130514L - PHYSICIAN MISCONDUCT

Lecture for 4^th year medical students Salman bin Abdulaziz University Kharj on May 14, 2013 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard)

1.0 ABUSE OF PROFESSIONAL PRIVILEDGES

Un-ethical research on patients is abuse of professional privilege. This usually takes the form of research without informed patient consent.

Abuse of treatment privileges consists of unnecessary treatment, iatrogenic infection, and allowing or abetting an unlicensed practitioner.

Abuse of prescription privileges is manufacturing, possessing, and supplying a controlled drug without a license; prescription of controlled drugs not following procedures; diverting or giving away controlled substances; dispensing harmful drugs; sale of poisons; and writing prescriptions using secret formulas.

Financial fraud may be pharmacy fraud (billing for medicine not supplied), billing fraud (billing for services not performed), equipment fraud (using equipment that is really not needed or using equipment of poorer quality), or supplies fraud.

It is illegal to get financial advantage from prescriptions to be filled by pharmacies owned by the physician. Kick-backs are unethical and illegal.

False or inaccurate documentation is a breach of the law and includes issuing a false medical certificate of illness, false death certification, and false injury reports.

Court action could be brought against a physician for the following crimes against the person: manslaughter (voluntary & involuntary); euthanasia (active and passive): battery for forced feeding or treatment; criminal liability for patient death; induced non-therapeutic abortion; iatrogenic death; abusive therapy involving torture; intimate therapy; rape and child molestation; and sexual advances to patients or sexual involvement.

2.0 PRIVATE MIS-CONDUCT DEROGATORY TO REPUTATION, muru’at

Breach of trust is a cause for censure because a physician must be a respected and trusted member of the community.

Sexual misbehavior such as zina and liwaat are condemned.

Physicians can abuse their position by abuse of trust (eg harmful or inappropriate personal and sexual relations with patients and their families), abuse of confidence (eg disclosure of secrets), abuse of power/influence (eg undue influence on patients for personal gain), and conflict of interest (when the physician puts personal selfish interests before the interests of the patient).

 Other forms of misconduct are in-humane behavior such as participation in torture or cruel punishment, abuse of alcohol and drugs, behavior unbecoming, indecent behavior, violence, and conviction for a felony.

3.0 BUSINESS MIS-CONDUCT

Physicians in private practice must adopt good business practices.

Halal transactions are praised. An honest businessman is held in high regard.

Leniency in asking for payment is encouraged especially when serving in poor communities.

Full disclosure is needed in any transaction.

Measures and scales must be fulfilled when dispensing drugs.

Bad business practices are condemned. There is no blessing in immoral earnings. Unethical competition is prohibited. Cheating is condemned. Also condemned are financial fraud including criminal breach of trust, fee splitting, and bribery.

Sale of goodwill of a practice is allowed. Also allowed is agreement among partners that they will not set up a rival practice on leaving the partnership. Entering into a compact with pharmacists or laboratories involving fee splitting and unnecessary referrals is not moral.

Treatment regimens cannot be patented as an intellectual property.

Physicians are entitled to a reasonable fee. Medical fees cannot be fixed. They are based on mutual agreement between the physician and the patient.

4.0 CONFLICT OF INTEREST

A physician who at the same time is the manager of a for-profit hospital could be tempted to put the profit motive before good health care by cutting down expenditure on necessary treatment.

An occupational physician may find himself between fulfilling his professional duties to the patient and protecting the financial interests of his employer.