In a deeply distressing incident at the Government Medical College Hospital in the Calicut district of the southern Indian state of Kerala, on 16 May 2024, a four-year-old girl, admitted for the removal of an extra finger, instead underwent surgery on her tongue. This alarming medical negligence case is a grievous error and a stark reminder of the urgent need for comprehensive systemic reforms to ensure patient safety and accountability in India’s healthcare system.
Medical negligence is not a new phenomenon in India, and this latest case is a tragic addition to a growing list of preventable medical errors. It plagues hospitals, clinics, and care settings nationwide, with research from the National Library of Medicine revealing a staggering annual incidence rate of up to 5.2 million cases in India alone.
Despite this alarming figure, only 46% of healthcare providers adhere to ethical guidelines, signalling a dire need for accountability and reform, according to the Indian Journal of Medical Ethics. Surgical errors, responsible for 80% of medical error deaths, and mismanagement, contributing to 70% of emergency fatalities, underscore the gravity of the situation. According to reports, regional disparities are evident, with Punjab, West Bengal, Maharashtra, and Tamil Nadu exhibiting the highest malpractice rates.
Amidst this crisis, seeking legal advice becomes imperative, accompanied by the meticulous gathering of evidence and consultation with medical experts. However, navigating the complex medico-legal landscape is fraught with challenges, from deciphering medical and legal jargon to enduring the emotional and financial toll of prolonged legal proceedings. The Supreme Court's stance, articulated in landmark cases like Jacob Mathew vs the State of Punjab, emphasises the necessity of holding medical professionals accountable while acknowledging the nuanced nature of medical negligence.
The legal landscape surrounding medical negligence in India has undergone notable changes, particularly in terms of criminal consequences. Under Section 304(A) of the Indian Penal Code (IPC), those found responsible for causing death by negligence face a maximum penalty of two years imprisonment along with a fine. However, the introduction of the Bharatiya Nyaya (Second) Sanhita Bill has made amendments.
While the bill increased the punishment for such acts to five years, medical professionals, if convicted, are still subject to a lower penalty of two years imprisonment. This revision, outlined in Section 106(1) of the Sanhita, maintains the possibility of criminal prosecution for medical negligence, albeit with a reduced maximum sentence compared to other death-related scenarios.
While the bill increased the punishment for such acts to five years, medical professionals, if convicted, are still subject to a lower penalty of two years imprisonment. This revision, outlined in Section 106(1) of the Sanhita, maintains the possibility of criminal prosecution for medical negligence, albeit with a reduced maximum sentence compared to other death-related scenarios.
With millions of lives at stake annually, urgent action is imperative. Enhanced medical training, particularly in rural areas, and the implementation of specialised courses like the Acute Critical Care Course (ACCC) offer promising avenues for reducing fatalities. By upholding professional standards, fostering a culture of accountability, and prioritising patient safety, India can mitigate the devastating impact of medical malpractice and pave the way for a healthier, more equitable future.
The healthcare sector, particularly in government hospitals, is marred by systemic issues that often lead to such devastating mistakes. These issues range from inadequate training and overworked staff to insufficient checks and balances. To prevent future occurrences of medical negligence, it is imperative to undertake comprehensive reforms that address these root causes.
One of the primary factors contributing to medical errors is the lack of adequate training for medical professionals. Medical education in India needs to place greater emphasis on practical training and patient safety protocols. Continuous Medical Education (CME) programs should be mandatory, ensuring that healthcare professionals are up-to-date with the latest medical practices and safety standards. Implementing rigorous training modules focusing on patient safety, error prevention, and ethical practices can significantly reduce the likelihood of such errors.
Hospitals must adopt and strictly adhere to internationally recognised patient safety protocols. The World Health Organisation's surgical safety checklist, which has been shown to reduce surgical complications and deaths, should be mandatory in all hospitals. This checklist includes verifying the patient’s identity, surgical site, and procedure before anesthesia is administered. Such protocols, when followed diligently, can act as a crucial safeguard against human error.
Overworked and fatigued medical staff are more prone to errors. The healthcare sector needs to address staffing shortages and ensure that doctors and nurses are not overburdened with excessive workloads. Adequate rest and manageable working hours are essential for maintaining high standards of care. Hiring more medical professionals and support staff can alleviate pressure and reduce the risk of mistakes.
A culture of accountability within healthcare institutions is vital. This means fostering an environment where medical errors are openly reported and addressed without fear of retribution. Establishing a transparent system for reporting and analysing errors can help identify underlying issues and prevent future occurrences. Additionally, accountability measures should include stringent actions against negligence, ensuring that those responsible are held accountable and that corrective measures are implemented.
Effective communication between healthcare providers and patients is crucial in preventing medical errors. Patients and their families should be thoroughly informed about the procedures they are undergoing, including the risks involved. Obtaining informed consent should be a rigorous process where the patient’s understanding and agreement are documented. This practice not only respects patient autonomy but also acts as an additional check against potential errors.
Advancements in technology can play a significant role in reducing medical errors. Electronic Health Records (EHRs) and computerised physician order entry systems can minimise the chances of mistakes due to illegible handwriting or miscommunication. Implementing barcode systems for patient identification and surgical procedures can ensure that the right patient undergoes the correct procedure. Telemedicine and digital consultations can also aid in reducing diagnostic errors and ensuring that patients receive timely and accurate treatment.
Regular audits and inspections of healthcare facilities can ensure compliance with safety standards and protocols. These audits should be conducted by independent bodies to provide unbiased assessments of hospital practices. Identifying areas of improvement through these audits can help hospitals implement necessary changes proactively.
India can learn valuable lessons from countries that have successfully implemented measures to reduce medical errors. For instance, the National Health Service (NHS) in the United Kingdom has a well-established system for reporting and analysing patient safety incidents. Their National Reporting and Learning System (NRLS) collects data on adverse incidents, which is then used to improve patient safety measures across the country. Similarly, the United States has made significant strides with the implementation of the Patient Safety and Quality Improvement Act, which encourages voluntary and confidential reporting of adverse events.
The tragic incident in Kozhikode is a poignant reminder of the critical need for systemic reforms in our healthcare system. Preventing medical negligence is not just the responsibility of individual healthcare providers but requires a concerted effort from all stakeholders, including government bodies, healthcare institutions, and medical professionals. By implementing comprehensive reforms that address training, safety protocols, staffing, accountability, patient communication, technology, and regular audits, we can move towards a healthcare system where patient safety is paramount.
It is high time we prioritise patient safety and ensure that our healthcare system is equipped to provide the highest standard of care. The cost of inaction is too high, as each case of medical negligence not only erodes public trust in the healthcare system but also leads to irreparable harm to patients and their families. Let the incident in Kozhikode be a turning point, driving us to create a safer, more accountable, and patient-centric healthcare system. By addressing the systemic flaws that allow such incidents to occur, we can ensure a safer future for all patients. The time for change is now, and it is our collective responsibility to make it happen.
(Amal Chandra is an author, policy analyst and commentator. Views are personal.)
