Break the silence on medical negligence before it kills us
The Kenya National Union of Medical Laboratory Officers (KNUMLO) bold admission that three in ten Kenyan patients receive the wrong diagnosis or treatment confirms levels of public anxiety. Is it time we demanded a New Year’s resolution from the Medical Board, Health Ministry and County Governments?
The KNUMLO statement alleges that many Kenyans are wrongly put on anti-tuberculosis and anti-retroviral drugs or had their ulcers mis-diagnosed with H.Pylori. Misdiagnosis may only be the tip of the spear piercing our right to health. Behind their statement are thousands of horror-stories of nurses, doctors or clinicians delaying or failing to attend to their patients, harming patients or undertaking life-changing procedures without consulting them.
Eleven-month-old Ethan Mwaniki Njuki died at the Ruaraka Uhai Neema Hospital on the same day as the Medical Laboratory Officers Union statement. A preliminary autopsy suggests that he may have died from an adrenalin injection overdose. His parents are now demanding investigations and action by the Medical Board and the Director of Public Prosecutions.
A conspiracy of silence compounds the risks of professional misconduct we face when seeking treatment. There are no official statistics on medical negligence leaving us to rely on media reports. In September, Lucy Kinya was awarded Kshs 25.6 million in compensation after she was left paralysed while giving childbirth. No less than six hospitals were instructed to pay Kshs 150 million in compensation to patients over the last year. Over the last ten years, the Medical Board may have handled 671 cases with 72 cases in 2018. Despite this, less than three doctors have been de-registered in the last twenty years.
Sadly, the conspiracy of silence is also global. As many as 100 infants died this Christmas at the Kota JK Lon Hospital in the Rajasthan state of India. The hospital has claimed the deaths were due to premature deliveries. The child rights commission have disagreed. They argue that the children died from the extreme cold and the lack of oxygen facilities in the hospital wards. In the United Kingdom, at least 50 public hospitals closed the year with the prospects of legal action for their failure to make changes that would keep patients safe. In India and United Kingdom as well as in Kenya, the price of patient safety is our constant vigilance and oversight.
Given the rising cases of injuries and deaths, it is incomprehensible that the Medical Board does not regularly publish which medical facilities and practitioners have cases of medical negligence preferred to them and the status of these cases. The publication of this information does not suggest proof of culpability. It merely honours the right of patients to seek a fair administrative process and redress. The British Medical Journal does this. The cases provide an opportunity for medical practitioners and hospitals to learn from ongoing cases and avoid the same. Both the desire to do no further harm and rising costs of medical suits should provide an additional incentive to hospitals to stop the cover up.
Our right to safety in public and private health facilities is embedded in our Constitution and Health Act. A 2020 public campaign is needed by the Health Ministry and County Governments to have citizens internalise the excellent National Patients Charter. Increasing data collection and publication by the Medical Board, Health Ministry and County Governments would increase both public safety and accountability. We should also demand all health institutions have patient safety programs that train practitioners on avoiding medical errors and improving communication standards. Could we explore the idea of independent health workers or local ombudsman who are available to counsel patients on their treatment?
Keeping patients safe requires the hospital infrastructure, equipment and the entire professional chain to all work. Misdiagnosis is not necessarily malpractice or medical negligence. For malpractice to be actionable, a patient’s medical condition must have worsened as a result of treatment provided or not provided. In cases of death, these are no longer only health concerns, they are now criminal matters.
We also have responsibilities to take care of ourselves. Leaving the duty of health-care entirely in the hands of doctors is dangerous. We have a personal duty to ensure that we are registered with NHIF, consume a healthy diet, exercise and maintain healthy lifestyles. Remaining ignorant of the causes and symptoms of heart-attacks, cancer, cirrhosis, pneumonia and diabetes is not only a failure of the state or market, it is a failure of citizenship.
First published Saturday Standard, January 4, 2020. Kindly reproduced here with permission from the Standard Group