Reviews

How the media report medical errors

Blunders will never cease

On the front page of London's Evening Standard of 14 February the face of 3 year old Najiyah Hussain, beside the headline "She was killed by a hospital," looks the epitome of wronged innocence. The paper's principal focus is the human tragedy of Najiyah and of her family. There has been little time, and little space, for analysis. But we are told: "Police are investigating the incident and a doctor has been suspended."

The facts seem obvious. Najiyah, "given laughing gas instead of oxygen," was the victim of a mistake that you would not expect could happen in a modern health service. A victim, just like Wayne Jowett, who died on 2 February, a month after vincristine was injected into his spine instead of a vein at Queen's Medical Centre, Nottingham. And just like the 74 year old man who died at the Royal Sussex County Hospital, Brighton, after the wrong drug was administered during surgery on 7 February.

Yet mistakes of the kind that led to such deaths are not as rare as the public believes. It is just that, by focusingas newspapers and other popular media almost invariably doon the human tragedy of the victims and notions of individual culpability, the extent of errors and the system failures responsible are overlooked. The Daily Mail's first report on the death of Najiyah Hussain was: "Doctor may face gas death charge." Lower down the story mentions that safety procedures are meant to ensure that nitrous oxide cannot be confused with oxygen, but the finger has already been pointed.

In all this there is an assumption that doctors generally don't make mistakes, and those who do have failed to live up to some imagined medical paragon. But is there a point in the reporting of errors at which the volume of cases will lead away from a focus on individuals to an acceptance that mistakes are inevitable in any system operated by humans and that there is a need for a system based rather than a blame based approach? In this respect, Alison Harper's following account of how she covered two incidents in Brighton offers some hope.

Trevor Jackson, BMJ. 

A risky business

"Nothing is 100% foolproof, health care is a risky business. We have to recognise that it's given by people and not machines and people do make mistakes," Stuart Welling, chief executive of Brighton Health Care NHS Trust, told BBC Southern Counties Radio on 14 February:

He was speaking less than a week after an elderly patient had died after being given the wrong drug in an emergency procedure, less than 48 hours after a local surgeon had publicly claimed that mistakes were happening on a daily basis in Sussex hospitals, and on the day that the trust admitted that a child with suspected meningitis had been moved to a London hospital after being given four times the correct dose of an antiviral drug. Not a good week for him and not a good week for the reputation of health care in the area.

It started with an elderly man dying in intensive care at the Royal Sussex County Hospital in Brighton five days after being given the wrong drug during an operation for an abdominal aortic aneurysm. It was this case that prompted my contact, Doctor A, to speak out. His claims, made on BBC Southern Counties Radio, not only shocked the hospital trust but led to a quick denial on its behalf. With his identity protected, I asked Doctor A how common medical mistakes were. He replied, "I should think daily is the answer; in fact, I am certain." Were there times when patients' lives were put in danger and not recorded? "I am certain," he replied. With such incidents going unrecorded, he said that investigations into the blunders were not being carried out.

Reporting these claims was not easy. Doctor A knew both the consultant anaesthetist suspended after the fatal mistake at the hospital and nursing staff who were on duty in the operating theatre. Not only did I have a responsibility to protect him, but, having almost no medical knowledge, I needed to trust everything he said. Putting the incident into context was vital. The operation was a major procedure, with the highest mortality-morbidity rate at the hospital. The patient was elderly (74), which increased the risk of things going wrong. I was also told that the error was made during a crisis, and, rather than a drug being administered incorrectly, it was the wrong drug that was given. Instead of a plasma expander being given, an anaesthetic, bupivacaine, was injected intravenously. This contradicted the information that the trust had released to the mediathat bupivacaine should have been injected into the spine instead of the vein.

Doctor A was prepared to go out on a limb and say mistakes were happening daily in hospitals throughout Sussex and that it was the skill of doctors and surgeons which prevented these becoming fatalities. Unreported and uninvestigated medical accidents could continue without patients or the public knowing. Charles Turton, medical director at Brighton Health Care, assured the public that clinical errors were not an everyday occurrence, but Doctor A stands by his claim.

Alison Harper, Brighton and Hove reporter. 

BBC Southern Counties Radio