Nashwa’s death is tragic. What can be done to prevent such incidents?
According to reports, the child was administered a lethal dose of a very commonly used electrolyte. The reported mode of delivery was incorrect, since potassium chloride is only given very slowly through a drip. Several significant matters have emerged from this incident, including the quality of training, if any, of the involved doctors and nurse.
We don’t intend to speculate on the various aspects of this case (official investigations haven’t concluded yet); instead, we want to take a step back and look at the larger picture. This is necessary as Pakistan seems to be stuck in a never-ending cycle of medical mishaps and protests, followed by hasty investigations and scapegoats — until the next disaster.
Editorial: Medical malfeasance
Any avoidable loss of life in a healthcare facility is a matter of utmost concern and requires an impartial investigation and an appropriate response. Blindly condemning healthcare professionals, getting First Information Reports registered against perceived perpetrators and sealing the erring hospital will do nothing to prevent such incidents from happening again.
In fact, as has been well-documented, such measures lead to much broader harm for not only the health profession, but for society in general. It is imperative, then, to take a more nuanced approach in order to analyse what ails the healthcare system.
Dispensing healthcare has risks. Adverse events, which are injuries occurring as a result of unintended or undesirable acts of medical treatment, are part and parcel of the profession.
Medical errors result because of the “failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” They remain the third leading cause of death in the United States over the past decade, while in Europe, a World Health Organization report notes an incidence of 8-12 per cent medical error-related adverse events in hospitalised patients over the last two decades.
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The Journal of American Medical Association concludes that “errors must be accepted as evidence of system flaws and not character flaws.” A seminal report by the Institute of Medicine also recognises medical errors as an inherent part of medical practice.
This does not, of course, mean that such events should be accepted as fait accompli. They need to be investigated to find the root cause so that future events may be prevented.
The Institute of Medicine recommends designing safer health systems so that mistakes are harder to make, as well as instituting reporting mechanisms to identify the shortcomings so that preventive measures can be devised and implemented.
Negligence vs malpractice
It is important that those who are commenting on and covering healthcare-related events be cognisant of these different yet closely related terms.
Medical negligence is the failure of a healthcare professional to provide care that would be reasonably expected in a certain situation, or the act of doing something that a reasonable healthcare practitioner would not do. Leaving a swab or an instrument in the abdominal cavity after an operation or not following the protocol of giving a certain medication falls under this definition.
Events such as these are entirely preventable because there are standard protocols and checklists available, following which such events ought never to occur. Many such events are called never events.
These protocols are part of standardised medical training. But in Pakistan, with huge variations in the level of training of various cadres of healthcare professionals, never events keep occurring — indicating a major system flaw.