Unlike India, many countries track medical negligence closely

Rema Nagarajan
20 December 2013, 06:54 PM IST

A recent article that I did on medical negligence (http://timesofindia.indiatimes.com/india/Clean-slate-for-doctors-on-medical-negligence/movie-review/27394151.cms) was about how many developed countries tracked cases of medical negligence and medical errors. By tracking the incidence, the authorities are able to examine why such cases of negligence or error happen. After identifying the cause, they are able to adopt measures to help reduce such cases which often cause great pain and suffering and sometimes even permanent disability. Many such cases can also cause deaths. Tracking is also to ensure that patients and their families who are thus harmed for no fault of theirs can be helped, at least through monetary compensation.  

There was a general sense of disbelief among many readers looking at the numbers on medical negligence and deaths and injuries coming from many other countries. To dispel some of that disbelief I would like to elaborate the source of the data for a few countries to show how seriously the issue is taken and how carefully it is monitored.

In the UK: The National Health Service Litigation Authority (NHSLA) in the UK revealed that 10,129 claims cases were filed in the 12 months up to March 2013, compared with 9,143 the previous year. The NHSLA a special health authority responsible for handling both clinical and non-clinical negligence cases on behalf of the NHS brings out a fact sheet each year outlining details of claims cases. According to the NHSLA claims are now settled in an average of 1.25 years, counting from the date of notification to the NHSLA to the date when compensation is agreed or the claimant discontinues their claim. Thus the authority also tracks how much time it takes for a claims case to be processed. Its annual fact sheet gives a break-up of the claims cases by specialty and also by which specialty accounted for the highest compensation.

And in June this year, Health secretary Jeremy Hunt revealed that 500,000 patients were harmed and 3,000 died each year from lapses in safety in the NHS. He added that known cases of error included 161 people with foreign objects left in their bodies, like swabs or surgical tools; 70 people suffering wrong-site surgery, where the wrong part of the body or even the wrong patient was operated on; and 41 people given incorrect implants or prostheses. This was widely reported in the Press. Compare that to our health ministry which has no data on medical negligence or error in Delhi, let alone the whole country.

In the US: The April 2013 issue of British Medical Journal Quality and Safety included a study done by researchers of Johns Hopkins University which estimated anything between 80,000 to 160,000 deaths annually from diagnosis errors. According to the Journal of the American Medical Association (JAMA), medical negligence is the third leading cause of death in the US. Yet, according to a Harvard Medical Practice Study, only one in eight or 2% of patients injured by medical negligence filed malpractice claims. It is often believed, without any concrete evidence, that much of the litigation in the US is frivolous. Researchers at the Harvard School of Public Health examined over 1,400 closed medical negligence claims and found that 97% were meritorious and about 80% involved death or serious injury. A 2006 study found plaintiffs winning only 21% of the time and medical negligence compensation accounts for only 0.3% of national healthcare costs. 

In Australia: In 2011-12 approximately 1,300 new claims were reported in the public sector and about 1,700 claims were reported in the private sector. On average, the length of time between incident and when the claim was opened was about 2 years, and 3 to 4 years between the health-care incident and when the claim was closed. Only 9-10% of the cases took more than five years.  About 54% of the 2,978 combined public and private sector claims cost less than $10,000, 25% cost between $10,000 and $100,000, 16% cost between $100,000 and $500,000, and 5% cost $500,000 or more. This was stated in a report compiled by the Australian Institute for Health and Family Welfare, a government institution. The report gives a detailed analysis of how many claims are filed in the private and public sector, how much average compensation was paid, the time taken to settle claims, specialties accounting for the claims cases and so on.

If these countries can do it, why is India unable to do so? Why are doctors here defensive about their negligence or errors being examined and recorded? Why does the government not heed the public demand for a more accountable health delivery system? These are important questions that need to be addressed at the earliest.

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