Medical negligence

By Flavia Nassaka

Know what will lessen your risk

The High Court in Kampala recently awarded Shs450 million in costs and damages to a mother whose baby suffered brain damage during delivery at Mulago National Referral Hospital.  The Judge ruled that Mulago Hospital should compensate Sarah Watsemwa Goseltine because its medical workers negligently handled the birth. The court heard that a nurse put WatsemwaGoseltine on labour induction drip without explaining to her what it was for, mishandled the delivery, and the doctor delayed to attend to her for about 40 minutes after the nurses had noticed that delivery was botched. Their actions and omissions led to irreversible brain damage to the baby.

This case is one of thousands. In most cases, however, victims of medical negligence in Ugandans suffer silently.

Though there are no exact statistics of people who die as a result of medical negligence, many are victims of wrong diagnosis, treatment, and surgery but the incidents are rarely reported. Still, Dr. Katumba Sentongo, the registrar of the Uganda Medical and Dental Practitioners Council (UMDPC) says that the council records over 50 complaints against medical practitioners every year.

Medical negligence or malpractice, which involves a medical professional doing something or not doing something that causes an injury or harm to the patient, can take many forms.  When you go to the dentist to remove a sick tooth, a normal one could be removed instead. You could go to the hospital in urgent need for medical care and find there’s no one to attend to you. You could be given wrong blood transfusion for your group during or a doctor may leave undesirable items in your body during a surgery. Some patients have had a scissor or cotton wool left in them.  In all such cases, the medical workers can be sued for negligence or malpractice.

One of the most publicized cases of negligence in Uganda was in 2014 when Rosemary Namubiru; a HIV positive nurse, used an injection that she had pricked herself with on a baby. Though tests indicated that the baby was not infected as a result, court found her guilty of criminal negligence and sentenced her to three years in jail since the scenario involved exposure to HIV. The sentence was later reviewed.

But Katumba says although what we mostly see are cases that happen in government facilities, such issues also occur in private facilities but they are rarely reported. He says patients are silent about it perhaps because they blame themselves for making a bad choice of clinic.

But for Sharon Murungi, an advocate, it is ignorance about the rights of the patient that likely maintains this conspiracy of silence.

She says it is useful to provide the public with a better understanding of the applicable law and how it operates in cases of medical malpractice.

What a victim can do

Murungi says in order to constitute negligence, it must be proved that the doctor has a duty of care on the individual, whether there was any form of injury, or that the conduct of the practitioner did not measure up to the standard of care the law required of him/her.

To prove medical negligence, one needs to compare what the treating doctor did to how other competent doctors within the same specialty would have handled it. If a skillful and competent doctor under the same circumstances would not have made a diagnostic error, then the treating doctor may be liable to malpractice.

Katumba says any one is free to issue their complaints to the UMDPC once they suspect that the doctor has handled them negligently. He says the Medical Council, which reviews such issues once a medical practitioner is found guilty of misconduct, either warns the practitioner, puts them on probation or withdraws their license and eventually erases them from the register.  Such practitioners are not allowed to practice anywhere in the country.

How to lessen your risk of encountering negligence

Katumba advises patients to be proactive about medical care by doing research to understand their health condition before choosing a practitioner or a hospital to go tosince certain types of errors crop up more often than others.  Reading will help one learn about the doctor and the hospital before making a choice as some resources will give you an idea on what kind of treatment you need. A patient might be harmed if the doctor prescribes the wrong medication or might be harmed by medication that the doctor prescribes to treat a misdiagnosed condition. In a hospital setting, the right drug might be given to a wrong patient. That is why one needs to ask all the time.

“It’s critical not to allow yourself to be intimidated by the medical system. Speak up and advocate for your own well-being,”says Dr. Maria Adongo, who is based at Mulago Hospital, “If patients sense that something is wrong they should tell their healthcare providers or have a family member or friend accompany them on important healthvisits.”

Why the medical errors

While she admits procedures are sometimes done by inexperienced personnel,  Adongo says  what is called medical negligence sometimes is not negligence per se. She explains that some patients hop from facility to facility leading to missed and delayed diagnoses. She says it is difficult to trace the medical history of such patients and when a doctor embarks on some kind of treatment because the patient is already weak, they get complications or die.

Dr. Jeremiah Twa-twa, an MP and member of the Parliamentary Committee on Health, says while doctors as professionals operating in a very sensitive area are expected to be very keen on their work, sometimes they are frustrated by the systems they work in. He says referral hospitals and health centers are under staffed and poor equipped.

“Haven’t you read stories of operations carried out with torches or amputations without painkillers? A practitioner operating under such circumstances should be blamed with reservation,” he says. For such medical workers, Twa-twa says they should be protected with some kind of indemnity insurance.

Most if not all of the medical errors can be prevented but surprisingly they keep happening from time to time.  Experts say that cases of medical negligence ending in court action in Uganda are likely to increase as patients increasingly become aware of their rights and civil society organisations give a voice to those who cannot fight for their rights. Because of this Katumba says there is need to enforce medical standards in order to avoid escalation of such cases. He says the Medical Council plans to employ inspectors in all regions across the country to collect complaints from the medical facilities and forward them to the council headquarters.

He however notes that the law does not allow the council itself to file complaints against any practitioner, even in cases where a judge finds one guilty of a crime.