Right of the senior next of kin in possible medical error/negligence: case scenario, a death due to strangulated incisional hernia

Abstract

The deceased was a 60 year old female with a recently diagnosed right ovarian cyst and an incisional hernia. She complained of abdominal pain for a period of one and a half month duration. Abdominal pain for two weeks was her fist presenting complaint and she found her way to hospital at the end of the second week where she was diagnosed to have the above two conditions. During the next one month period she had been admitted three times to the same ward for the same complaint. Partially reducible incisional hernia with a small amount of free fluid in the right iliac fosse was the only significant finding of her last admission. On the second day following the last discharge she had vomited few times and became unresponsive to be pronounced dead at the Out Patient Department (OPD). The post mortem examination revealed strangulated hernia with small bowel gangrene. Strangulation of incisional hernia is a surgically correctable condition which contributes towards preventing a sudden unexpected death. Death of a patient despite of repeated admissions for the same illness without proper and timely medical intervention is an incident to be discussed. A patient seeks medical advice in order to achieve a relief and a possible cure. A patient relies on doctors’ decisions for their life. On the other hand it is a right of a patient to obtain maximum possible care with the available facilities at a given setting. The case under discussion critically scrutinizes such issues within the parameters of an avoidable death. Forensic Pathologists not uncommonly encounter deaths that could have been prevented had the ideal intervention been done at the correct level and correct time. Even when the death is resultant upon an overt case of medical malpractice, most of the time no further discussion is raised unless the next of kin files a case of medical negligence. Retrospective clinico-pathological correlations and attempts of minimizing such further mishaps are rarely taken up spontaneously unless statutory obligations such as “mandatory reviews” are imposed. The post mortem examination is the final conclusive scientific measure in ascertaining the cause of death in sudden and unexpected deaths. An effective communication between the clinician and the Forensic Pathologist is pertinent in such a context to correlate the clinical and post mortem findings. This necessity is mandatory when medical negligence is alleged as in this case. The three hospital admissions with same symptoms within one month’s time made the next of kin to assume a probable medical negligence. A medical error and medical negligence are two different entities. Medical negligence is a condition where many criteria including the duty of care of a doctor has to be proved by the prosecution. The authors as Forensic Pathologists would like to recommend that it is mandatory to have sound scrutiny of certain surgical deaths with “no-fault approach” similar to the process adopted with regard to maternal deaths in order to prevent recurrences of mishaps in future.