ANGEL OF DEATH

Janki Mistry

Some time ago, I saw a movie, which shook me up enough to produce this article. It was
a story about a young man who had everything going right for him until he encountered a
tragedy, which left him so distraught that he lost his mental stability and was admitted to
a very well known asylum. I need not elaborate upon the whole movie but only the last
part wherein the man is cured and falls in love with the daughter (who is also a doctor) of
the senior doctor. When this senior doctor finds out about this affair, he orders that the
young patient be brought to the operation theatre. Once there, the doctor cuts the carotid
artery of the young man and turns him into a vegetable. This man who was once the most
dynamic, funny, jovial prankster became a living corpse… and the reason… the doctor
didn’t like him!!! One cannot even begin to grasp the audacity of this deed.
Many years ago eminent doctor and author – Robin Cook shocked the world when he
wrote the book ‘Coma’. The book was a flagrant revelation of the malpractices of the
medical world wherein the doctors in order to steal the vital organs like kidneys,
purposely induced patients into coma by tampering with the anesthesia administered at
the time of surgery. Both these examples are fictional but every fiction is inspired by
reality and so were these.

Whenever a patient consults a doctor he surrenders his whole being to him, trusts him
completely, gives him a place no lesser than the Almighty Himself and in return only
expects that his doctor will do the best for him. Not to mention that the hefty fees are
never even questioned. Since times immemorial doctors have been given a place of high
reverence in our social structure and their profession is considered the noblest. But it is
high time that we realize the fact that doctors are ultimately mere mortals who are
affected by pangs of greed, anger, jealousy, selfishness and cruelty just like any other
person. Hence let us not be too shocked to hear incidents of patients being induced into
coma for their organs, babies being delivered through caesarean section even when not
required, women being sexually harassed by male nurses or doctors on the labour table or
during time of examination, rude and inhuman attitude towards poor patients and not to
mention patients even losing their lives because of the carelessness of doctors or nurses.
I will narrate an incident that was told to me by a doctor himself. The last resort for a
patient sinking of a heart attack would be an adrenaline injection pumped directly into the
heart. This practice though now obsolete was quite in vogue even a few years ago. Now
many a times in primary health centers or government hospitals, it would so happen that
the adrenaline injection would be out of stock, again due to the negligence of the
inventory department if at all it exists. In such a situation, some nurse to avoid the wrath
of the senior doctors would fill the syringe with sterile water which was injected in the
patient’s heart and naturally, the patient who may have survived, lay dead on the doctor’s
table. This reflects the height of callousness that one human being can show toward the
other.

Government civil hospitals are raking examples of medical malpractices. In one such
hospital’s orthopaedic department, the resident doctors have reached a height of cruelty
and insensitivity. I think they have assumed the duties of God without Him even asking
for help! In a civil hospital’s setup the resident doctors run the entire show of treatment
and the interns assist them. Whenever a poor patient comes with multiple fractures and
traumatic injuries, the interns are usually sent on some errands and when no one is
watching, an injection of potassium chloride is administered to the patient. For my doctor
friends who are reading this article, I need not elaborate what potassium chloride does to
a patient but for the laymen, I would like to inform you that it gives instant death sweet
death!!! The irony of this whole situation is that everyone from the junior most ward boy
to the Dean knows about this misdemeanor but no one is even bothered to raise his or her
voice against it. For them it is just another bed number, an object, a casualty! And of
course then a façade of a preliminary postmortem is carried out which reveals the cause
of death – multiple trauma.
I happen to know a few doctors who are of course not a part of this practice but take a
pusillanimous approach towards the whole situation. They say that they have neither the
capacity nor the time or energy to fight the system. My only question to them is: if the
righteous do not come forward and take a stance, then who will? By not raising a voice
against crime, does not one become a part of its cause?
Psychiatric practitioners, as a part of their treatment are allowed to hypnotize patients or
drug them so that they enter a trance like semi conscious state. Business or family secrets
are then extracted from patients and later on doctors make loads of money out of black
mail and at this juncture I think it would be redundant to mention sexual harassment of
female patients.

Yet another face of medical malpractice is -- medical errors caused by doctors or nurses
due to lack of knowledge or faulty diagnoses. A 2004 study by Dr. Samantha Collier of
Health Grades Inc. (U.S.), used Medicare data to estimate the number of preventable
deaths due to medical errors. Her findings? 1,95,000 people per year die needlessly due
to medical errors at US hospitals. That’s more than three times the fatalities caused by
auto accidents. The population of US is around 29 crores and technologically the country
is far more advanced than ours. By these estimates can we extrapolate the figures for
India where the population is 100 crores and medical technology available to 50% of the
people is close to nothing?
In many cases doctors tend to make guinea pigs out of their patients. They are put
through a gamut of irrelevant tests and unnecessary examinations because the doctor does
not know his job well.
In the words of W. E. Deming, guru of total quality management,
“If we had to live with 99.9% success rate in the industry, we would have two unsafe
plane landings per day at O’Hare, 16000 pieces of lost mail every hour and 32000 bank
cheques deducted from the wrong bank account every hour.”
The above quote suggests that even 99.9% is not good enough. But recent international
data suggests that failure rate in medical profession due to iatrogenic injuries is close to
1% which is substantially higher than industry. Drug therapy is the most common type of
therapeutic intervention and iatrogenic complications are medication errors in the drug
treatment process that leads to harm. Medication errors are worse than a crime.
Adverse event (AE) is a definable injury caused at least in part by medical management;
the injury must have prolonged the hospital stay or caused disability at the time of
discharge or both.
Adverse drug event (ADE) means an injury or AE resulting from medical intervention
related to drug.
Adverse drug reaction (ADR) is any unwanted effect caused by drug when used in
recommended dosage and is appropriate.

Epidemiology of medication errors and their complications:

1. In the US, annually AEs are responsible fro 180,000 deaths – the equivalent of
three jumbo-jet crashes every 2 days.
2. ADRs are the fourth most common cause of death in US accounting for more than
100,000 deaths per year.
3. For India the extrapolated figures would be 400,000 deaths due to ADRs and
720,000 AEs per annum.

In India …

• Of all visits to the medical emergency department 6 percent are drug related.
• ADRs accounted for 45% of all ADEs.
• Of all ADE related visits 52% and of all ADE related admissions 55% were
considered preventable.
• In a study of over 3500 prescriptions, the use of drugs was unnecessary in 47%,
irrational in 19% and hazardous in 11%
• Voluntary consumer action network, in a recent survey of 200 prescriptions,
confirmed irrational drug use and has warned that doctors found to be mis-
prescribing would be sued in consumer courts for medical negligence.

The standing question is – what should we do to solve this problem? According to me 3

ideas have a promise.
1. Legislative action is needed to change the medical malpractice system.
Consumers should be made aware of legal remedies available against such
practices. Medical negligence or malpractice is defined as lack of reasonable care
and skill or willful negligence on the part of the doctor in the treatment of the
patient whereby the health or life of the patient is endangered. If the consumer can
establish to the satisfaction of the court that : a) The doctor owed him a duty to
conform to a particular standard of professional conduct; b) The doctor was
derelict and breached that duty; c) the patient suffered actual damage; d) and the
doctor’s conduct was the direct or proximate cause of the damage; then he is in a
position to sue the doctor for damages. Criminal negligence goes beyond the
matter of mere compensation. The doctor has not only made a wrong diagnosis
and treatment, but also shown such gross ignorance, carelessness and neglect for
the life and safety of the patient that criminal charge can be brought against him.
For this he may be prosecuted in the criminal court for having caused injury to or
death of his patient by rash and negligent act amounting to culpable homicide
under section 304-A of the Indian Penal Code. Some examples are as follows:
• Injecting anaesthetic in fatal dosage or in wrong tissues.
• Amputation of wrong finger, operation of wrong limb, removal of wrong
organ.
• Operation on wrong patient
• Leaving instruments or sponges inside the part of body operated upon.
• Transfusing wrong blood.
• Leaving tourniquets too long, resulting in gangrene.
• Performing a criminal abortion etc.

2. Health care institutes need to put the best performance improvement technologies
that can rapidly solve problems of medical errors. Management techniques such
as Kaizen, mistake proofing, human factors technology, benchmarking, job
performance aids and business process improvement can be made use of.
3. And last but not the least doctors need to be reminded that the Hippocratic oath
that they took at the time of registration does not in effect become a hypocritic
oath.