The recent Supreme Court judgment in the Anuradha Saha case could well be a landmark verdict that has the potential to significantly improve healthcare delivery. It awarded a hitherto unheard of sum of Rs.5.96 crore as compensation to Dr. Kunal Saha, husband of Anuradha, who died as a result of medical negligence in 1998.
The judgment is significant for two reasons. First, it shows that the highest court in the land takes medical negligence seriously and is prepared to levy punitive fines for serious cases resulting in loss of life. This would surely embolden the lower courts also to levy stiffer penalties. Second, the very strong signal it sends out to the medical community on the need to reform its ways and pay more attention to patient safety. More such judgments will surely force the healthcare community to at least start adopting the much-needed patient safety measures.
According to statistics provided by the American Medical Association, medical errors contribute to between 40,000 and 80,000 deaths each year in the United States. Other reports put the figure at as high as 1,80,000. Medical errors are believed to be directly and solely responsible for over 7,000 deaths each year. What is grudgingly agreed upon is that medical errors are emerging among the top 20 causes of death in the U.S.
If this is the situation in the U.S., where there are clear and defined standards of care and protocols to be followed and where there is a system of medical audit in place, one can well imagine what the situation is like in India. There are no estimates available of the number of patients being impacted by medical errors and we do not even have a system in place to measure them on a countrywide basis. Part of the problem is the fear of what might emerge should we start measuring and no one, least of all the government, is interested in opening a Pandora’s box.
Medication errors
So where exactly do medical errors occur? Well, for starters from the diagnosis. Very often the diagnosis is incorrect or delayed with serious consequences. The documentation of what’s really wrong with you may also contain errors. The notes may carry wrong information which may be acted on by another doctor, leading to serious consequences. Medication errors are a major component of medical errors. The wrong drug being administered, wrong dosage of the drug being given, the drug being given at the wrong frequency, dosages being missed out, drugs which interact with each other being given, drugs to which the patient is allergic being administered, the list is endless.
Then we have the “never” events, those that should never ever occur, like patients being operated on the wrong eye or limb; sponges, scissors etc., being left in the body during surgery; food being pushed down the airway tube and medical equipment that doesn’t work.
Hospital-acquired infections due to a lack of proper infection control systems is another major reason for adverse events. Hospital-acquired infections are believed to affect 5 -10% of all patients admitted to hospitals in India but this number may be as high as 25% among patients admitted to Intensive Care Units. Hospital infections occur in the best of healthcare facilities in the world but to have the infection occur when all precautions are taken is one thing and to have them occur because infection control measures are not followed is quite another.
The complete lack of coordination among the various specialists treating patients is a major reason for medical errors. It is very rare for all specialists to sit together and review the treatment plan and this not being done is often disastrous. The Joint Commission International says, in its annual report on Quality and Safety, that lack of communication between healthcare providers contributed to more than half of all adverse events.
There are enough systems available to enhance patient safety and minimise errors. Simple software applications can alert doctors about wrong dosage, drug-drug interactions, two different brand names of the same drug being administered, etc., but even India’s top hospitals do not use them though they cost very little. The healthcare industry in India will not adopt such systems as they do not lead to an increase in revenue for the hospital or doctor though there is an overwhelming volume of evidence to show that they reduce errors and improve patient outcomes. So it becomes imperative for the government to insist that such safety systems be used.
In the absence of any government intervention, it is judgments like these that will introduce the fear factor in the medical community and force it to adopt patient safety systems.
The country owes a debt of gratitude to Dr. Kunal Saha. His relentless fight for more than 15 years has opened up the possibility of better healthcare for millions. If that happens, Anuradha Saha would not have died in vain.
(The author is a consultant in internal medicine. He can be reached at sumanthcraman@ gmail.com)
