Therapeutic misadventure: A misadventure is mischance or accident or disaster. Misadventure is of three types:
(1) Therapeutic (when treatment is being given).
(2) Diagnostic (where diagnosis only is the objective at the time).
(3) Experimental (where the patient has agreed to serve as a subject in an experimental study).
Therapeutic misadventure is a case in which an individual has been injured or had died due to some unintentional act by a doctor or agent of the doctor or the hospital.
Almost every therapeutic drug and every therapeutic misadventure procedure can cause death. Injection of serum, antibiotics, etc. may cause anaphylaxis in sensitive persons. History of sensitivity should be obtained before injecting such substances. Negative history and negative test does not rule out rare possibility of anaphylactoid reaction and even death.
A physician is not liable for injuries resulting from adverse reaction to drug unless some negligence on his part contributed to cause the injury. Ignorance of the possibility of a reaction, or continuation in the prescribing of a drug with adverse reaction amounts to negligence.
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. 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.
The doctor should particularly tell a patient of possible drowsiness or similar accident- producing reaction caused by many drugs. Some examples of therapeutic misadventure are:
(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) Prolonged use of stilboesterol may cause breast cancer.
(4) 1131 therapy may cause thyroid cancer.
(5) Electric equipment, hot water pads, and heating pads may produce burns.
(6) 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.
(7) Radiological procedures used for diagnostic purposes may prove fatal form a part of therapeutic misadventure, e.g., poisoning by barium enema, traumatic rupture of the rectum and chemical peritonitis during barium enema.
(8) 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.
NEOPLASIA INDUCED BY MEDICAL TREATMENT
It is difficult to prove a cause and effect relationship between the therapy and trauma.
(1) Haemangioendothelioma of liver induced by thorium dioxide is the classic example.
(2) Radiation will cause leukaemia.
(3) 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.
(4) Chlornaphazine and phenacetin may cause urinary tract carcinoma.
(5) Contraceptive steroids can cause adenomas of the liver in females, and if continued unintentionally during pregnancy, the infant may develop a benign liver tumour.
(6) Diethylstilboesterol causes vaginal adenosis and clear cell carcinoma of the vagina.
(7) Exposure to pesticides cause skin and vulvar carcinoma.
To avoid a therapeutic misadventure in prescribing drugs, the following points should be noted
(1) 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.
(2) Sensitivity tests should be done before injecting preparations which are likely to produce anaphylactic shock.
(3) The doctor should warn the patient of side-effects which may occur while he is taking the drug.
(4) The doctor should inform the patient about the possibilities of permanent side-effects to avoid therapeutic misadventure.