(II) Misadventure Is Mischance, Accident or Disaster. It Is of Three Types

Q). Write a short note on Therapeutic Misadventure?
Ans).
(I) Definition: Therapeutic Misadventure is a case in which an individual has been injured or had
died due to some unintentional/ inadvertent act by doctor or his agent or hospital (somewhat similar
to medical maloccurrence) without negligence or intent to harm. In Therapeutic Misadventure, the
injury or an adverse event is caused by medical management rather than by an underlying disease.
Therapeutic misadventure is one of the three types of Medical misadventure
(II) Misadventure is mischance, accident or disaster. It is of three types:

1) Therapeutic: when treatment is being given.
2) Diagnostic: when diagnosis is the only objective at that time, e.g., injection of radiopaque dye in
radiological investigation, bronchoscopy and angiography.
3) Experimental: where patient has agreed to serve as a subject in an experimental study
(drug/operative procedure).
(III) Therapeutic misadventure includes medication errors, medical and surgical errors, surgical
complications, iatrogenic or nosocomial infections, or postoperative complications.
(IV) Examples of Therapeutic misadventure:

(1) Hypersensitivity reaction, sometimes serious or fatal, may be caused by penicillin, aspirin,
tetracycline, etc.
(2) Excessive administration of an antidote to a poisoned patient, may cause death.
(3) Electric equipment, hot water pads, and heating pads may produce burns.
(4) Blood transfusion may cause serious or fatal complications from bleeding resulting from haemolytic
reaction due to hypofibrinogenaemia, hypothrombinaemia and thrombocytopaenia. Other
complications are haemosiderosis, viral hepatitis, hyperkalaemia and hypocalcaemia.
(5) Radiological procedures used for diagnostic purposes may prove fatal, e.g., poisoning by barium
enema, traumatic rupture of the rectum and chemical peritonitis during barium enema.
(6) Foetal and neonatal deaths in utero may occur from drugs administered to the mother during
pregnancy, e.g., dicumarol, diabenese, serpasil, iodides, synthetic vitamin K, thiazide diuretics, etc.
(7) NEOPLASIA INDUCED BY MEDICAL TREATMENT: It is difficult to prove a cause-and-effect

relationship between the therapy and trauma.
(i) Prolonged use of stilboesterol may cause breast cancer.
(ii) Iodine131 therapy may cause thyroid cancer.
(iii) Haemangioendothelioma of liver induced by thorium dioxide is the classic example.

(iv) Radiation will cause leukaemia.
(v) X-radiation or radium application to the head, neck or upper thorax for various non-malignant
conditions during childhood have an increased risk of developing thyroid gland cancer and also of the
salivary glands and other head and neck structures.
(vi) Chlornaphazine and phenacetin may cause urinary tract carcinoma.
(vii) Contraceptive steroids can cause adenomas of the liver in females, and if continued
unintentionally during pregnancy, the infant may develop a benign liver tumour.
(viii) Diethylstilboesterol causes vaginal adenosis and clear cell carcinoma of the vagina.
(ix) Exposure to pesticides cause skin and vulvar carcinoma.
(V) Some precautions that doctor must take to prevent TM: -
(1) Having standard knowledge and right decisions: -
(i) An experienced medical practitioner having standard knowledge should be aware of the usual
unexpected and unexplained reactions with different drugs in different individuals.
(ii) He should be acquainted with the iatrogenic effects, side effects and contraindications of different
drugs, at least of those used by him.
(2) History of sensitivity –

(i) Should be obtained before injecting any drug, especially antibiotics, biological products and sera.
(ii) Sensitivity tests must be done before injecting preparations which are likely to cause anaphylactic
reactions.
(iii) Negative history and even negative tests do not however rule out possibility of anaphylactoid
reactions and even death.
(iv) Patient should be specifically informed of this orally and in writing
(3) To prevent adverse effects –

1. (i) Before prescribing any drug known to cause any adverse reaction, the doctor should make a
reasonable effort to determine if any adverse reaction is likely to occur.
(ii) While prescribing a drug that has adverse side-effects, the doctor must be certain that the
prescribed drug was the proper one for the disease.
(iii) If there is any other drug which would be effective in treating the disease and is less likely to cause
an allergic reaction, it should be prescribed.
(4) Warning the patient –

(i) If a drug causes drowsiness or other accident-prone side-effects, doctor should clearly inform the
patient, and advise to avoid driving, working near dangerous machines etc. For legal immunity, it is
advisable to even write this information on the prescription sheet.
(ii) The doctor should inform the patient about the possibilities of permanent side-effects
(e) Informed valid written consent before any therapeutic procedure.
(VI) Physician’s liability –
1) It is a known fact that almost every therapeutic drug and every therapeutic procedure can cause
death.
2) A doctor would not be held responsible for harm caused to the patient by adverse reaction by drug
provided that doctor had exercised due care.
3) Such mishap does not provide ground for negligence.
(VII) Therapeutic Misadventure as defence against medical negligence:
1) Therapeutic misadventure is one of the defenses used by doctor when case of medical negligence
is brought against the doctor.
2) Ignorance of the possibility of a reaction, or continuation in the prescribing of a drug with adverse
reaction amounts to negligence. If doctor fails to stop offending drug, he cannot take this defense.
3) The defence of the doctor stands only if he can show that; the steps he took was quite justified, the
hazards were quite unexpected and is not known to occur, he took reasonable precaution against the
possible hazard as its possibility was known to him or, he had no other way but to take the risk of
hazard, though he knew its possibility.
(4) In case of experimental misadventure, if the doctor wants to use this point as a defence against a
charge of negligence he must justify the reason for his experimentation and must show that he got
valid consent from the patient or his guardian, after duly explaining him the merits and demerits of the
experiment and the risk involved in the act.

(II) Misadventure Is Mischance, Accident or Disaster. It Is of Three Types

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

(II) Misadventure Is Mischance, Accident or Disaster. It Is of Three Types

Uploaded by

Copyright:

Available Formats

Q). Write a short note on Therapeutic Misadventure?

(II) Misadventure is mischance, accident or disaster. It is of three types:

(IV) Examples of Therapeutic misadventure:

(2) Excessive administration of an antidote to a poisoned patient, may cause death.

(7) NEOPLASIA INDUCED BY MEDICAL TREATMENT: It is difficult to prove a cause-and-effect

(iii) Haemangioendothelioma of liver induced by thorium dioxide is the classic example.

(2) History of sensitivity –

(3) To prevent adverse effects –

(4) Warning the patient –

(e) Informed valid written consent before any therapeutic procedure.

(VI) Physician’s liability –

3) Such mishap does not provide ground for negligence.

(VII) Therapeutic Misadventure as defence against medical negligence:

You might also like