Far too many diagnostic, medication and surgical errors are still taking place in Kenya’s hospitals a decade after the Government began ramping up health spending.
An investigation by Standard Group reporters suggests errors are reported in one of every three hospital visits and have serious results in as many as 20 per cent of cases. This is far higher than the international average and must be addressed in the public interest. The Standard hopes to do this with a patient safety campaign beginning today and running into next week.
The series of articles we have planned will unravel the catalogue of failings that have made hospitals dangerous. We show how doctors who make mistakes escape without censure and, as a result, go on to harm more lives. We will show how the institutions supposed to reduce the error rates turn a blind eye to many of the problems. We will also look at how this culture of recklessness can be turned around to make hospitals places where human error is factored in as a problem to work around rather than hidden away as a potential source of litigation.
There is ample evidence that errors in diagnosis, medication and surgery are leading to unnecessary deaths every day. Health authorities, for instance, report that malaria accounts for a third of all deaths, with respiratory diseases leading to another 24 per cent. However, many of these deaths arise from a variety of fever cases wrongly diagnosed or treated as malaria.
According to one National Hospital Sector Strategic Plan, as many as half of all ‘malaria’ inpatients die during treatment. The import of this is unmistakable: Getting malaria and fever diagnoses right at first blush could knock the illness from its slot as the country’s top killer.
Doctors make errors in many other cases, jumping to wrong conclusions due to pressures of time, lack of proper diagnostic tools and tests, or inadequate training and knowledge. We do not intend to vilify the medical fraternity unduly for these failings.
Rather, we seek to ensure something is done to keep track of mistakes and stop them from recurring. If better diagnostic tools and techniques, closer supervision of inexperienced staff or lighter workloads are what is needed to save lives, hospital authorities have a duty to work towards providing them.
The only reason this patient safety problem has not got more attention as a major public health issue is that many of the errors do not have immediately visible consequences. Diagnosis and medication mistakes are often caught at future visits after causing little harm to patients. Surgical errors are often more easily noticed and have graver consequences, including death.
The full extent of the problem is not clear to patients, health authorities or medical practitioners due to lack of accurate statistics. In the West, about a third of diagnostic mistakes that were serious enough to be reported anonymously by other physicians lead to death or serious injury. Local hospitals do not conduct adequate reviews or conduct autopsies on many suspicious patient deaths out of fear of attracting legal proceedings. The result is that doctors prone to errors, and processes that fail, are not caught in time, leading to even more deaths and mistakes. For this reason alone, and to prevent anguish to more families, all hospitals need to adopt a culture more inclined to investigating their own failings and dealing with them.
It is inescapable that, despite the best interventions and intentions of hospital staff, mistakes will occur. To err, after all, is human. Thus, we don’t want to see Kenyans turn to a culture of excessive litigation on all errors. Rather, we believe errors should be distinguished from professional negligence and the two dealt with appropriately. To this end, we expect accountability from the Kenya Medical Practitioners and Dentists Board.
The manner in which it has pursued its mandate so far leaves much to be desired, leading the public to conclude the medical profession will protect its own even where lives are at stake. Transparency on errors and swift action on professional negligence are key to improving patient safety and reducing legal disputes.
