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Margarida Eiras, Adjunct Professor, School of Health Technologies of Lisbon, Portugal ([email protected]) Paula Bruno, Alves & Associados, Sociedade de Advogados, Lawyer, Portugal ([email protected]) Background and purpose PublicaDons and internaDonal conferences dedicated to the topic of PaDent Safety, have been highlighDng the problem of blaming physicians and healthcare professionals when an adverse event or incident occurs, with a strong and direct relaDon with the inherent fear of legal consequences. Acknowledging that there is a huge discrepancy between the Law and the PaDent Safety principles regarding blame/fault, this poster will cover the main differences observed. Results Conclusion NormaDve principles are not compaDble with the principles of paDent safety. All the recommendaDons, publicaDons and lectures worldwide proclaim a blame free environment. The legal tradiDonal regimen of subjecDve liability, based on fault, the fundamental principle of PaDent Safety – a no (individual) blame culture. In order to improve PaDent Safety, we would suggest the adopDon of a objecDve liability (no fault) in the Portuguese legal system, allowing for the analysis of advert events and moDvaDng a proacDve aLtude. References Bruno, P., Registo de Incidentes e Eventos Adversos: Implicações Jurídicas da implementação em Portugal (20), Wolters Kluwer/Coimbra Editora, 2010 Commi\ee on Quality of Health Care in America, IOM, (2001). Crossing the quality chasm: a new health system for the 21st Centuary. Washington,DC:The naDonal Academy Press.; Hindle, D,; Braithwaite, J.and Ledema, R. (2005). PaDent Safety Research – a review of technical literature. Sydney NSW.; Kohn,L.T.; Corrigan,J.M & Donaldson, M.S.(2000). To err is human. Washington DC: NaDonal Academy of Sciences; Morath, J. M. & Turnbull (2004). To do no harm – Ensuring paDent safety in health care organizaDon. San Francisco:JosseyBass.; Portuguese LegislaDon; JOUE, (2009/C151/01) FAULT: TWO FACES OF THE SAME COIN Methods A literature review was conducted through two searches of Medline and Embase database. Selected government and paDent safety organisaDon websites were also searched for relevant literature. In addiDon to journal arDcles and reports, technical and working papers and other forms of literature were also idenDfied through hand searching of the references of key publicaDons and by searching of selected websites. Blame and Fault PaEent Safety principles Adverse event Risk management: Root Cause Analysis, Failure Mode and Effect Analysis Disclose ReporDng systems System approach Law normaEve principles Harm (physical and moral) Civil liability: SubjecDve liability AssumpDons of liability: …, fault,… Criminal liability: …, fault,… Disciplinary liability Guilt?

Culpa - Duas Faces da Mesma Moeda

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Existe uma enorme discrepância entre os ditames do Direito e os da Segurança dos Doentes em relação à CULPA. Para os princípios da Segurança do Doente imputar a culpa ao profissional de saúde não é correto e não resolve a questão de fundo. A evidência revela que o erro não tem apenas um fator causal, se culpabilizarmos o individuo, não será possível desenhar uma estratégia honesta e efetiva que garanta a melhoria da segurança. Em vez de questionarmos “quem” deveremos questionar “como”. Só nesta perspetiva será possível motivar todos os envolvidos no processo de cuidar para a compreensão da problemática do erro na prestação de cuidados. O Direito não se compatibiliza com os princípios da Segurança dos Doentes, todas as recomendações internacionais, publicações, formações, palestras mundiais e nacionais proclamam a não culpabilização dos profissionais, a não perseguição do culpado e por conseguinte não compreendem os princípios do Direito neste particular, que procura o culpado para apurar responsabilidades.

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Page 1: Culpa - Duas Faces da Mesma Moeda

                     

Margarida  Eiras,  Adjunct  Professor,  School  of  Health  Technologies  of  Lisbon,  Portugal  ([email protected])  

Paula  Bruno,  Alves  &  Associados,  Sociedade  de  Advogados,  Lawyer,  Portugal  ([email protected])  

Background  and  purpose  PublicaDons   and   internaDonal   conferences   dedicated   to   the   topic   of   PaDent   Safety,  have   been   highlighDng   the   problem   of   blaming   physicians   and   healthcare  professionals   when   an   adverse   event   or   incident   occurs,   with   a   strong   and   direct  relaDon  with  the  inherent  fear  of  legal  consequences.  Acknowledging   that   there   is   a   huge   discrepancy   between   the   Law   and   the   PaDent  Safety   principles   regarding   blame/fault,   this   poster   will   cover   the   main   differences  observed.  

Results  

Conclusion  NormaDve  principles  are  not  compaDble  with   the  principles  of  paDent  safety.  All   the  recommendaDons,   publicaDons   and   lectures   worldwide   proclaim   a   blame   free  environment.   The   legal   tradiDonal   regimen  of   subjecDve   liability,   based  on   fault,   the  fundamental  principle  of  PaDent  Safety  –  a  no  (individual)  blame  culture.  In   order   to   improve   PaDent   Safety,   we   would   suggest   the   adopDon   of   a   objecDve  liability   (no   fault)   in   the  Portuguese   legal   system,   allowing   for   the   analysis   of   advert  events  and  moDvaDng  a  proacDve  aLtude.  References  Bruno,  P.,    Registo  de  Incidentes  e  Eventos  Adversos:  Implicações  Jurídicas  da  implementação  em  Portugal  (20),  Wolters  Kluwer/Coimbra  Editora,  2010  Commi\ee  on  Quality  of  Health  Care  in  America,  IOM,  (2001).  Crossing  the  quality  chasm:  a  new  health  system  for  the  21st  Centuary.  Washington,DC:The  naDonal  Academy  Press.;  Hindle,  D,;  Braithwaite,  J.and  Ledema,  R.  (2005).  PaDent  Safety  Research  –  a  review  of  technical  literature.  Sydney  NSW.;    Kohn,L.T.;  Corrigan,J.M  &  Donaldson,  M.S.(2000).  To  err  is  human.  Washington  DC:  NaDonal  Academy  of  Sciences;  Morath,  J.  M.  &  Turnbull  (2004).  To  do  no  harm  –    Ensuring  paDent  safety  in  health  care  organizaDon.  San  Francisco:Jossey-­‐Bass.;  Portuguese  LegislaDon;  JOUE,  (2009/C151/01)  

FAULT:  TWO  FACES  OF  THE  SAME  COIN  

Methods  A  literature  review  was  conducted  through  two  searches  of  Medline  and  Embase  database.  Selected  government  and  paDent  safety  organisaDon  websites  were  also  searched  for  relevant  literature.  In  addiDon  to  journal  arDcles  and  reports,  technical  and  working  papers   and   other   forms   of   literature  were   also   idenDfied   through   hand   searching   of   the   references   of   key   publicaDons   and   by  searching  of  selected  websites.  

Blame    and    Fault    

PaEent  Safety  principles  •  Adverse  event  •  Risk  management:  Root  Cause  

Analysis,  Failure  Mode  and  Effect  Analysis  •  Disclose  •  ReporDng  systems  •  System  approach  

   

Law  -­‐  normaEve  principles  •  Harm  (physical  and  moral)  •  Civil  liability:  

•  SubjecDve  liability  • AssumpDons  of  liability:    …,  fault,  …  

•  Criminal  liability:  …,  fault,  …  •  Disciplinary  liability  •  Guilt?