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MalpracticeMalpractice

Introduction to Primary Care: a course of the Center of Post Graduate Studies in FM

PO Box 27121 – Riyadh 11417Tel: 4912326 – Fax: 4970847

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Objectives

• Objectives:

– be able to state the extent of medical malpractice

– define the importance of medical malpractice

– be able to explain the liability formula

– be able to discuss the role of expert opinion in malpractice

– be able to explain the malpractice defenses

Malpractice

• Improper or negligent treatment of a patient, as by a physician, resulting in injury, damage, or loss.

• Improper or unethical conduct by the holder of a professional or official position.

• The act or an instance of improper practice.

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Is an act or omission by a health care provider that deviates from what is the accepted standards of practice in the medical community. This act or omission then causes injury to the patient.

In laymen’s terms, medical malpractice is basically professional negligence by a health care professional that leads to an injury or complications on the part of the patient

Medical Malpractice Defined

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The Nature and Extent of Medical Error

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Situation in Saudi Arabia

• The Regulations of Medical Practice, developed by the Ministry of Health (MOH).

• The Medico-Legal Committee (MLC ) carries the responsibility of receiving claims and investigating the professional malpractice that results in morbidity or mortality.

• Investigations involve reviewing all patient medical files and records as well as interviewing the presumed accused medical staff members, in order to reach a verdict

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The yearly number of final decisions in claims classified by sector of the medical health care service in Saudi Arabia.

Different services 1420 1421 1422 1423 1424

Ministry of Health

Medical Services

111 100 123 188 188

Private Sector

Medical Services

124 123 123 169 144

Military

Medical Services

16 13 14 17 12

University

Medical Services

5 1 6 6 3

Other

Medical Services

9 18 5 13 6

Ref: Abdulhamid Samarkandi. Status of medical liability claims in Saudi Arabia, Ann Saudi Med 26(2) March-April 2006 www.kfshrc.edu.sa/annals

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The trend in the total number of claims in different medical specialties

Ref: Abdulhamid Samarkandi. Status of medical liability claims in Saudi Arabia, Ann Saudi Med 26(2) March-April 2006 www.kfshrc.edu.sa/annals

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The percentage of claims in different medical specialties.

Ref: Abdulhamid Samarkandi. Status of medical liability claims in Saudi Arabia, Ann Saudi Med 26(2) March-April 2006 www.kfshrc.edu.sa/annals

What are the factors leading to malpractice?

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Malpractice FactorsMalpractice Factors• The physician:PhysicianPhysician is in key position to influence

malpractice. After all it is him who initiate Rx.

• The patient:Communication approachCommunication approach: in which it is

proposed that patient don’t know much about their illness or Rx & that it is this ignorance that lead to malpractice.

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Malpractice FactorsMalpractice Factors• The practice/system:- LackLack of policy and guidelines.

- LackLack of appointment system.

- LackLack of resources.

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• Duty (Did a physician-patient relationship exist) +• Breach of duty (Did the physician fail to meet the required

standard of care) +• Causation (Did the physician’s breach cause the patient’s

injury) +• Damages (Did the patient incur medical expenses, pain,

suffering, lost wages as a result of the breach)

= LIABILITY

The Liability Formula

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• Expert opinon

• No need for expert opinion– Common knowledge exception

• Right leg-left leg

– Res ipsa loquitur (the thing itself speaks )• Sponge in abdomen

Proof of Malpractice

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• Conformed to the standard of care

• Alternative methods of treatment

• Clinical innovation

• Contributory Fault

• Assumption of the risk

• Waiver

Malpractice Defenses

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• Vicarious liability

• Captain of the Ship Doctrine– Particularly for surgeons

• Borrowed servant doctrine

• Referring physicians

• Covering doctors

• Physician assistants

You can be liable for the acts of others!

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Prevention of malpractice • Anticipate what might go wrong

– inform patient– prepare for complications– avoid surprises

• Competence, Communication,• Consent, Compassion, Compliance,• Current, Calm…• Charting / documentation is critical in high risk

situations (Accurate, detailed)• Good record keeping

Insurance

• New act in KSA:– All doctors have to have malpractice insurance– Contracts are not renewed without insurance

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Thanks