The document discusses medical malpractice and risk management in healthcare. It defines medical malpractice as situations where a patient is injured or dies as a direct or indirect result of negligent care by a healthcare professional. This can include misdiagnosis, medication errors, surgery mistakes, and more. It also outlines the key elements a patient must prove in a medical malpractice case. The document then discusses risk management strategies used by healthcare organizations to reduce risks and prevent compensable events, such as investigating incidents, developing safety policies, and educating staff.

1. ANNETTE KASERA
BScN, KRCHN

2. LITIGATION
One can easily say that healthcare now is a risky business. A
report released in 1999 by the Institute of Medicine indicated
that medical errors contributed directly or indirectly to the
deaths of between 44,000-98,000 hospitalized patients each
year. This report suggested that 90% of these errors result from
system failures and not necessarily from individuals. (Valorie
Dearmon 2014)
A person who alleges negligent medical malpractice must
prove four elements:
• A duty of care was owed by the Doctor/Nurse.
• The Doctor/Nurse violated the applicable standards of care.
• The person suffered a compensable injury/death.
• The injury/death was directly or indirectly caused by the
substandard conduct.

3. Discussion
MEDICAL MALPRACTICE
Medical malpractice is defined as any
situation whereby a patient is injured or
suffers fatal harm as a direct or indirect
result of a healthcare professional. This can
include but not limited to:
 Misdiagnosis or Delayed Diagnosis.

4.  Childbirth Injuries (failure to diagnose a
medical condition of the mother, such as
preeclampsia,Rhesus incompatibility,
hypoglycemia, anemia, or gestational
diabetes, failure to identify birth defects,
failure to identify ectopic pregnancies, failure
to diagnose a disease that could be
contagious to the fetus, failure to anticipate
birth complications due to baby or maternal
factors, failure to respond to signs of fetal
distress, incompetent use of forceps or a
vacuum extractor.

5.  Medication Errors (the doctor prescribes the wrong
medication, wrong dosage, the doctor prescribes to
treat a misdiagnosed condition, the prescription is
correct, but the nurse administers the incorrect
amount or incorrect administration method).
 Anaesthesia Errors (failure to investigate the patient's
medical history for possible complications, failure to
inform the patient of the risks involved, giving too
much anesthesia to the patient, failure to monitor the
patient's vital signs, improper intubation of patients
and using defective equipment).
 Surgery Errors (puncturing internal organs, operating
on the wrong body part, or leaving surgical
instruments in the body, the nursing staff might be
negligent in administering post-op care).

6.  Student nurses can also be
held liable for their actions
and can be sued. A student
nurse is held to the same
standard of care as a
registered nurse when
performing RN duties. If a
student nurse cannot safely
function in the performance
of these duties while
unsupervised, then they
should not be carrying out
the duties (American Nurses
Association 2001
Guidelines).

7. RISK MANAGEMENT
Healthcare risk management is the process
healthcare providers and organizations use to
reduce the occurrence of unintended injuries
or damages during the delivery of medical
care. This may vary according to the
organizational structure, the type and size of
the facility, and the scope and complexity of
patient services delivered. (NORCAL
Litigation Handbook 2016)

8. The goal of the healthcare risk management
function is to foster an environment that minimizes
risks to patients, visitors and staff, thus reducing the
frequency of potentially compensable events or the
severity of losses when events do occur. An effective
risk management program requires commitment
and cooperation from all members of the healthcare
team. (NORCAL Litigation Handbook 2016)
Risk Management Functions
Most risk management programs:
 Identify, review and investigate unusual incidents.

9.  Identify potential exposure through a review of existing
internal systems related to personnel, policies and
procedures, facility equipment and premises, medical
record documentation, patient follow-up systems and
discharge advice to patients.
 Develop and implement policies designed to help reduce
risk and increase patient safety.
 Avoid recurrence of accidents or unusual incidents.
 Advise medical staff and facility management of
actions to be taken to improve problem areas.
 Educate healthcare providers and staff regarding
appropriate work practices and patient care systems.

10.  Assess patient satisfaction with the services rendered
by the hospital.
 Investigate and resolve patient or visitor complaints.
 Ensure compliance with accreditation standards e.g.
JCIA, ISO and all applicable laws and statutory
regulations.
 Coordinate the legal defense process when a claim is
forthcoming. (NORCAL Litigation Handbook 2016)

11. INFORMED CONSENT
 This is a process for getting permission before conducting a
healthcare intervention on a person. An informed consent can
be said to have been given based upon a clear appreciation
and understanding of the facts. To give informed consent, the
individual must have adequate reasoning faculties and be in
possession of all facts. Impairments to reasoning and
judgment that may prevent informed consent include basic
intellectual or emotional immaturity, high levels of stress such
as PTSD, severe intellectual disability, mental
illness, intoxication, severe sleep deprivation, Alzheimer's
disease, or being in a coma.
 In cases where an individual is considered unable to give
informed consent, another person is generally authorized to
give consent on his behalf, e.g., parents or legal guardians of a
child (though in this circumstance the child may be required
to provide informed assent) and conservators for the mentally
ill.

14. CONCLUSION
The reality of our times is that all of us who work in the
healthcare setup are open to lawsuits from
disgruntled patients, relatives and aggrieved families.
The best we can do to shield ourselves from those
outcomes is to continuously improve the quality of
care we give, communicate clearly with each other and
with our clients about expectations and
responsibilities from both sides and to undergo regular
audits of our practice in order to identify and rectify
any gaps.

15. RECOMMENDATIONS
• The Nairobi Hospital consent form should be more
inclusive of all invasive, non-invasive procedures,
surgeries in order to accommodate the variety of
services offered at the hospital.
• The Nairobi Hospital should have a clear framework
for protecting the staff in case of lawsuits.
• All of us should make it our mission to clearly explain
to patients what procedures are planned for them, the
risks involved, the benefits and do this in cooperation
with the Doctors.

16. QUESTIONS
THANK YOU.