When a patient is rushed into the emergency ward of a hospital, it’s his life that is put in the hands of the healthcare practitioners working there. The responsibility to make sure that nothing goes wrong rests squarely with them, as a doctor or nurse’s job is not that of a plumber or an electrician. Their decision is non-retractable.

Here are a few statistics to drive home the point:
• More than 250,000 deaths occur every year due to medical errors.
• 70% of the deaths in medical negligence cases are attributed to human errors.
• At least 1% of the inpatients in almost every hospital become victims of medical negligence.

All these statistics point to one thing – medical errors are one of the major causes of death across the world.

Main types of medical errors

Most deaths occur due to misdiagnosis, delayed diagnosis, administration of wrong (or wrong combination of) drugs, wrong parts operated, surgical instruments were forgotten, blood-type wrongly detected or poor record-keeping. Apart from these, things such as not checking the expiry dates of medicines or the functioning of the IV pump may also result in deaths.

Fixing Accountability – What needs to be done?

Hospitals, these days are run by professionals, MBA’s as CEO, GM and Unit Head, who at times may not be doctors. At best, they are revenue officers, responsible for making the unit profitable. Every day they have a ‘Morning meeting” of all HODs of the hospital staff, where they get daily updates of each Dep’t, the number of beds vacant in ICU, revenue achieved y’day, bills filed for the claim, payments made etc.

These days, it is not just one doctor, but an entire chain that treats a patient in a hospital.
Until you make everyone in the chain responsible, no one would be able to prevent these meaningless deaths.

In the case of death or permanent disability of a patient because of medical negligence, this is how accountability can be fixed.

1. Criminal cases to be registered against the ones involved in administering medicines and treatment of a patient, such as the Nursing staff & the Nursing Head. This would apply in the case of administering wrong medicine, expired medicine or wrong dosage that is not prescribed by the doctor. If they have this fear of going to jail, they will double check everything which will save precious lives.

2. If the treating doctor’s diagnosis is wrong: The Medical Board should evaluate the case and if the charges are found to be proved, a criminal case must be registered against the erring doctor, followed by suspension of his/her license for a few years. and not allowing him to practice. What was the HOD doing when this patient was being treated? The HOD must put his signature on the line of treatment advised by the treating doctor on the patient file. HOD being senior in terms of age, experience, qualification, salary needs to be held responsible for this death and made a part of the FIR.

3. Medical Superintendent, Medical Director: to be directly held responsible for non-implementing of clinical SOP, protocols, inspection, and closing of the service gaps. Their future growth in the organization should be linked to the data of deaths and permanent disability of patients admitted for treatment in that hospital.

4. Stores-in-charge: Why he maintained & issued expired inventory in his stock? Why did he not raise an alarm in his reports to the GM/ CEO of the hospital in writing?

5. Operations Head: How was he unaware of the existence of expired medicines in his stock? What was regular stock taking done by him?

6. GM/ CEO of the Unit: He is every day looking only at revenue numbers, bottom line, EBITDA, ROI but what about the deaths in the hospital under his eyes. He should be made responsible to counsel the patient’s family to understand the pain and grief which they suffer, waive off the bill, sack the wrong people in the chain and make a report about each such incident to submit to the top management at head office so that they can inbuilt systems to prevent such mishappening in future. He is the leader on the ground who must ensure regular training, checks, and balance of the system is in place and he should be in fear of losing his high paid job whenever such an incident happens.

7. Top Management, Board Members of the Hospital: The top should be held accountable. They must inform their staff of the incident and what steps they have taken after the incident to prevent it from recurring. The compensations given to the patient should be deducted from their salaries in equal proportion.

8. More inspections: More random and rigorous checks on hospitals for defaults in service. Various accreditations like NABH, JCI, and empanelments done by various organizations should review and such hospitals rigorously and refrain from issuing certifications in future.

9. Civil Surgeons regular reporting: Hospital reports to be submitted regularly to the Health Ministry: and they need to devise better policies and systems for hospitals approvals.

10. Better laws and enforcement: Parliament to enact stricter laws for punishment and compensation that the judiciary needs to enforce.

Your feedback and reactions are welcome.