Medical errors and malpractices in Ghana, Who’s to blame?

Errors are inevitable, yet quality and safety procedures distinguish good health facilities from bad ones and can save the lives of thousands. This is my philosophy as I help establish and advocate for well-defined measures to prevent the numerous medical errors and malpractices that continually get the newspapers bashing.

Healthgrades, an online healthcare provider rating service released its America’s 50 and 100 Best Hospitals for 2016, and it was clear the basis was on quality and safety.

The Chief Strategy Officer, Evan Marks, remarked, “We are pleased to recognize those organizations that have achieved this distinction and urge all consumers to do their homework when selecting a hospital—especially as it relates to emergent conditions—since hospitals do not perform equally”.

The celebrated five-star health facilities had an overall 26.5% lower risk-adjusted in-hospital mortality rate for 19 procedures and conditions, compared with other hospitals, and if same should have happened in the lesser hospitals, more than 170,000 lives could potentially have been saved within two years, according to the white paper.

This is statistics for America; but what is the situation in Ghana like? Medical errors continue to occur and result in the death of thousands, yet are not given the right description in medical reports not to talk of measures to combat the menace.

Errors have occurred from wrong medication (type, dosage, route), diagnosis due to incorrect lab test requests, poor lab results and surgical procedures. The issues with surgical procedures are ones you’ll dread. These range from cutting the wrong organ to leaving surgical instruments in patients.

During preparation for surgery, patients are made to sign consent forms as if to exonerate the surgeons from procedures that go wrong due to their ineptitude and sometimes recklessness. It begs understanding that some of these procedures are routinely done elsewhere without any casualty or any complications.

The horrifying results of medical negligence

Last week, a lady called to find out the reason why the doctor left cotton in her sexual canal after an intrauterine evacuation procedure following her incomplete abortion. She complained of heaviness in her pubic region for two days after the procedure and when bathing, a heavy ball of cotton full of blood dropped all of a sudden. I wasn’t surprised so I had to call her to my end to explain how reckless some health professionals can be, apologized accordingly and suggested a possible legal action to which she declined. An abnormal but normal attitude I have observed among Ghanaians.

Last year, a procedure on a close relative with an issue of blurred vision rendered her blind, shut down most of her organ systems and she finally died.

A lady in my village was told by a lab attendant that she had contracted HIV because the test proved positive. This reckless lab attendant ignored the regulations governing such procedures, which demanded utmost confidentiality, counseling and above all non-disclosure of results to the patient directly. When I got wind of this case, I recommended having further tests to confirm as is the normal procedure. These further investigations came out negative, by which time; this woman had grown lean and emaciated from the thoughts of being positive alone.

The most recent is what has happened to the young girl, Priscilla Pomaa, a native of Chiraa as reported by peace fm.

These are serious consequences of medical errors and malpractices. Every now and then they do happen in our health facilities; but are normally attributed to a clinical condition to put someone in a safe situation and this is the reason why they are not identified and categorized well if at all in medical reports.

According to the American College of Physicians’ Ethics Manual, it is the responsibility of Physicians (health professionals) to disclose to patients information about procedural and judgment errors made in the course of care, if such information significantly affects the care of the patient. I know for sure this is not the case for Ghana and most developing countries.

The reasons are simply; fear, remorse, anger, guilt, isolation, possible backlash, doubt, and feelings of being incompetent.

As a result of the above-mentioned, most medics are on the defense anytime something goes wrong. Most healthcare professionals behave like the biblical Adam; they look for the line of least resistance and stuff it with the blame they should have borne themselves. Amongst some areas of blame are;

1. The Lab results did not come on time, although they know the turnaround time for each test.
2. It is the nurse, who did it,
3. A student did that and the blame game goes on and on.

When the above factors prevail, there are no measures to regulate the practices and outcomes of care givers as well as protect the patient and even sometimes the health professionals.

I am yet to find out the institution responsible for quality and safety in our health facilities.

Is it the Ghana Standards Authority? Or the Food and Drugs Authority? My belief is that we’ll need an independent body to deal with such issues if we are to promote safe and efficient health delivery in our health facilities.

Going through the directorates of the Ghana health service, I didn’t see much relating to quality and safety, same for the Ministry Of Health, yet among the objectives of the Ghana health service the primary caregiver under the ministry is to ‘‘increase access to good quality health services.

America for instance has about five strong institutions beside the FDA to ensure quality health and patient safety backed by an act, the ‘‘Patient Safety and Quality Improvement Act of 2005’’.

This is besides the numerous institutions created to promote health in their country. What we have is the ‘‘Patient’s Charter’’ that contains just a miniature of what quality and safety is about; patients’ rights and responsibilities.

Measures to ensure patient safety have been well-researched into and are working perfectly in the developed world. The universal bar-coding of medications, the electronic patient record system, implementation of safe practices, patient safety research centers are not higher for Ghana.

There are internationally agreed upon measures that Ghana has subscribed to ensure quality and safety yet we resist implementing them. ISO- 15189: 2012 for instance has been accepted by Ghana through the SLMTA (Strengthening Laboratory Management Towards Accreditation) a program instituted by the CDC-USA.

Non implementation of these standards has resulted in people dying from fake lab results and consequent misdiagnosis and mismanagement of diseases.

The issue of quacks and improperly trained or half-baked professionals is something Ghana is grappling with.

I continue to think about the reason why the leadership of this country will be so glad to employ untrained high school leavers in the name of youth employment in a critical area like health. Meanwhile there are numerous qualified and registered nurses, allied health professionals and medical doctors sitting at home due to a ban on public sector employment.

After two to three weeks, these ‘‘quacks’’ are allowed to pick syringe and needle, aspirated medication and are bold to inject them into human beings. Some serving as phlebotomist, lab assistants, surgical assistants and not even understanding just the clotting cascade. Not to talk of the issue of pre-analytical errors associated with phlebotomy and lab tests.

I was expecting state agencies in the health sector and the regulatory authorities to resist this. The Nursing and Midwifery council, the Medical and Dental council, the allied health professions council, the Standardization authorities, the National Accreditation Authority and the likes, to come out boldly to kick against such actions. The loudness of their silence is heartbreaking as human lives are traded on the platter of incompetence and sometimes avoidable medical errors.

Have we asked ourselves these questions? If qualified professionals, who have been trained between two to six years and sometimes seven, are making mistakes in our health facilities how much more a stranger? How much more frustrated youth who have no health education at all? If people can be trained at wards and on benches then of what use is the many years of schooling?

The last time I put these questions to a politician, his answer was that they would be sent to villages and rural areas.

This is clearly irrational and also smacks of discrimination against a certain group of citizens. Are people living in Accra or Kumasi more important than those in the villages? You will send them to go to my village to kill my family right? This is ridiculous and who told you the trained professionals do not want to go to these villages?

The issue of quality and patient safety is so important to me and I want all agencies to help make a change to protect our lives. You don’t know when someone will give you a wrong injection, fake lab results, wrong surgical procedure or even inappropriate information about your health.