• How lives are wasted
The nature of healthcare delivery can be described as “delicately complex”. It requires the services of Physicians, Nurses, Medical Laboratory Professionals, Physiotherapists, Social Workers, and Pharmacists. Institutions also require both administrative and managerial expertise for smooth organisationalexistence. Given the complexity of this system, and an attempt to balance business and humanity, it is not surprising that preventable human errors occur on a daily basis. This often poses serious threats to patients undergoing treatment, which sometimes results in their death. Appolonia Adeyemi, who has been tracking this development, reports that most of the blunders are preventable, as they have resulted from carelessness
Monica, a native of Idumu Ogo in Aniocha North Local Government Area of Delta State, had her first child through cesarean operation in 2013. Weeks after, she started experiencing abdominal pains that took her through several hospitals in the state until her admission at the University of Benin Teaching Hospital (UBTH), Benin in Edo State.
At the hospital, doctors discovered that what she had suffered for about seven months was a result of a spatula-like surgical instrument left behind in her abdomen after a gynaecological surgery. As it turned out, hers became, as it were, one of the strings of medical blunders patients regularly endure in this part of the world. She was lucky to have survived the horrible ordeal. But, she is not an isolated case.
Surgical blunders happen everywhere, sometimes resulting in court cases for those who know their right, especially in advanced countries, where there are legal firms specialising in taking erring doctors to court.
A career professional and housewife, Alarape has been bed-ridden for months now. Alarape, who is in her early 40s, recounted her ordeal in the hands of some medical personnel, while soliciting divine intervention for a quick recovery. She said: “My illness started with severe stomach pain. My husband later rushed me from my home in a Lagos suburb in February to the Emergency Center of a teaching hospital, when the abdominal pain became unbearable. “At the hospital, a stomach surgical operation was carried out on me in the first week of March for what the medical team called intestinal stomach obstruction. Sadly, the surgeons did not do the surgery properly. They messed up my stomach inside.
They destroyed my large intestine in the name of surgery as I later learnt that I was dying slowly on the operation table. I later went into coma in the Intensive Care Unit (ICU) for one month,” Alarape narrated. Incidentally, the doctors in an Indian hospital where Alarape was referred, noted that the doctors that treated her not only messed up her intestines but that a section of her intestine has been cut off. As a consequence, Alarape, the doctors said may not be able to pass faeces from her anus any longer.
“Though, I was treated and discharged, the doctors at the Appolos Hospital insisted that I must come back, precisely in February next year for the final corrective surgery. And of course, the financial implication, which runs into millions of Naira, is frightening,” she further said. Also at another teaching hospital not too long ago, a Lagos-based female journalist, who had gone for dental treatment ended up with embarrassing skin swellings around her mouth and cheek bone. The unexpected deface shocked the victim, family and friends.
Although, the team of dental professionals at the hospital, who provided the initial care, had explained the shocking outcome as adverse drug reactions, the negative impact of that development on the woman was terrible. Since the incident, she has been moving from one skin doctor to the other in search of solution. As it happened with Alarape, the woman never bothered to lodge a formal complaint to the hospital authorities.
There was also a story of Nwugo Okoye, who until her death was the Head of Corporate Communications at Etisalat, one of Global System for Mobile Communication (GSM) operators in the country. Before then, Okoye had worked as Manager in charge of Internal Communications at MTN; this was after over a decade of robust practice in the advertising industry. Incidentally, Okoye’s fruitful and vibrant life was cut short after a failed Myomectomy (an operation done to remove fibroids while leaving the uterus intact). Okoye had gone into the theatre certain she would make it.
She could afford to have the surgery done anywhere in the world. But she chose to have it here. A supposedly simple surgery many other women have had and came out successfully in Nigeria, proved fatal in Okoye’s case. Investigations later pointed to a human error as the course for her death. Akabunma, who hailed from Isu in Ebonyi State, also died of such human error in the hands of medical personnel. After his death, his body was dissected for autopsy where it was found that a hand towel had been left behind his left lung during surgery for emphysema seven years before.
He had complained of chest pains incessantly in the years before his death. He was 64 years of age at the time of his death. In like manner, a middle-aged woman, who craved anonymity, was said to have underwent a double mastectomy, only to find out after the operation that she did not have cancer. Her test results had been switched with those of another woman.
Another patient, who had an operation to his ear, because he suffered from vertigo, was equally operated on the wrong ear. However, there have also been several cases of swab of cotton wool, scissors and other surgical tools that are forgotten in the body of patients that underwent surgery in recent times. Some of the victims of these unfortunate medical blunders, no doubt, went through hell, moving from one hospital to the other in search of solutions.
This is apart from the huge financial costs they end up expending in order to get well. Some patients actually die in the process, while a few others sail through. Incidentally, only a negligible number seek compensation. Yet, medical errors, according to experts, do not only involve surgery. Though, those in this category are usually the ones making screaming headlines in the media. This is understandable. They are so sensational and the results often so final. Aside surgeries, however, there are numerous other medical blunders that do occur on daily basis.
One of such is drug errors during anesthesia, which remain a serious cause of iatrogenic harm also. But, despite the wide range of reported incidence and perceived lack of consensus regarding the magnitude of the problem, it is, in the words of experts, unacceptable that any patient suffers harm, no matter how minor, while undergoing anesthesia. There is also misdiagnosis in the medical laboratories. The one that readily comes to mind is the celebrated case of renowned attorney and human rights activist, Chief Gani Fawehinmi.
He had a taste of these medical mishaps that made him to shuttle between Lagos and London before his death. His hospitalisation in a London hospital was informed by a misdiagnosis of his ailment, which he did not know until he got to London. After several checks by doctors, he was confirmed to be suffering from lung cancer and had to be placed on cancer treatment. Though, it was not clear how much damage the initial misdiagnosis and wrong treatment had on his health.
Before this revelation, however, doctors in Victoria Island hospital where he was first hospitalised treated pneumonia. Indeed, millions of medical mistakes are mostly premised on wrong diagnoses, which lead, in most instances, to unavoidable deaths. In cases where the diagnoses are right, negligence and lack of respect for the patient is said to be the main enemy in the course of treatment in which someone has to pay the price. However, medical personnel in the country seem not to be the only ones committing these blunders.
Chief Gani Fawehinmi. He had a taste of these medical mishaps that made him to shuttle between Lagos and London before his death. His hospitalisation in a London hospital was informed by a misdiagnosis of his ailment, which he did not know until he got to London. After several checks by doctors, he was confirmed to be suffering from lung cancer and had to be placed on cancer treatment. Though, it was not clear how much damage the initial misdiagnosis and wrong treatment had on his health. Before this revelation, however, doctors in Victoria Island hospital where he was first hospitalised treated pneumonia.
Indeed, millions of medical mistakes are mostly premised on wrong diagnoses, which lead, in most instances, to unavoidable deaths. In cases where the diagnoses are right, negligence and lack of respect for the patient is said to be the main enemy in the course of treatment in which someone has to pay the price. However, medical personnel in the country seem not to be the only ones committing these blunders.
contributing to the occurrence of medical errors, in order to develop more effective processes to prevent their occurrence. Incidentally, medical mistake is grouped under an umbrella term for all errors including mishandled surgery, diagnostic errors, equipment failures, and medication miscalculations. Though, medical errors are difficult to measure, not only because of inadequate reporting and varied definitions, but also because most incidents are not single acts, but a chain of events.
For instance, prescribing a wrong dose of a drug may be counted as a single mistake and named “error of prescription”, but this imprecision may have occurred because the patient’s medical record contained an inaccurate body weight or because a laboratory report was missing.
In spite of the problems associated with defining medical error, experts have identified these to include adverse drug events, improper transfusions, surgical injuries and wrong-site surgery, suicides, restraint-related injuries or deaths, falls, burns, pressure ulcers and mistaken patient identity. Studies have also shown that majority of adverse incidents occurring in healthcare delivery are preventable mistakes. However, restraint-related injuries, deaths and suicides per se are not errors but consequences of neglecting to restraint the patients.
Given this background, medical errors are, therefore, those mistakes that occur in the healthcare system, which ordinarily, if given immediate and adequate attention, could have been prevented. Despite cases of medical errors in Nigeria, limited information exists on negligence claims.
In 2006, there was the case of a child, who became Human Immuno Virus (HIV)-infected through blood transfusion in a Nigerian teaching hospital even though both parents of inquiry recommended the dismissal of the Chief Medical Director and payment of damages to the family. But, whether or not these directives were effective is hard to prove. Similarly, a drug manufacturing company was charged for medical malpractices for testing a drug on Nigerian children in 1996, which resulted in injuries, disabilities and deaths.
Although, the rate at which medical negligence claims is reported in Nigeria is relatively low, previous reports have shown evidence of reactions to inadequate care and errors in treatment in Western countries from which lessons can be drawn. For instance, estimates show that between 1996 and 1997 medical negligence cost £235 million, while negligence claims against general practitioners rose 13-fold between 1989 and 1998 in the UK alone. There is no doubting the fact that modern technological development has made a big impact on the tools available for investigating diseases more accurately. Except for a few centres, most of these tools are lacking in Nigerian hospitals. This is the reason why experience of using them is lacking, which means doctors do not get trained to use them; hence the patient suffers as a consequence.
It is also true that even in the few hospitals with these facilities, when patients undergo such investigations, the results are sometimes not interpreted correctly, thus emphasising the need to ask for help from more experienced colleagues. However, the other fundamental reason why issues of poor diagnosis will persist for a long time is due to the largely uneducated nature of the Nigerian population. This means that patients are not able to challenge any decisions made on their behalf because they perceive seeing a doctor as a privilege or favour rather than as a matter of constitutional rights. Doctors, therefore, are seen as demi-gods, who are to be worshipped as they can do no wrong.
A doctor, who craved anonymity, narrated what he called the low point of his practice in which he almost sent a patient to her early grave because he was too tired to examine her. According to the doctor, he had spent over 24 hours on duty because a colleague, who was to relieve him, did not turn up. He had attended to a long list of patients’ non-stop, without an opportunity to go for a short break.
He said: “Although I was physically in the consulting room when the patient entered, I tell you, my soul was already on my bed at home. So, I failed to do what I was supposed to do as a doctor and that error would have sent my patient to her early grace but for His grace.”
Vice Chairman, Association of General Private Medical Practitioners of Nigeria (AGPMPN), Dr. Tunji Akintade, while reacting to incidences of medical blunders said, “Medical negligence is a concern for all including the medical and the assaulted personnel. This is because if there is a case of carelessness involving death or injury, the person that is affected will suffer for it. Though, the doctor behind such acts usually would not at peace.
According to him, either the patient or his family can lodge a complaint to the Medical and Dental Council of Nigeria (MDCN), which can in turn set up a panel to determine whether there has been a case of negligence or not. “Somebody has to bring the negligence to the awareness of MDCN before such could be looked into,” Akintade said. Akintade said that enlightenment is going on among doctors and that they are aware that no matter how friendly they are with patients, if anything goes wrong in the course of treatment, they would no longer remember their friendship. “Doctors are getting more aware about this; among the public, a lot of awareness is also going on,” he added.
Also speaking, former President of the Nigerian Medical Association (NMA), Dr. Osahon Enabulele, cautioned against accusing medical teams whenever something goes wrong. He said that other factors such as lack of basic facilities in hospitals could be responsible for many of the errors. He, however, noted that patients and their relations have every right to lodge complaint against medical practitioners when negligence is suspected. “Complaints can also be brought against hospitals when they fail to do what they are supposed to do.
They have a constitutional right to get such a case to court,” Enabulele said. However, Enabulele says that negligence should be differentiated from medical blunder. According to him, blunder could be caused by several other factors including dearth of working equipment, especially diagnostic equipment that are valuable to practitioners as ancillary support services in addition to their clinical acumen. “Medical blunder could equally arise from misreading medical report,” he added.
He pointed out that every profession is inching towards perfection and that is why in the whole issue of continual educational development, the role of constant engagement with the system, should be in place. “The truth of the matter is that when negligence occurs, the regulatory bodies are informed and they in turn take it up. Again, it may take time but gradually the cases are adjudicated upon. When judgment is pronounced, which results in punitive measures against the practitioners, the practitioner obviously will sit up,” he said.
Yet, a public health physician was quoted recently to have said that in resource-challenged settings like Nigeria, more patients are likely going to die in hospitals due to medical accidents occasioned by negligence than the impact of the illnesses they are suffering from. This, according to the doctor, is a known fact, even if it appears questionable and only applicable to a developing country like Nigeria. Though, the Lagos State government stirred the hornets’ nest last year when it passed the Corona’s bill into law, the law, according to analysts, has some defects.
For instance, it contained, according to them, aspects considered injurious to medical care, which can prevent doctors from sticking out their necks to saves lives already at the brink of death. For now, it remains a reality that many Nigerians have died, and would still die, simply because their cases were poorly handled in hospitals. Some have gone unnoticed and in the case where the victim is a prominent person, some questions may be asked.
Like all cases, no one will be held responsible or brought to book. But, how can this unusual epidemic confronting ignorant Nigerians and their families be tackled? Would doctors continue to bury their mistakes while patients die?
Culled from New Telegraph
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