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Presentation at a ‘Grand Round of the Pediatric Department,’ of King Salman Heart Center, King Fahad Medical City, Riyadh on 14 June 2016 by Professor Omar Hasan Kasule Sr. MB ChB (MUK), MPH (Harvard), DrPH (Harvard) Faculty of Medicine, King Fahad Medical City
DEFINITION and DESCRIPTION
§ Malpractice is failure to fulfill the
duties of the trust put on the physician.
§ Negligence is breach of duty resulting in
damage or injury.
§ Negligence defined according to the
standard of care.
EXAMPLES of NEGLIGENCE
§ Treatment without informed consent
§ False imprisonment or confinement
§ Intentional infliction of emotional
distress
§ Defamation: slander if verbal and libel if
written
§ Abandonment of a patient
§ Breach of confidentiality
§ Negligent referrals
§ Failure to warn about risks
§ Failure to report a notifiable disease
§ Professional errors that may be ordinary or
extraordinary; harmful or non-harmful.
BASIS of LIABILITY
§ The physician owed a duty of care
§ The physician failed in that duty
§ The failure resulted in damage.
MALPRACTICE SUITS: COURT PROCEDURE
§ Filing a complaint by the plaintiff
§ Serving a summons on the defendant
§ Plea of guilty or not guilty by the
defendant
§ Discovery (lawyers for both sides collect
more information)
§ Opening statements at the trial by both
sides
§ Testimony and examination of witnesses,
closing arguments, and judgment.
§ The burden of proof of breach of standard
of care lies with the plaintiff.
AVOIDING / PREVENTION of MALPRACTICE SUITS
§ Obtaining and maintaining registration
§ Sticking to defined professional standards
of care
§ Peer review, quality assurance, and use of
protocols
§ Defensive medicine and politeness with
patients
§ Conscience of all health care workers to
make sure that mistakes do not occur.
§ Well written records can be a defense for
the physician.
LEGAL TESTS FOR NEGLIGENCE I: The Boolam
Case
§ Boolam, a mentally ill patient, suffered
fractures during electroconvulsive treatment. This type of treatment was
accepted as a normal treatment for mental disorders at that time. The patient
had consented to the procedure. When he suffered a fracture he sued in court.
The judge ruled that doctors could not be found negligent if they acted
according to a professional opinion accepted by a reasonable body of medical
opinion even if there could exist a contrary opinion by another responsible
body of medical opinion.
LEGAL TESTS FOR NEGLIGENCE II: The Boolam
Case
§ In a case of Bolitho, a patient who
suffered brain damage because the doctor failed to intubate, the court ruled
that doctors are expected to follow responsible medical opinion but would not
be found negligent in cases in which that opinion did not stand up to logical
analysis. The court thus set a principle that the court could over-rule medical
opinion that was not logical in a specific case. The implication of this was
that medical opinion was not the final arbiter of the standard of care to be used
in defining negligence.
CASE # 1
§ A medical officer pierced the ear drum of a
patient who protested loudly about the pain and eventually became deaf in that
ear. A consultant who was standing by did not say anything. The patient sued
both the medical officer and the consultant.
CASE # 2
§ A medical officer by chance at the site of
an accident tried resuscitation and failed. He was sued by the victim’s family.
CASE # 3
§ A surgeon carried out an operation using a
new technique unknown in the hospital but the patient recovered well with no
complications.
CASE # 4
§ A consultant at a dinner without seriously
questioning the patient advised doubling the anti-coagulant dose. The patient
died of hemorrhage the next day.
CASE # 5
§ A physician forgot to prescribe an
antibiotic for a patient with acute lobar pneumonia but the patient recovered
uneventfully after one week.
CASE # 6
§ A patient with no obvious injury after a
minor accident was discharged without X-ray investigations. He developed back
problems 3 months later leading to leg paralysis. He sued the hospital for
negligence.
CASE # 7
§ A 45-year old mother of 5 grown up children
had hysterectomy because of prolonged, heavy, and irregular menstruation. The
surgeon took care to preserve the ovaries and therefore saw no need to put her
on HRT. Three years later she had a hip fracture due to osteoporosis treated by
hip replacement and she was started on HRT. Six months later she developed pain
in the right groin and investigations revealed cancer of the ovary which had to
be removed. Her daughter who was a nurse in the hospital argued her to sue the
hospital for malpractice but she herself was not very sure of what had gone
wrong.
CASE # 8
§ An aspiring actor was advised by her media
consultants to change her facial features in order to succeed in landing major
and lucrative acting roles. She went to a doctor who advertised his cosmetic
surgery services on the television and women’s magazines. She signed a consent
form for surgery but did not see a notation in the footnotes that the operation
was entirely at her own risk. Six months later and after a series of operations
she was angry. Her face was asymmetric and her eye lids drooped. She asked for
his license as a plastic surgeon. He told her he was a general surgeon who had
interest in plastic or cosmetic surgery. With her career ruined she decided to
take him to court.
CASE # 9
§ A patient with epilepsy well controlled on
drugs for the past 10 years, experienced a minor epileptic seizure. His
physician increased the drug dosage and told him all would be well and that he
could go back and resumes driving the school bus. The patient asked for an MC
to explain his day’s absence to the manager of the school bus company.
The next morning the patient crushed the bus into a wall as he was driving it
out of the garage. He explained that he felt sleepy at the time of the
accident.