Eradicating medical negligence will require more than a probe

Amid the blame shifting, finger pointing and the ‘It wasn’t me’ chorus that emerged from the medical fraternity following the surgery mix-up at the Kenyatta National Hospital lies the chronic decay of the larger health sector.

Unlike the ministries of Finance, Agriculture or Education, which tend to have huge budget allocations and therefore constantly attract media attention, the health sector and the ministry in charge tend to operate in an ecosystem that is relatively distanced from the limelight yet under chronic mismanagement. This status is not accidental but well organised, with profiteers and accomplices stalling and fighting any attempts to institute essential reforms. Three aspects stand out.

First, the immediate response by the Health Cabinet secretary to send KNH Chief Executive Officer Lily Koros on compulsory leave and launch of a probe is purely reactionary and can only bring change if the leave order is followed by sacking once gross misconduct can be proven. And now that we have the probe ongoing, what the public needs is more than the usual "no stone will be left unturned" mantra.

We need to know the scope and terms of reference of the probing team. How many people are part of the team? How were they selected? Does the team have an operational model that will inform its inquiry? Does it have the capacity to undertake such an assignment given the fact that it is not just about the sensitivities surrounding the two patients but the entire team that was on duty and the line management structure in place?

Assisting counsel

Does the team have assisting counsel with sound understanding of medical-legal issues to prepare clear findings that can eventually lead to culpability if not a successful conviction if taken to court? And what measures have been put in place for surgeries due this week and moving forward? What protocol has been established to ensure that this mix-up never recurs?

In a country where investigation reports are rarely implemented, it is one thing to form a probe team, task force or committee only for the recommendations to gather dust, especially if they threaten the status quo. So the Cabinet secretary needs to take charge and assure the public that this probe will be different.

Second, the immediate silence and then blame shifting by the medical fraternity is testament of a sector whose staff are not pulling in the same direction. The ego wars and debates about who should take responsibility are no different from the political class who are keen on seniority and recognition instead of service to citizens.

What patients and the wider public are interested in is not who exonerates themselves first from culpability but what should ideally happen in the surgery admission and case management process. That there was no way perhaps the Kenya Medical Association would convene a press conference flanked by members from the Nursing Council of Kenya, Kenya Medical Workers Union, Union of Laboratory Technologists and even the Pharmacy Council of Kenya only goes to show how divided the sector is. This is a dire situation.

The CS needs to direct the principal secretary in the ministry to urgently convene a meeting of all leaders in the various councils, unions, associations and societies in the health sector to engage on a Ways of Working document that will form the basis of a new health sector strategic phase that is patient and quality-driven.

Medical tribunals

Third, Parliament and the Council of Governors should urgently consider the creation of national and perhaps county-based medical tribunals to handle cases of medical negligence. The present framework where cases are reported to the Kenya Medical Practitioners and Dentists Board (KMPDB) comprising fellow medical practitioners is not patient-centred. Rather, it swings towards protecting the medical practitioner. Perhaps this is why there is an awful silence about cases of medical negligence.

Doctors cannot speak out against their fellow medics who err. They cover up and come up with this chorus - "the system has failed us." This can only be addressed by a national policy that culls rogue medical professionals and national civic awareness of patient rights pegged on the creation of a patient rights charter that should be signed by all medical professionals as part of their employment contract.

There is no way the health sector can continue working without an independent oversight framework checking on practitioners. While the jury is still out on assessing the impact of the Independent Policing Oversight Authority, at least we know that such a body can address the challenges of police misconduct besides the Internal Affairs Unit.

The KMPDB in its present constitutive state has failed miserably as a neutral arbiter on matters of professional misconduct by members. The creation of medical tribunals with representation of professionals outside the medical fraternity could provide the necessary deterrence mechanism.

Mr Wanyonyi is a media regulation and strategic communications specialist. [email protected], @edward_wanyonyi