In the Name of Allah the Compassionate, the Merciful

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• In the Name of Allah the
  Compassionate, the Merciful

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?? ??????The God Is Healing
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Medical MalpracticeM.H.Ghadiani,M.D.Internist
Fellowship of NephrologyAssistant Professor of
Legal Medicine Organization of Iran
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• And he who saves a man,s life shall be considered
  as one who has saved the life of mankind as a
  whole.
• (?? ??? ??????? ????????? ??????????? ???????)
• The Holy Quran,
  Surah Al-Mâidah(Part of 32)

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Every physician must be answerable to three
judges

• Allah almighty or divine justice court
• His/her conscience or internal judge
• External judge or authorized courts

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• The main principle in medicine is that whatever a
  physician does for a patient is to be a benefit
  but not to be harm for him/her. So, when a harm
  is created by physician, it has occurred against
  his/her will. In condition that the physician
  does it according to medical and scientific
  rules, has not made a mistake or error and he/she
  will not be considered as culpable.

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• Physician is free to do whatever
• is deemed to be right and justified and hence
  he is not obliged to act without knowledge or
  insight, if he/she is not certain about what to
  do, he/she can consult with his/her colleagues or
  refer to valid scientific centers. Whenever there
  is freedom, the responsibility is also with it,
  therefore the physician is liable for his/her
  deeds (right or wrong).

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When a physician doesnt do whichever of
diagnosis and remedial stages well, he/she
commits a medical malpractice, such
asHistory taking, Clinical and Para clinical
examinations, On time diagnosis, Correct remedy,
Post- treatment follow- up, Counseling and
necessary guidance according to medical
scientific rules
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Authorized courts which considering complaints
and medical errors in Islamic Republic of Iran

• Medical council organization
• Legal Medicine organization (L.M.O)
• Inspection organization of Iran-subunit of the
  judiciary
• Governmental punishments organization- subunit of
  Ministry of Justice
• Ministry of Health, Treatment and Medical
  training
• University of Medical Sciences
• Judicial courts of justice

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• Types of medical malpractice
• Carelessness
• Improvidence
• Lack of proficiency
• Inattention to governmental rules
• Mixed

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• Carelessness
• Abandonment of an indispensable action such as
• Not to give Oxygen or Salbutamole spray to the
  asthmatic patient in emergency situation
• Not to take ECG in a patient with sustained
  chest pain suspected to IHD (Ischemic Heart
  Disease)
• Not doing Necessary consultation
• Not taking blood pressure in hypertensive patient
  

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• Improvidence
• Commit a wrong action without careful attention
  such as
• Administration of Prostaglandin instead of
  Progesterone in a pregnant woman with spotting
• Ureter is blocked instead of uterine artery in
  the course of hysterectomy
• Remain sterile gas in abdominal cavity during
  surgery
• Operation on normal leg instead of injured one

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• Lack of proficiency
• 1. Scientific
• Unawareness regarding to the routes of drug
  administration
• Unawareness regarding to a specific method of
  surgery
• 2. Practical
• Mismanagement of normal vaginal delivery
• Using wrong cast or splint resulted in
  compartment syndrome

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• Inattention to governmental rules
• Non acceptance of emergency patient
• Establishment of clinic without license
• Performing some of the surgical operations which
  must not be done in private offices
• Not sending biopsy sample to pathologist

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• Conditions of negligence attribution to the
  physician act
• The duty of patient's treatment would be with
  him.
• The scientific rules and technical methods in
  diagnosis and treatment of patient would not be
  obeyed.
• Followed by these, the patient would be injured
  physically, psychologically, financially or
  spiritually.

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• Physician with having large scale of great
  knowledge, sufficient information, proficiency in
  his/her specialty, good intention in his/her
  manners and with respect to related laws and
  rules, he/she is sometimes, unsuccessful in
  his/her patient's management.

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• Despite of advances in diagnostic
• and therapeutic fields of medicine,
  dissatisfaction of the patients from physicians
  is increasing.
• This subject has a significant role in health and
  medical care systems in all of the world.

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• An investigation in England showed that there are
  one hundred oral complaints for every written
  complaint and 4 dissatisfied patients for every
  oral complaint, Consequently every written
  complaint is followed by nearly 400 dissatisfied
  patients.

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• A study at New York hospitals shows that 1 of
  hospitalized patients suffer from physical
  injuries arising from medical malpractice.

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• Physician
• Patient
• judge
• form a triangle.

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• Different types of relationship
• between physicians and the law
• Forensic medicine specialist
• Consultant (usually specialist in other fields of
  medicine)
• Witness
• Defendant
• Plaintiff

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The causes of increasing of complaints against
physicians

• Increase in population
• Increasing of physicians
• Inattention to medical ethics and relationship
  between physician and patient
• Inattention to proper history taking and
  physical examination
• Increasing of patient's awareness about their
  rights
• Complexity and diversity of diseases
• Use of invasive diagnostic and treatment
  procedures

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The causes of increasing of complaints against
physicians

• Lack of proficiency of physicians
• Inattention to governmental rules
• Not explanation of patients by physicians about
  diagnostic and treatment procedures

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• Some of the complications are both predictable
  and preventable
• Some of them are predictable but not preventable
• Some of them are neither predictable nor
  preventable

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• Complication is different from malpractice.
  Malpractice means the errors which have been
  caused to avoidable injuries and damages.
• Complaint can be against physician, remedial
  system or medical staff.
• Non ideal conclusion on treatment of a patient,
  is not necessarily meaning malpractice

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• The physicians legal responsibility may
  have various aspects
• Patients motive for complaining is only
  compensation of financial loss. In these cases
  the physician can benefit from insurance that
  covers such losses.
• physician may be criminally liable in cases such
  as illegal abortion that would be punishable and
  is not covered by insurance contracts.
• Both legal and criminal liability cases exist,
  for example when a patient dies because of
  illegal abortion. In these cases the legal part
  can be covered by insurance, but the criminal
  part is not covered.

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Main topics for medical malpractice prevention

• 1. Notice to medical ethics especially based on
  teaching of Islam
• 2. Improvement of relationship between physician
  and patient
• 3. Increase of knowledge and practical skills of
  physicians
• 4. Necessity of organizing the retraining
  seminars and congregations for quantity and
  quality promotion of medical services

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• 5. Increasing constant supervision on medical
  measures
• 6. Paying attention to governmental rules
• 7. Promotion of technical and medical equipments
  of hospitals, remedial and diagnostic centers
• 8. Patients education regarding to the
  complications of diagnostic and therapeutic
  procedures

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• The surveys show that, among different kinds of
  malpractices, inexperienced physicians most
  involved in carelessness and lack of proficiency
  Whereas, experienced physicians most involved
  in improvidence and inattention to governmental
  rules.

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• Whatever you can, be in the service of the needy,
• With a bit of advice, or a help or a penny