Vincristine…again

The case history is based on actual medical negligence claims or medico-legal referrals; however certain facts have been omitted or changed by the author to ensure the anonymity of the parties involved:

An 18 year old patient was undergoing chemotherapy as part of his treatment for leukemia. The treatment comprised:

• Vincristine – to be given intravenously.
• Cytosine – to be given intrathecally.

The JMO's supervising Oncology Registrar was on a rostered day off and so the JMO asked one of the other Registrars, who he knew well, to supervise the administration of the chemotherapy. The Cardiology Registrar agreed to assist, believing that his role was to simply observe the procedure. Due to a bed shortage, the patient was on the cardiology ward rather than the oncology ward. Tragically, the nursing staff and JMO got the syringes of medication mixed up and the JMO administered the Vincristine intrathecally instead of intravenously.

At least 23 incidents have been reported worldwide of Vincristine being injected intrathecally by mistake. Almost all of these incidents have proved fatal. In this case, the JMO did not carefully review the medications prior to administration. The experienced Oncology Registrar was not available and there was a misunderstanding about the role of the supervising Registrar. Additionally, the treatment was being provided in a ward in which there was little experience in the administration of chemotherapy.

A well known politician

The JMO was asked to attend the morgue to certify a patient as deceased. On arrival, the JMO was given the patient’s medical records. The JMO noted that the patient was a well known Politician. The morgue attendant told the JMO that the patient’s body had a few ‘unusual features’. He then ushered the JMO towards the bed on which the body had been placed. The JMO removed the sheet from the patient’s body. He was rather shocked to see some unusual body piercings and tattoos on the Politician’s genitalia. He quickly performed an assessment and death certification.

On returning to the wards, the JMO joined in a discussion with some of the Nurses and other hospital staff about the Politician. The JMO disclosed the fact that he had just examined the patient’s body and outlined in graphic detail the nature of the tattoos and body piercing. At a party later that evening, the JMO became involved in a further discussion about the Politician.

The next day, the JMO was paged to attend the Medical Superintendent’s office. A journalist had just contacted the Superintendent to ask for confirmation of rumours about ‘certain irregular features’ of the Politician’s body. The JMO was horrified that the information had been provided to the press. The Superintendent said that the patient’s family had already been contacted by the journalist and they were extremely angry about the breach of confidentiality.

Medical practitioners owe a duty of confidentiality to all of their patients and this duty continues even after the death of a patient. JMOs should take care to avoid any ‘gossip’ or disclosure of information that they obtain about patients during the course of their work.