Dubai Health Authority

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Investigation of Medical Complaint Dr. Layla Al
MarzouqiHead of Clinical Governance Health
Regulation Department (HRD)
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Medical Complaint

• Expressions of dissatisfaction or concerns about
  a health care service made by consumers.
• All complaints concerns are included, whether
  they are formal written complaints, a concern
  expressed during discussions with a health care
  professional, or views expressed as part of a
  consumer feedback survey.

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Institute of Medicine in US

• preventable medical errors kill 98,000 /year
• 100,0000 excess injure preventable medical errors
  sixth leading cause of death in America
• Aggressive case finding may identify injuries and
  errors that are not documented in a patient's
  chart

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Bureau of Justice Statistics

• 25 of all the doctors in USA get sued / annual
• 50 65 all doctors in USA sued at least once in
  their career
• ½ adverse events occurring inpatients resulted
  from surgery.
• Complications from drug treatment, therapeutic
  mishaps, and diagnostic errors were the most
  common non-operative events.

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• Despite shocking number of medical errors
• few injured patients ever file a medical
  negligence lawsuit
• fewer file frivolous claims
• epidemic of medical malpractice, not of
  malpractice lawsuits

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Risk factors for error

• Healthcare Complexity
• Complicated technologies, powerful drugs
• Intensive care
• prolonged hospital stay adverse event increased
  by 6 /day in hospital
• emergency department
• part time doctors not trained in emergency care
• fluctuating demand for services, which results
  in uneven and sometimes abbreviated care
• limited time available to arrive at a definitive
  diagnosis
• emergency department is the point of entry for
  acutely ill patients

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Risk factors for error

• System and Process Design
• Problem in medical errors is not bad people in
  health careit is that good people are working in
  bad systems that need to be made safer
• Poor communication/documentation
• Disconnected reporting systems within a hospital
  fragmented systems in which numerous hand-offs of
  patients results in lack of coordination and
  errors
• Cost-cutting measures/staff shortage

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Risk factors for error

• JCIA report
• root cause gt1/2 the serious adverse events in
  accredited hospitals was poor communication
• Other leading causes
• inadequate assessment of the patient's condition
• poor leadership or training

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Risk factors for error

• Competency, Education, and Training
• Variations in healthcare provider training
  experience
• Failure to acknowledge the prevalence and
  seriousness of medical errors
• July effect

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Risk factors for error

• Human Factors
• Sleep deprivation
• Fatigue
• Depression and burnout
• Diverse patients
• Age -64
• patient's underlying illnesses
• Unfamiliar settings
• time pressures
• Complications increase as patient to nurse
  staffing ratio increases

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Preventing medical errors will

• lower health care costs
• reduce doctors insurance premiums
• protect the health and well-being of patients
  reduce hospital stay

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• We are aware of no study showing that medical
  care can be provided without error

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• After an error has occurred, what action to take?

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• How to conduct
• an investigation

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Objective

• To protect public health safety by resolving
  investigation and prosecuting complaints about
  health care.

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Types of complaint

• Health complaints
• Non health complaints
• Insurance
• Criminal
• Financial
• Behavior

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Medical complaint in the emirate of Dubai-
accepted
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Degree/Severity of health complaints

• Major
• Moderate
• Minor

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Severity of complaints

• Minor complaints
• Complaints that can be resolved based on the
  assessment findings
• Example Patients with no injury or increased
  length of stay

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Severity of complaints

• Moderate complaints
• Complaints require only assessment might need
  to be investigated based on assessment findings.
• Example Increased length of stay as a result of
  incident, Surgical intervention required as a
  result of an incident.

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Severity of complaints

• Major complaints
• Complaints that need to be investigated
  immediately by an investigation committee without
  assessment.
• Example Procedure involving wrong patient or
  body, part, Medication error leading to death.

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Investigation

• Major Complaint

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Clinical Governance Office

• Decision to investigate
• Select investigation committee member (
  private/public)
• Facilitate their work
• Conclude any member
• Review investigation report

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Investigation committee

• Each case will consists of following committee
  members from the same speciality of the case
• One Chairperson
• At least 2 Health Professionals registered and
  licensed
• Legal representative will be consulted upon need

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  Conflict of Interest and Confidentiality Agreement   ????
  We the undersigned declare that we have no actual or potential conflict of interest this includes both financial and other interests that could compromise our performance of our official duties or the standing of the Dubai Health Authority (DHA) Health Regulation Department.   We further verify that the content of all material and information associated with our role as investigator with the DHA- Health Regulation Department will remain confidential this includes the process of investigation and complainant / healthcare provider information   ??? ?????? ????? ??? ???? ???? ?? ????? ????? ?? ????? ?? ?????? ??? ?? ???? ??? ???? ???? ??????? ??????? ??? ?? ??? ????? ??????? ?????- ???? ????? ????   ??? ???? ????? ???????? ?? ???? ????????? ( ??????? ??????? ???????? ??????? ???????? ???? ?????? ?? ?????????) ????? ???? ???? ??????? ??? ??? ??? ??? ???? ???? ???????
Investigation committee member ??? ???? ??????? ?????? Investigation committee member ??? ???? ??????? ?????? Investigation committee member ??? ???? ??????? ?????? Investigation committee member ??? ???? ??????? ??????
Name ?????       Signature ???????  
Employment Title ?????? ???????   License Number ??? ??????  
Facility Name ??? ???????            
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Chairperson

• Decide on the meeting and send invitation
• Lead the meeting / Distribute the role
• Prepare investigation report
• Sign all document
• Interview is singed by doctors complainant
• Available to discuss/clarify out
• Translation

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Chair Person/Member

• Sign conflict of interest and confidentiality
  form
• Review files
• Attend all meetings
• Respect/ introduction ( name. complaint)
• Conduct Interviews- venue, time, date , attendee
• Investigate medical aspect
• No result to be given to complainant
• Not interfere with each other decision
• Ask question equally
• Disclosure to third party

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Chair Person/Member

• Consult other specialty
• If compliant or healthcare professionals is not
  contactable
• Malpractice definition-law
• Reasons for decision
• Mobiles not allowed
• Recorder use
• Court
• Sign the report

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Old definition

• Negligence
• Failure to act with prudence a reasonable person
  with similar training experience would exercise
  under same circumstances.
• Includes medical error in diagnosis, treatment or
  illness management
• Malpractice
• When negligence act or omission by a doctor or
  other medical professional results in damage or
  harm to a patient.
• Act or omission by a healthcare provider which
  deviates from accepted standards of practice
  causes injury to the patient

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New Definition Malpractice

• Malpractice
• Is an error occurs due to
• Unfamiliarity of the practitioner with technical
  aspects which each practitioner assumed to be
  familiar with
• Negligence
• Paying insufficient efforts

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Not Malpractice

• The following shall not be considered medical
  liability, if
• damage was sustained due to the action of the
  patient
• physician followed certain medical method in
  treatment
• medical side effect complications know in
  medical practice

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• Recommendation from the medical complaint
  committee reviewed HRD
• Disciplinary action -law

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Appeal

• Appeal occurs when the complainant or treating
  doctor is not satisfied with the outcome of the
  complaint
• Appeals will be forwarded to higher authority for
  further action
• Appeal decision not the disciplinary action

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Criteria Appeal

• Appeal should fulfill the following conditions
• Whiting 15 days of receiving the final result of
  the investigation
• New evidence
• Either
• appoints appeal committee members-three members
  at least
• Reject the appeal

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Criteria Appeal

• Decisions shall be final
• One appeal per case

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Writing an appeal

• Be professional
• More evidence
• Disciplinary action implemented after 15 days
• How effective ?
• Rejected / submission of the license/ assessment
• Assessment panel
• Decision of assessment panel ( same post/
  privilege/ downgrade/ under supervision)
• Return the license

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Applying for reassessment

• Sheryan
• Assessment icon
• Schedule assessment date
• On line assessment ( 10 specialties) /interview
• Fee

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Contact Us

• Business village Building B third floor Office
  number 333-335
• 04-5022956/53
• cg_at_dha.gov.ae
• www.dha.gov.ae

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• THANK YOU