Nairobi — Doctors are today standing in the dock over medical mistakes. And in more than half the cases examined by the government's own chief pathologist, doctors got their diagnoses wrong.

They treated non-existent ailments after failing to identify the real cause of their patients' illnesses.

In some cases, Kenya's doctors have killed, not cured. Now cases of negligence are at such a level that doctors, hospitals and clinics will most certainly be faced with an avalanche of lawsuits unless the trend is rapidly arrested, according to top pathologist Dr Moses Njue.

"This country will see litigations by the public against health institutions like never before," said Dr Njue, who is head of the Medical-Legal Unit at the Medical Services ministry.

"The public is getting more and more educated and asking questions about what happens to them as patients or to their relatives," he added.

He said wrong diagnosis was the commonest form of negligence where a patient was treated for the wrong disease.

Common forms of negligence include a doctor failing to see a patient when asked or failing to refer a case to hospital. It also involves failing to admit a patient when necessary, poisoning by inappropriate drug and keeping inadequate clinical records.

Too lax

Hundreds of patients who walk into hospitals and clinics every day suffer the consequences of these forms of negligence by doctors who are too lax to spend sufficient time examining them.

Some doctors lack the patience to run thorough tests to help them accurately determine the appropriate treatment for the patient. Instead, they tend to rely on their own knowledge and experience without scientific support.

"It's common knowledge that where tests are not done, accurate diagnosis is missed in over 50 per cent of the cases," Dr Njue said on Saturday.

He added that in centres where tests are never done, or where laboratories are not properly used, "people are just practising witchcraft."

He said that as a pathologist he had carried out autopsies where the examination of a patient by a doctor was found to be wrong or different in more than 50 per cent of the cases.

Dr Njue, an outspoken specialist who often upsets the establishment with his position, told the public to understand that there is no guarantee they will get well after seeing a doctor.

Dr Njue has practised forensic pathology for six years and general pathology for 11 years. There are 13 forensic pathologists and 70 general pathologists in the country.

More Kenyans are coming out to lodge complaints where they feel a doctor was negligent or engaged in malpractice.

The Medical Practitioners and Dentists Board is receiving two complaints a week, in addition to the people who decide to file lawsuits directly in court, or have no knowledge or financial ability to make their case heard.

The board hears complaints and judges whether or not a doctor was negligent, based on whether another doctor with similar skill would have acted the same way in similar circumstances.

"The public is now enlightened and people are seeking a second opinion if they feel that they are in doubt," said the board chief executive, Daniel Yumbya.

He attributed the increase in the cases reported to the board to increased public awareness due to media exposure. He said it is not necessarily because doctors have become more negligent.

"Even cases that have been mismanaged by nurses or clinical officers are all coming to the board. Once they are investigated, we turn them over to the relevant boards such as the Lab Technologists Board, the Nursing Council and the Clinical Officers Council," Mr Yumbya said.

Complaints range from overcharging to wrong diagnoses and mishandling of gynaecological problems.

Since it was set up in 1999, the board has received 363 complaints and determined 73 of them. The pending 290 cases are at various stages of investigation.

"When we determine these cases we have six options: we can dismiss the case, we can admonish the practitioner by warning, we can place the practitioner on probation and attach them to a specialist who will then report to the board.

"We can also send them for retraining in one of the local universities, direct the suspension of the practitioner for a given period, and, in the worst cases, the practitioner can be deregistered," he explained.

A fall in the garden

Two years ago, Peninah Mutolo, 70, slipped and fell in her kitchen garden in Machakos and managed to get back on her feet and trudge home.

She then sought treatment at the nearest hospital, was seen by a doctor, treated and discharged with no more than a bandage around her ankle, a muscle relaxing ointment and some pills to ease the pain.

For three weeks, she limited her movements to the home compound and thought she was getting better until she woke up one day and could not walk due to the pain in her ankle.

She was taken to a different hospital and this time the doctor ordered an X-ray and found out that she had broken her ankle, a fact the first doctor had not identified.

She never lodged a complaint. She, like thousands of Kenyans, suffered in silence.

But Mrs Mutolo is among the luckier victims of negligence who live to tell their tales. Some never got a chance.

The little girl who died

Two months ago, a mission hospital was ordered to pay more than Sh300,000 to a family whose child died while undergoing treatment.

Nyeri's acting chief magistrate Lucy Gitari found the hospital guilty of negligence for the death that took place nearly six years ago.

Little Betty Gakii died on October 7, 2002, five days after she was admitted with fever and upper respiratory tract infection.

Medical reports showed that the girl, who was two years and nine months old, had a fever but was being treated for malaria.

A day later, her condition deteriorated and after further examination, doctors found that she had a respiratory infection and moved her to the Intensive Care Unit.

One doctor inserted a tube in her throat and her condition improved but when another doctor went to check on her, she recommended that a bigger tube be inserted.

Betty's condition deteriorated and plans were made to transfer her to Gertrude Children's Hospital in Nairobi but she died a few hours after the larger tube was inserted.

A post-mortem exam report presented as evidence that had been prepared by pathologist Dr Moses Njue stated that the girl died as a result of respiratory failure due to perforation of the trachea by a tube.

Dr Njue said that if the tube had not been changed, Betty would have lived.

The magistrate said that the evidence indicated that the perforation occurred after the tube was changed.

The hospital has since lodged an appeal against sentence in the High Court.