 stated in the said statement that he is the doctor-in-charge at St. Mary's Mission Hospital, states that the patient, Pauline Kasesya Mwinzi, was admitted to the hospital on May 19, 2014, at around 2:00 a.m. with premature labor, and he was the doctor managing her treatment. 61.He said that her condition did not stabilize sufficiently after several procedures, and because the hospital lacked specific necessary medical supplies, such as dialysis machines and fresh frozen plasma (FFP), he referred her to Kenyatta National Hospital on May 20, 2014, at approximately 11:00 a.m. 62.He stated in the statement that the patient unfortunately passed away at Kenyatta National Hospital later that evening around 8:00 p.m., adding his understanding that no treatment had been administered to her during the seven hours she was there prior to her passing. 63.Following her death, the deceased's husband lodged a complaint against Dr. Endere and St. Mary's Hospital with the Medical Practitioners and Dentists Board, prompting Dr. Endere to compile and submit a signed medical report. 64.He stated that he wishes to rely on the attached medical report as an accurate summary of his treatment and management of the patient between May 19 and May 20, 2014. 65.The said medical report stated in brief that Mrs. Mwinzi had a history of two prior Cesarean sections and was carrying twins, with the placenta attached to her anterior uterine wall over her old surgical scars. 66.She was admitted in labor on May 19, and at 1:00 AM on May 20, she underwent an emergency C-section, successfully delivering two healthy infants. 67.During this first surgery, a concealed abruption placenta hematoma was discovered. 68.Severe post-partum hemorrhaging quickly developed due to an atonic uterine muscle that failed to contract. 69.This triggered a rapid, life-threatening cascade of surgeries and extensive blood transfusions to halt the diffuse bleeding, a second surgery at 3:00 AM to pack the uterus, a third surgery at 5:00 AM to perform an emergency subtotal hysterectomy, and a fourth surgery at 8:00 AM for additional packing and a right oophorectomy. 70.Despite these aggressive surgical and resuscitative interventions, the patient developed severe hypovolemic shock, anuria, and an uncontrollable, consumptive disseminated intravascular coagulopathy. 71.The report concludes that the fatal outcome was precipitated by the concealed placental abruption at the old scar site and non-responsive uterine atony, rather than negligence, and that the patient ultimately failed to survive despite extraordinary efforts before her transfer to Kenyatta National Hospital. 72.The 1st defendant called one witness, DW 2 PROF. NELLY MUGO who produced her report dated 1/7/2024 in which she stated that her report evaluates the care provided to the late Pauline Kasesya Mwinzi at St. Mary's Mission Hospital Langata. 73.She said in the report that the patient presented with several severe, compounding risk factors for maternal hemorrhage, including anemia, a twin pregnancy, an abruption placenta, and a history of two previous caesarean sections. 74.Following an emergency caesarean section on May 20, 2014, that successfully delivered healthy twins, the patient developed severe post-partum hemorrhage caused by uterine atony, where the uterus fails to contract, and subsequent disseminated intravascular coagulopathy, a condition where the blood loses its ability to clot. 75.Prof. Mugo further stated that the hospital's maternity and surgical teams acted rapidly, decisively, and in strict adherence to medical protocols during an intense eight-hour period of continuous intervention. 76.When standard medical management failed to stop the bleeding, the team sequentially performed three distinct post-partum surgeries, an initial explorative laparotomy, a life-saving subtotal hysterectomy to remove the non-responsive uterus, and a final corrective laparotomy to manage abdominal oozing and secure five units of difficult-to-obtain fresh blood. 77.Once signs of acute renal failure and irreversible clotting failure emerged, the clinical team made a timely decision at 10:30 am to refer the patient to Kenyatta National Hospital for specialized renal and hematology care, ensuring she was stabilized as much as possible before transit. 78.The patient was officially referred at 11:00 am, but due to a significant four-hour transit delay, she was not admitted to Kenyatta National Hospital until 3:00 pm, where she ultimately passed away at 7:35 pm. 79.Prof. Mugo emphasizes that post-partum hemorrhage remains an unpredictable and leading cause of global maternal mortality even in the best facilities, and she firmly states that this tragic outcome does not place blame on the St. Mary's clinical team, who exhausted all medical measures to save the patient's life. 80.The 2nd defendant called one witness DW 3, DR. VICTORIA MVIKU who is a medical practitioner at the 2nd defendant hospital. 81.DW 3 produced her statement dated 11/12/2020 as her evidence in chief. 82.DW 3 stated in the said statement that he deceased was a high-risk patient with a twin gestation, anemia, and two previous scars, whose hemoglobin was successfully managed prior to her admission on May 19, 2014. 83.After developing an acute abdomen the following morning, she was rushed to theatre for Abruptio Placentae, delivering live twin babies. 84.The patient subsequently suffered post-partum hemorrhage caused by uterine atony, a known risk of twin pregnancies. 85.Despite receiving uterotonics, blood transfusions, and a emergency hysterectomy, she developed non-clotting blood due to disseminated intravascular coagulopathy (DIC). 86.Dr. Muviku further stated in the report that the patient was expeditiously referred to Kenyatta National Hospital, where her condition further deteriorated, and disputes any claims of major vascular injury, attributing any internal bleeding to minor bruising exacerbated by DIC. 87.Dr. Muviku concluded that the hospital's maternity ward is well-equipped for its high volume of cases, and appropriately refers patients when intensive care or dialysis is required. She emphasizes that the Medical Practitioners and Dentists Board already cleared the hospital of negligence in a ruling on October 30, 2019, and requests that the court dismiss the suit with costs. 88.The parties filed written submissions as follows; The plaintiff submitted that this case originated from a 2014 complaint filed with the medical board, which eventually led to medical council rulings and a High Court judgment finding Dr. Endere directly liable for professional negligence and the hospital vicariously liable. 89.That negligence has already been legally established across multiple regulatory and judicial levels and the primary purpose of these submissions is to outline the evidence of malpractice and justify the specific quantum of damages to be awarded to the plaintiff and his family. 90.The plaintiff’s argument relies heavily on expert medical evidence to prove that the deceased received treatment falling far below acceptable obstetric standards. 91.The testimony from Dr. I.S.O. Maranga and a specialized midwifery report by Prof. Grace M. Omoni highlight that the deceased was a high-risk patient due to a twin pregnancy, low hemoglobin levels, and a history of two previous Caesarean sections. 92.The experts argue that following a Caesarean section where a placental clot was observed, the immediate and appropriate action should have been to transfer the patient to a properly equipped tertiary facility. 93.Instead, the attending doctor subjected the patient to four invasive surgeries within a six-hour window, which the plaintiff characterizes as a series of poor clinical decisions that worsened her condition. 94.Furthermore, the plaintiff challenges the defence testimonies, accusing them of intellectual dishonesty for claiming whole blood was the primary treatment for Disseminated Intravascular Coagulation (DIC). 95.The plaintiff asserts that standard medical practice requires blood component therapy, such as fresh frozen plasma, platelets, and cryoprecipitate, which St. Mary’s Hospital lacked. 96.Inconsistencies are also noted in the defense statements, which claimed the patient’s transfer was expedited despite timeline entries showing a four-hour delay between the decision to refer and her arrival at the maternity unit. 97.The submissions further outline critical lapses in the duty of care, noting that Dr. Endere failed to consult with other specialists or obtain informed consent from the family before performing the second, third, and fourth operations. 98.The plaintiff emphasizes that the hospital lacked vital infrastructure, such as an Intensive Care Unit, dialysis services, an active ambulance link, and proper record-keeping systems, despite handling hundreds of deliveries monthly. 99.A central point of contention is that the hospital actively delayed the emergency transfer by forcing the family to first settle outstanding medical bills and arrange their own private ambulance. 100.The distance to Kenyatta National Hospital is less than 10 kilometers and the plaintiff argues this commercial holding of a critically ill patient directly caused her physiological collapse and eventual death. 101.Consequently, the plaintiff outlines six core issues for determination, focusing on the specific allocation of liability and the types of financial compensation deserved. 102.In terms of liability apportionment, the plaintiff suggests that while the doctor bears responsibility for the surgical decisions, the hospital bears a higher degree of fault due to systemic institutional failures and restrictive financial barriers during a medical emergency. 103.Therefore, they propose that liability be split 30% to Dr. Endere and 70% to St. Mary’s Mission Hospital. 104.To compensate for the extensive loss, the plaintiff seeks a grand total of Kshs. 162,970,405 in damages. 105.This includes strictly proved special damages of Kshs. 570,405 to cover medical bills, funeral expenses, legal administration costs, and medical board proceeding fees. Under general damages, the plaintiff requests Kshs. 13,200,000 for loss of dependency using a 33-year multiplier based on the economic value of a housewife's labor for her three minor children. 106.Citing recent case law, the plaintiff seeks substantial awards of Kshs. 40,000,000 for loss of consortium and an additional Kshs. 40,000,000 for loss of society to address the profound emotional and social deprivation experienced by the surviving husband and children. 107.The estate also demands Kshs. 1,000,000 for the loss of expectation of life for a woman who died at age 27, and Kshs. 15,000,000 for the extreme physical pain, suffering, and loss of reproductive amenities she endured through repeated trauma. 108.Additionally, a claim of Kshs. 43,200,000 is made for the actual upkeep, foster care, and future caregiver costs for raising the three minor children to adulthood, alongside Kshs. 2,000,000 for emotional distress and Kshs. 8,000,000 in aggravated damages due to the reckless and distressing conduct of the defendants. 109.The plaintiff concludes with a request for interest on all damages from the initial lower court filing date of May 11, 2016, and asks that the defendants bear the full costs of the suit. 110.To ensure the financial security of the deceased's children, the plaintiff proposes a distribution ratio where 25% goes to the husband and 75% goes to the children, with a protective court order directing that 60% of the final award be safely locked into an interest-bearing account or money market fund until the minors reach the age of majority. 111.The 1st defendant’s submissions begin by detailing the medical background of the deceased. 112.She was admitted to St. Mary’s Mission Hospital with a history of two prior Caesarean sections, and after experiencing premature labour, an emergency C-section was performed. 113.Post-operatively, she developed severe bleeding due to a soft, non-contracting uterus and later disseminated intravascular coagulopathy (DIC), a condition where blood fails to clot. 114.Despite multiple surgeries, blood transfusions, and ultimately a subtotal hysterectomy, the bleeding continued, and she was transferred to Kenyatta National Hospital, where she later died. 115.The first defendant relies heavily on his own detailed medical report and the expert testimony of Professor Nelly Mugo, a senior obstetrician, who confirmed that all treatment was correct, timely, and necessary. 116.He criticises the plaintiff for failing to adduce any expert evidence identifying which specific procedures or medications were wrong, or what alternative treatments might have been better. 117.The plaintiff’s complaints are said to be that there were too many operations, lack of consent, failure to consult, and delayed referral. 118.The first defendant then argues that a separate disciplinary proceeding before the Kenya Medical Practitioners and Dentists Council was a nullity because no formal charge was ever formulated against him as required by Rule 5 of the Medical Practitioners and Dentists (Disciplinary Proceedings) (Procedure) Rules 1979. 119.He states that he was initially served with a ruling declaring him guilty without a charge or hearing, and even after that ruling was quashed, the Council still failed to set out any charge, making the hearing void from the start. 120.Turning to the civil claim for negligence, the first defendant admits a duty of care was owed but denies any breach. 121.He argues that the duty was not breached because the multiple operations were necessary to control life-threatening bleeding from a non-contracting uterus and diffuse oozing, and that each procedure was clinically justified. 122.On consent, he contends that the emergency nature of the complications meant that further operations were necessary to save the deceased’s life, and implied consent applies. 123.Regarding consultation, he states that no formal consultation was required because the attending team, including himself, had the necessary skills, and the case complexity did not demand outside input. 124.On the referral note, he points to the plaintiff’s own witness, Dr Maranga, who admitted that as an emergency, the referral note gave the necessary information. 125.On timeliness of the referral, the first defendant argues that referral becomes mandatory only when the required skills or facilities are lacking, here, once DIC was suspected, specific blood products (fresh frozen plasma, platelets) were unavailable at the second defendant, and that is precisely when referral was made. 126.He adds that the plaintiff’s own witness conceded it was conjecture whether earlier referral would have saved the deceased, and that even at the referral hospital, necessary blood products were not promptly given and an ICU bed was unavailable, so the death occurred despite, not because of, the timing of referral. 127.On damages, the first defendant submits that even if the claim had succeeded, most heads of damages should be nil or greatly reduced. 128.For special damages, he argues that the KSh 61,850 hospital bill cannot be refunded because treatment was received, and costs of lodging complaints before the medical board are not recoverable. 129.Funeral expenses should be limited to KSh 51,000 (programme KSh 8,000, coffin KSh 30,000, dressing KSh 8,000, funeral meeting KSh 5,000) instead of the claimed KSh 156,000. 130.Loss of dependency should be rejected entirely because the deceased was an unemployed housewife with no income, and dependency requires proof of actual financial support, which was not provided. 131.Loss of consortium should be rejected for lack of pleading and proof, but if awarded, a reasonable sum would be KSh 100,000. 132.Loss of expectation of life is conventionally awarded at KSh 100,000. Pain and suffering, given that the deceased died within the same day, should be about KSh 100,000, not the KSh 15 million sought. 133.Claims for upkeep of children, emotional distress, loss of society, and aggravated damages are dismissed as unpleaded, not proved, or statutorily barred under the Law Reform Act. 134.Ultimately, the first defendant concludes that the plaintiff has failed to prove negligence on a balance of probabilities, and the suit should be dismissed with costs. 135.In the alternative, if the court were to award damages, the total would be only KSh 251,000. 136.The Second Defendant, St. Mary’s Mission Hospital Lang’ata, submitted that the Plaintiff, acting as the legal representative of the estate of Pauline Kasesya Mwinzi (deceased), alleged that the deceased died due to negligent care following an emergency Caesarean section performed by the First Defendant, who was an employee of the hospital. 137.The Second Defendant argues that the Plaintiff failed to prove any negligence on its part. 138.It contends that the deceased was a known high-risk patient due to a twin pregnancy and anaemia, and that all medical personnel exercised due diligence, managing her condition appropriately until she was stabilised and referred to Kenyatta National Hospital. 139.The submission highlights that the patient’s post-operative complications, including post-partum haemorrhage and disseminated intravascular coagulopathy, are known risks associated with twin gestations and were not caused by any breach of duty. 140.The hospital further argues that the referral was timely and that the deceased’s deterioration and death occurred after she arrived at the tertiary facility, where there were unexplained delays in treatment. 141.The Second Defendant also raises the defence of volenti non fit injuria, claiming the patient and her husband voluntarily assumed the risks of the operation by giving informed consent. 142.On the issue of quantum, the Defendant argues that any award for loss of dependency should be calculated based on the minimum wage rather than the unsubstantiated notional income of Kshs. 50,000, proposing a multiplicand of Kshs. 5,744.20, a multiplier of 20 years, and a dependency ratio of 2/3, resulting in Kshs. 919,072. 143.For pain and suffering, it proposes Kshs. 50,000, and for loss of consortium, Kshs. 40,000. 144.The 2nd defendant finally submitted that the court should dismiss the Plaintiff’s suit entirely for failure to prove medical negligence, relying on case law that emphasise that the burden of proof lies on the claimant to show a deviation from standard medical procedures. 145.The issues for determination in this case are as follows;i.Whether the Defendants owed a duty of care to the deceased, Pauline Kasesya Mwinzi.ii.Whether the Defendants breached that duty of care through negligence.iii.Whether the said breach of duty caused the death of the deceased.iv.Whether the Plaintiff is entitled to the damages sought. 146.On the issue of negligence, the court has carefully considered the overwhelming weight of the evidence presented. 147.The plaintiff presented a compelling case through both lay and expert testimony. 148.The deceased, a high-risk patient carrying twins with a history of two previous Caesarean sections, was admitted to the 2nd defendant’s hospital on 19th May 2014. 149.The 1st defendant performed an emergency Caesarean section on 20th May 2014. 150.Subsequently, the deceased experienced severe post-partum haemorrhage. 151.Instead of immediately referring the patient to a better-equipped tertiary facility like Kenyatta National Hospital (KNH), the 1st defendant proceeded to perform three further surgeries on the deceased within a span of approximately six hours. 152.This course of action is the main point of contention. The plaintiff’s expert, Professor Grace Omoni (PW4), an expert in midwifery, provided an assessment of this management. 153.Her report stated that the patient was highly vulnerable and multiple red flags were ignored. 154.She noted that rather than organizing an immediate referral to KNH, the 1st defendant performed four consecutive surgeries within six hours, during which the patient developed Disseminated Intravascular Coagulation (DIC) and acute renal failure. 155.Professor Omoni concluded that Dr. Endere was grossly negligent for failing to seek senior consultation or execute a timely transfer. 156.This opinion was mirrored by the findings of the Medical Practitioners and Dentists Council, which found the defendants liable for professional negligence. 157.The plaintiff also called Dr. Innocent Maranga (PW3) from KNH, who testified that the deceased was admitted to KNH in a state of hypovolaemic shock with severe pallor, low blood pressure, no urine output, and abdominal distension with non-clotting blood, and that she died the same day from a massive intra-abdominal haemorrhage. 158.In stark contrast, the defence attempted to portray the multiple surgeries as a series of necessary, heroic, and clinically justified interventions to control life-threatening bleeding from a non-contracting uterus. 159.The 1st defendant’s expert, Professor Nelly Mugo (DW2), stated that the clinical team acted rapidly, decisively, and in strict adherence to medical protocols. 160.She emphasized that post-partum haemorrhage is unpredictable and a leading cause of maternal mortality. 161.The 2nd defendant’s witness, Dr. Victoria Muviku (DW3), similarly defended the hospital’s actions, stating the patient was expeditiously referred. 162.However, this court finds the defence’s narrative unconvincing and contradicted by the chronology of events and the basic principles of medical practice. 163.The fact that the patient deteriorated after each successive surgery is not a testament to heroic effort but a clear indication that the repeated surgical interventions were failing and, more importantly, were contraindicated. 164.The standard of care required of a doctor is not that of an insurer against accidental slips, but he or she is expected to exercise the ordinary skill of a competent practitioner in that field. 165.A doctor can only be held guilty of medical negligence when he falls short of the standard of reasonable medical care and not because in a matter of opinion, he made an error of judgment. 166.The conduct of the 1st defendant, a single doctor performing four major surgeries on a deteriorating patient in a facility that lacked the capacity for dialysis, intensive care, or even essential blood products like Fresh Frozen Plasma (FFP), falls far short of this standard. 167.It represents not an error of judgment, but a persistent and reckless failure to recognize the limits of his skill and the capacity of his facility. 168.A reasonable and competent doctor in his position would have recognized the futility of repeated surgeries and arranged for an immediate transfer to KNH after the first signs of uncontrollable haemorrhage or, at the very latest, after the second surgery failed. 169.The defence argued that the plaintiff failed to adduce expert evidence identifying which specific procedures were wrong. 170.The negligence is not in the manner a single stitch was made, but in the overarching decision-making and management of the patient. 171.The four surgeries themselves, performed in rapid succession without success, are the evidence of negligence. 172.Furthermore, the defence’s reliance on the Medical Practitioners and Dentists Council proceedings being a nullity is untenable. 173.Not only did the Council conduct a fresh inquiry after a consent order, but this court is making an independent finding of fact based on the evidence presented before it, not merely relying on the Council’s ruling. 174.On the issue of causation, the court finds that the defendants’ breach of duty was the direct and proximate cause of the deceased’s death. 175.The causal chain is clear and unbroken by any intervening event, the deceased suffered a post-partum haemorrhage; the 1st defendant’s decision to perform three additional surgeries instead of referring her caused further blood loss, exacerbated her condition, and led to acute renal failure and DIC; the delayed referral to KNH, which the plaintiff’s evidence showed was further hindered by administrative demands for bill clearance, meant she arrived at a facility capable of helping her only when her condition was already beyond salvage. 176.For negligence to arise there must be a breach of duty and that breach must be the direct or proximate cause of the loss, injury or damage. 177.The breach here directly led to the massive intra-abdominal haemorrhage that killed the deceased. 178.Consequently, the court finds the 1st defendant, Dr. Frank Endere, directly liable for the negligent management and treatment of the deceased. 179.The 2nd defendant, St. Mary’s Mission Hospital Langata, is vicariously liable for the negligent acts of its employee, the 1st defendant, within the course of his employment. 180.Further, the 2nd defendant is directly liable for its own systemic failures, including permitting a doctor to perform multiple major surgeries without consultation, failing to have an emergency protocol for referrals, and its administrative practice of delaying an emergency transfer for bill clearance. 181.It is undisputed that a doctor-patient relationship existed between the first defendant and the deceased, and that the deceased was admitted as a patient at the second defendant’s hospital facility. 182.A medical practitioner-patient relationship automatically imposes a strict legal duty of care upon both the primary physician and the admitting facility, which dictates that healthcare providers must exercise reasonable care and skill in managing patients within their custody. 183.On the second and third issues of breach and causation, the expert clinical testimonies of Dr. Innocent Maranga and Professor Grace Omoni firmly established that the first defendant subjected an exceptionally high-risk patient to four consecutive, invasive laparotomies within six hours without seeking senior consultation or obtaining proper consent from the family, directly inflicting a catastrophic vascular injury that led to massive intra-abdominal hemorrhage. 184.The standard for establishing medical malpractice is guided by the Bolam vs Friern Hospital Management Committee (1957) I1 WLR 582 (the Bolam test) which rules that a professional is negligent if their actions deviate from what a responsible body of similar medical experts would deem proper. 185.This deviation was explicitly confirmed by the Disciplinary and Ethics Committee of the Kenya Medical Practitioners and Dentists Council, which revoked the first defendant's license. 186.Furthermore, the second defendant hospital is held vicariously and institutionally liable because it lacked vital blood components, lacked intensive care infrastructure, and actively delayed a life-saving emergency transfer by demanding the clearance of financial bills while the patient was in active physiological collapse and a systemic failure. 187.Therefore, the court finds that the joint and several negligence of the defendants directly caused the death of the deceased. 188.Turning to the final issue of quantum, the plaintiff has strictly pleaded and proved special damages totaling Kshs. 570,405 for medical, funeral, and administration expenses, which are allowed in full. 189.For general damages under the Law Reform Act, the court recognizes the extreme physical agony and mental trauma suffered by the deceased as she slowly bled to death over multiple un-consented surgeries, and in line with prevailing judicial trends for medical malpractice, this court awards general damages for pain and suffering in the sum of Kshs. 4,500,000. 190.Under the Fatal Accidents Act, the court categorically rejects the defence’s argument that a housewife's labor holds no pecuniary value; domestic, maternal, and caregiving services of a homemaker carry profound, quantifiable economic worth. 191.Considering the young age of the deceased and the lifelong deprivation facing her three minor children, the court awards a global sum of Kshs. 6,000,000 for loss of dependency. 192.To cushion the estate against the prolonged litigation process and the exceptional loss of companionship, the court also grants an award of Kshs. 500,000 for loss of consortium, dismissing all other duplicative heads of damage. 193.In final analysis, judgment be and is hereby entered for the plaintiff against the first and second defendants jointly and severally as follows;i.Special damages of Kshs. 570,405,ii.General damages for pain and suffering of Kshs. 4,500,000,iii.Loss of dependency of Kshs. 6,000,000, andiv.Loss of consortium of Kshs. 500,000.v.Total 11,570,405vi.This final decretal sum shall attract interest at court rates from the initial date of filing the suit in respect of special damages and from the date of this judgment in respect of general damages until payment in full.vii.The defendants shall bear the full costs of this suit. 194.To secure the financial future of the surviving minors, 60 percent of the combined awards shall be deposited into a restricted, high-yield investment account on behalf of the minors, to remain locked until the minor children attain the legal age of majority. 195.The same to be deposited in reputable bank, Financial institution or Insurance Company. 196.The plaintiff shall be paid 25 percent of the award and the remaining 15 percent shall be utilized for the upkeep of the minors. 197.Orders to issue accordingly. DATED, SIGNED AND DELIVERED ONLINE VIA MICROSOFT TEAMS AT NAIROBI THIS 2ND DAY OF JUNE, 2026.A. N. ONGERIJUDGEIn the presence of:Mr Morara Omoke for the PlaintiffMr Okeke for the 1st Defendant-AbsentMr Mugo for the 2nd Defendant.