Patients suffering in silence after surgeon cuts wrong flesh

Students of Univesirty of Nairobi demonstrate outside Kenyatta National Hospital Accident and Emergency unit yesterday. [Edward Kiplimo, Standard]
On August 26, 2008, Benjamin Mwangangi, a resident of Kayole in Nairobi, visited a city hospital. He was experiencing discomfort while urinating.

The hospital staff attended to Mr Mwangangi and he was admitted for surgery the next day. However, things did not go well as the knife slipped from the surgeon's hand and punctured his rectum.

The cut resulted in a bacterial infection.

To correct the mishap, a court was told, a second operation was scheduled for the next day. It was done by the same doctor who punctured his rectum.

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“Apparently, that too did not go well and unfortunately the man died at the hospital on August 29, 2008,” read the court document.

Mwangangi's family had filed a case demanding compensation for his death at the hands of a surgeon.

A postmortem report indicated that Mwangangi died from "acute peritonitis due to perforated bowels".

Armed with the report, Mwangangi's wife and father lodged a complaint with the Medical Practitioners and Dentists Board (MPDB).

Respondents culpable

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The board "found respondents culpable of professional negligence and ordered them to initiate mediation with a view of compensating the appellants". The decision was made on August 6, 2013.

But Mwangangi's family was not compensated as the Court of Appeal upheld an earlier ruling by the High Court that had thrown out the suit, filed in December 2013, on grounds the case was filed late.

The law requires that such cases are filed within three years but the family only did so on December 19, 2013.

Mwangangi's is just one of the examples of cases where the surgeon’s knife cuts the wrong part and the patient dies as a result.

The Kenyatta National Hospital has been in the spotlight after surgeons operated on the wrong patient and only realised their mistake after they had opened up his skull four hours later.

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However, this is not unique to Kenya. Even in the developed world, with the most modern equipment and highly trained personnel, similar cases abound.

A report in 2016 titled 'Wrong Body Part, Wrong Procedure, Wrong Patient: A rare look into surgical errors in Canada' published by National Post had findings similar to what some patients have gone through in Kenya.

Communication breakdown

From the 3,000 malpractice cases analysed, it was found that communication breakdown, illegible documentation and failure to adhere to the safety procedures contributed to surgeries going wrong.

In the report, about one-third of the cases ended up with the patients enduring injuries ranging from organ damage, paralysis or even death.

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Cases of foreign bodies, where surgical equipment such as sponges, scissors or towels are left in the body, were noted as to be frequent, especially if the operation was too long or met with complications such as excessive bleeding. It was also noted that operating the wrong part of the body or wrong person was bound to happen if the correct protocol was not followed.

Neurosurgeons and orthopedic surgeons, according to the report, had the highest cases of surgical accidents.

Back home, surgeons in general are the third leading medical practitioners in cases of malpractice at 13 per cent or 135 cases, according to the MPDB 2018 report. Gynaecologists top the list.

While some cases never see the light of day, others are fought in court where, if malpractice is proved, hefty compensations are awarded.

For Cyrus Kanyi, luck was on his side when, on October 6, 2017, a court awarded him Sh4.8 million for what justice JK Sergon concluded was poor management of injuries he sustained in an accident.

The court heard that Mr Kanyi had to undergo eight different operations that left him in a worse state than he was originally.

Mr Sergon said there was no dispute that having undergone numerous operations, the plaintiff suffered great pain and ended up with a permanent disability in his right leg, which also faced the risk of amputation.

“It is the plaintiff’s position that all those operations were botched and resulted in very serious complications on the part of the plaintiff which wounds have never healed 17 years down the line,” read the court papers.

Kanyi had been admitted at the hospital with a broken neck. His left thigh bone was also broken and he had more fractures on his legs.

In another case, an applicant missed out on Sh2.1 million compensation over what a judge described as a not-so-solid case. Justice JN Mulwa was told of an ordeal JNG went through after an operation to unblock her fallopian tubes at a hospital in Nakuru.

Nine days after the surgery, when she went back to have the bandages removed, an infection was detected and she was treated with painkillers.

However, on May 16, 2009, the patient went to another facility in Nairobi for an ultra-sound scan. That is when fluid was detected in her uterus. She was operated on again.

 “It was her testimony that upon this operation she was told some foreign matter, an abdominal pack, had been left in the stomach and it had damaged the intestines, the tubes and ovaries. It was her evidence that she underwent many other operations to repair the leakage and the intestines,” read the judgement dated April 20, 2017.

The doctors however argued that no foreign material was left in her body during the surgery. They said at the beginning and end of the procedure, all instruments were counted and confirmed as correct.

It was also stated in the case by the defendant, a doctor, that it was not the responsibility of the doctor to count the instruments, but the nurse's.

A similar case, part of the 2016 report and documented by the Canadian media, was where a pack of sponges was left in a woman's abdomen after she delivered.

Unimaginable pain

Rupinder Pannu told the Canadian Broadcasting Corporation she started smelling like "dead fish" and experienced unimaginable pain two weeks later. She later discovered some foreign material was stuck in her wound.

But not all surgical cases go wrong. Kenyan surgeons have also made some milestones that have brought them global admiration.

These include the recent re-attachment of a 17-year-old boy’s arm after it was accidentally chopped off.

Others are the 23-hour surgery at KNH to separate conjoined twins and the first brain surgery in Embu County early in the year.

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