Status of medical Liability ClaimsStatus of medical Liability ClaimsIn Saudi ArabiaIn Saudi Arabia

Prof. Abdulhamid Samarkandi, Prof. Abdulhamid Samarkandi, FFARCSIFFARCSIAnaesthesia Department, King Saud University

Chairman, Saudi Anaesthetic Association

Member of the Medico-Legal Committee, Riyadh Region

Scope of the Problem

Evolution in Health Care Services

- Upgrading Technology

- Training & Gained experience of Medical staff

Increased number of Medical Claims

- ↑ Population Census

- ↑ Awareness about Health matters

Handling of the Problem

Formulate and to set standards and regulations that determine the responsibilities of health

care providers ( Facility/ Physicians )

towards patients

Regulation for the Practice of Medicine & Dentistry

Enacted by the Royal Decree ( 1409 Hijri )

Determine Responsibility of Medical practitioners

Regulate Patient-Doctor relationship

The Medico-legal Committee

Members: Judge Ministry of Justice

Doctors 2 members

- Ministry of Health

- Teaching University Staff

Medico-Legal Committee

Role:

Carries the responsibility of receiving claims and investigating the professional malpractice that resulted in either morbidity or

mortality

Number & Locations: 8 Subcommittees,

Covering various regions of KSA

Process of Medical Litigation A Claim from the patient or his/her Representative towards a

medical malpractice ( from his view ) The Claim directed either to MOH or City government Investigation within the medical facility encountered in claim The MLC then assigned to follow with a process of thorough

review of all documents and medical filling together with interviewing both sides of the claim- the plaintiff and defendant

Reach a Final Decision of accusation or clearance from the claim according to the “Regulations of Medical Practice“ which is based on . Professional aspects . Governed by Islamic Shariaah law

Professional liability

The Civil liability: المدنية المسئولية This is the responsibility of a physician towards the

patient when harm being inflicted as a result of direct action against medical rules from the physician or proven negligence.

The Punitive liability: الجزائيـة المسئولية That deals with physicians who violate the rules and

regulations of medical practice even with no subsequent harm resulted to the patient.

The Disciplinary liability: التأديبية المسئولية Where a physician failed to meet with professional

standards, requirements and ethics .

Final Decision ( Verdict )I - Clearance from the claimII - Accusation - Warning - Financial Compensation - Prohibiting medical practice - Medical License withdrawal - Imprisonment

Data Analysis

Studied Period 5 years ( 1420 H – 1424 H ) / ( 1999 – 2003 )

Retrospective Analysis of Raw Data Official documentation of the MLC

Aim of the Work

Incidence of Claims towardsI- Study period of analysis

II- Medical Specialty

III- Sector of Health Care Facility

IV- Geographical Distribution over KSA

The Trend of the total number of claims in The Trend of the total number of claims in different medical specialtiesdifferent medical specialties

The percentage of claims in different The percentage of claims in different Medical SpecialtiesMedical Specialties

Sectors of the Medical Health Care serviceSectors of the Medical Health Care service

1420 1421 1422 1423 1424

Ministry of HealthMedical Services

111 100 123 188 188

Private SectorMedical Services

124 123 123 169 144

MilitaryMedical Services

16 13 14 17 12

UniversityMedical Services

5 1 6 6 3

OtherMedical Services

9 18 5 13 6

Distribution of the Convicted decisions over Distribution of the Convicted decisions over Saudi Arabia different RegionsSaudi Arabia different Regions

1420 1421 1422 1423 1424

Riyadh 88 67 47 48 54

Makka Al- Mokkarama 11 31 39 65 37

Eastern Region 29 25 44 31 34

Madina Al- Monawara 33 27 11 42 13

Aseer 30 14 23 24 36

Qassim 12 22 12 12 21

Holy Capital --- --- --- 53 61

Ehsaa --- --- --- 10 14

Anaesthetist Shared responsibility with Obstetrician for:1- Not checking blood availability or even reserving2- NO Intraoperative Anaesthesia Record of management

Female P 11+1 for Emergency CS ( Breech Presentation )

INCIDENT: Intractable Intraoperative Hge. NO Blood Available 6 hrs postoperatively Mortality follows

• Female P 2+7,39yrs

• 1st alive baby ,3intra-ut.death,

• 5th C.S baby dead,6th alive

• 7th stated Bl.transfusion from 18 week

• Resident wrote: Diazpam 20mg orally

Pancronium 4mg I.V

To be given 1 hr before transfusion

The mother given I.V pancronium the nurse came to take her to U.S after 50 min she was DEAD

Recommendations &

Personal Advice

No Minor Anaesthetic procedure Assess your Patient Thoroughly & ask for advice in case you need Share the Patient & Relatives in Plan of treatment Estimate accurately the Risk and discuss it with the patient Clear informed Consent Clear Documentation of every detail in date & time Update your Professional Knowledge Encourage Educational Activities ( Audits, M&Ms,….etc) In case encountered in an INCIDENT ( Subject for Interrogation ) - Review the whole case filling & records - Quote relevant literature - Provide testimony in writing highlighting specific events

When you are certain that the consequences When you are certain that the consequences of an error is disastrousof an error is disastrous

……so it is of logic to be too carefulso it is of logic to be too careful

No one is immune against pitfalls and mishaps, No one is immune against pitfalls and mishaps, so let us pray to Allah to provide us so let us pray to Allah to provide us

with his protection and mercywith his protection and mercy and give us the strength and ability and give us the strength and ability

to serve our patientsto serve our patients

To Whom They To Whom They ComplaintComplaint

Thank youThank you