Days later, Baby Nelly would lose that arm in a medical scandal that irked the entire nation. Her mother said at the time that she had noticed that something was not right with the baby’s arm a few days after the injection, so she went back to KNH to ask what was happening.
The baby’s arm was rotting, doctors told her. Somehow, the injection had severed key supply veins in the arm, making it virtually dead while still attached to the baby. Doctors fought to save it, but it was too late. In 2010, at the height of media coverage of the story, Baby Nelly was transferred to Kijabe Mission Hospital, where her arm was amputated. However, she did not live beyond her second birthday, dying that year from complications arising from the surgery.
The case was reported to the doctors’ regulator, the Kenya Medical Practitioners and Dentists Board (KMPDB).
Three years later, some rather shocking news was sent to Nairobi newsrooms from Mwingi. Mary Ndanu, 26, had been admitted to a local hospital for a caesarean section. When her appointment with the scalpel arrived, she was wheeled into the theatre and cut open. Midway through the surgery, the operating doctor got an irresistible urge to check into his local pub for a couple of drinks.
Ndanu, cut open and heavily anaesthetised, never made it out of the theatre. An autopsy report by pathologist Geoffrey Mutuma revealed that she had died from anaemia caused by excessive bleeding as her belly had been left open for too long after the removal of her dead baby.
Again, the case was reported to KMPDB.
Last month, a 28-year-old woman offered to tell us the story of her husband’s death at the hands of a medical team, but on condition that we do not reveal her identity because of family disagreements regarding the matter.
Her 35-year-old husband, she says, was checked into a prestigious private medical facility in Nakuru in January this year after he complained of recurring chest pain. The man, an athlete, was discharged three days later and put on antibiotics. Then from that moment, a string of what his wife calls “serious mistakes” started happening.
The man, it later turned out, had contracted pneumonia, yet no doctor mentioned this to her despite the bills piling up to hundreds of thousands of shillings. He was in and out of hospital and during the third month since his first visit to the doctors, he collapsed and died.
His death, as an autopsy report would later reveal, was both preceded and hastened by some diagnostic blunders and clinical negligence that made patients’ safety a game of chess in a hospital with an otherwise excellent reputation.
The man was being treated for acute bronchitis, so chances of saving his life were missed because the doctor did not make a referral when he did not respond to the medication that had been prescribed for him in the first few days.
His wife had watched helplessly as her husband’s health slowly deteriorated from mild breathing problems to depending on an oxygen mask to survive. At their Lanet home recently, the widow looked at a family portrait of happy moments with her husband, then in a little, tearful murmur, said: “He was very excited about our first pregnancy. He would make these jokes about how he’d enrol the baby we were expecting in a football academy if it turned out to be a boy. I was barely in my second trimester when he started saving for the baby... now he is no more.”
Unlike Baby Nelly and Mary Ndanu’s deaths, she never approached KMPDB for punitive action against the hospital. Her in-laws, however, negotiated an out-of-court settlement with the hospital.
Deaths are not unexpected in hospitals and in Kenya, as in many countries, the numbers are seldom monitored. That, however, does not mean that medical malpractices, simply known in the industry as medmals, should be hushed up. While these three cases only highlight a problem in the medical sector that KMPDB says it is addressing, many more are feared to be covered up through suspect hospital policies and outright fraud.
The cases may range from subtle accusations of overcharging to serious mistakes that may expose the errant doctor to criminal charges, such as the manslaughter allegations preferred against the Mwingi doctor believed to have caused the death of Ndanu.
Those aggrieved by the loss of loved ones, or those who survive with an injury because of a doctor’s negligence, accuse medical professionals of betraying their trust, while journalists, predictably, have drawn up sensational and — as many doctors would say in their own defence — misleading statistics about medmal.
That is why the debate about such malpractices in Kenya dominated a meeting of medical practitioners and other stakeholders in the medical field during the 42nd industry scientific conference held in Kilifi towards the end of last month.
Shortage of doctors and poor facilities, among many other factors that doctors say are beyond their control, are a recipe for disaster and have turned hospitals into what one commentator equated to “slaughterhouses”.
Such alarmist comparisons, says Dr Elly Nyaim, the chairman of the Kenya Medical Association board, serve only to blow the situation out of proportion as “these cases have always existed”, but it is only now that they are in the public domain, probably because of rampant activism in the field.
Ambulance-chasing lawyers, laments Dr Nyaim, have seen a window of opportunity to fleece doctors and are making a killing out of it. But Prof Kiama Wangai, a doctor and lawyer, says such scenarios have only become common because Kenyans have become “increasingly litigious” about medmal as the level of awareness about their rights rises due to growing literacy.
Keen to assure the public that the medical field in Kenya is not under siege, Dr Nyaim says that, like any other profession, there are a few doctors who commit mistakes, but insists that the bodies regulating doctors do not let them get away with their errors. Where proper treatment is given and death occurs due to disease and its complications, he says, one should not claim that “doctors and hospitals were negligent”.
Data about medmal indicates that KMPDB gets more complaints from obstetric and gynaecological patients than any other branch of medicine, accounting for 27 per cent of reported malpractices compared to financial overcharging and failure to refer patients, at 16 and 12 per cent, respectively. Other problems involved failure to refer and withholding patients’ data.
KMPDB’s statistical analysis of complaints reported from 2007 to 2012 indicates that 70 per cent of all complaints received by the board were about private hospitals, yet these attend to smaller numbers of Kenyans compared to public and mission facilities, which accounted for 16 and 13 per cent of alleged medmal, respectively. In total, the body received 742 complaints in the five-year period to 2012 and 40 between January and March this year.
Careful not to absolve errant doctors of blame in certain cases of medmal, Dr Nyaim decries the “pathetic” state of health care in Kenya, which he says contributes to the occurrence of negligence.
For instance, there are currently only 8,705 doctors and 1,046 dentists to attend to the over 43 million Kenyans in the country. If calculated against the entire nation’s population, one doctor attends to a little more than 5,000 people while a dentist takes care of 42,000 patients, far below the World Health Organisation-recommended 1:1,000 ratio.
To make matters worse, public hospitals, where the bulk of Kenyans seek medical attention, only have 2,000 doctors. Consider, also, many doctors have left active practice for other interests such as research, have died, or have flown abroad for greener pastures.
Medical equipment in public health facilities in the country are also in a bad state, some more than 20 years old or double their lifespan and, therefore, prone to frequent breakdowns. And the government is doing little to make the situation better.
Consider the allocation to the health sector in the last national budget — Sh34.7 billion out of the required Sh160 billion, or 5.7 per cent of the Sh1.6 trillion national budget — which Health Cabinet secretary James Macharia said was grossly inadequate.
The 5.7 per cent was a product of reductions four years in a row from 2010: In 2010, Sh7.20 out of every Sh100 was spent on health care, but in 2011 the figure fell to Sh6.10 and Sh5.9 in 2012. Much of this money, observers have said, was spent on curative medicine and very little on infrastructure.
As the relationship between doctors and patients is further strained, concerns have been raised about the efficacy of medical training institutions. While there is no empirical data to support the belief that younger doctors commit most of the offences, some older members have expressed fears about the casual way in which youthful medics approach medicine.
Prof George Magoha, the chairman of KMPDB, told the delegates at the conference in Kilifi last month that young doctors have a “morbid fear to ask for a second opinion”, so they follow their hunches.
INSTRUCTIONS OVER THE PHONE
He also accused his colleagues in private practice of charging their patients exorbitantly and not being available when needed. “Some of you give instructions over the phone to nurses!” he exclaimed.
Njeri Maingi, who lost a relative after a doctor with no training in oncology operated on a cancerous growth in her breast in Mombasa, cites poor training as a factor in the rise in incompetent doctors.
“Every doctor who goes into the medical profession has a duty to act with a reasonable degree of care and skill,” she says. “But how can they maintain such standards of practice when they get their training from all these substandard medical training schools coming up?”
But Prof Magoha insists that the problem lies elsewhere as well, not just inside the classrooms of medical training institutions. “While it may be hard to measure standards of hospital care, we can say confidently that each of these schools that have come up are taken through a systematic four-stage process of inspection before they can be given the green light to enrol medical students.”
Such explanations as inadequate facilities, exhaustion, and carelessness, however, remain anecdotal. But some doctors — and hospitals in which clinical negligence has occurred — have in the recent past found themselves at the punitive end of the law
For instance, the Nairobi Women’s Hospital was recently ordered by the High Court to pay Sh8.8 million as compensation for the loss of income of 29-year-old Lucy Njoki, who died from extensive lacerations to her uterus after complications during childbirth. The newborn also died shortly afterwards.
Prof Kiama Wangai, the lawyer-doctor who attributes the high number of reported cases of medmal to growing literacy levels, explains how the judge arrived at the Sh8.8 million sum: The High Court used a multiplier of 31 to determine the value of lost years to the age of 60, and the judge may have put into consideration the deceased’s salary, multiplied that by 12 months, and then multiplied the product with the remaining years till one is 60.
Added to the money, Prof Wangai further explains, the court awards funeral expenses, loss, and the emotional damage the negligence may have caused the bereaved family.
But do not go rushing to the courts yet, he cautions, because “even in hospitals where one patient died, hundreds walked out healthy”, and so, apart from a good lawyer, “you must have a very high index of suspicion and proof that the doctor acted negligently”.
“There may be other issues involved; maybe the patient did not give the doctor all the information about his or her medical history or he or she sought treatment late… and you know the patient has a right to refuse treatment, and when that happens the doctor has to obey,” says Prof Wangai.
The complainant must also prove that there were serious errors in the medical treatment which no competent doctor would have made. This must be proved by the expert testimony of a doctor.
“You have to show that the doctor was not reasonably skilful or competent as he should be, and that this alleged incompetence harmed you. You must also demonstrate that those errors caused or contributed to the injury or the unfortunate circumstances you are complaining of.”
In conclusion, the patient must prove how the incompetence cost him materially, such as lost wages or enjoyment of life, and how those injuries have changed his life. This, too, is done through expert testimony.
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