investigation of medical complaint dr. layla al marzouqi head of clinical governance health...

Investigation of Medical Complaint

Dr. Layla Al Marzouqi

Head of Clinical Governance

Health Regulation Department (HRD)

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.

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

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.

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

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

Risk factors for error

• System and Process Design

Problem in medical errors is not bad people in health care—it 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

Risk factors for error

JCIA report :•root cause >1/2 the serious adverse events in accredited hospitals was poor communication

•Other leading causes :• inadequate assessment of the patient's condition• poor leadership or training

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

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

Risk factors for error

Preventing medical errors will• lower health care costs

• reduce doctors’ insurance premiums

• protect the health and well-being of patients & reduce hospital stay

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

After an error has occurred, what action to

take?

How to conduct

an investigation

Objective

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

Types of complaint• Health complaints• Non health complaints

– Insurance – Criminal – Financial– Behavior

Medical complaint in the emirate of Dubai- accepted

Degree/Severity of health complaints

• Major• Moderate• Minor

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

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.

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.

Investigation

Major Complaint

Clinical Governance Office• Decision to investigate

• Select investigation committee member ( private/public)

• Facilitate their work

• Conclude any member

• Review investigation report

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

 Conflict of Interest and Confidentiality Agreement

تعهد

 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 

المكلفة التحقيق مهمة أداء على يؤثر قد مما غيرها، أو مادية أو شخصية مصالح أي وجود بعدم اقر أدناه الموقع أنا - بدبي الصحة هيئة الصحي التنظيم إدارة قبل من إلي

 من ( وغيرها عليه والمشتكي المشتكي ومعلومات التحقيق إجراءات المعلومات جميع مع بالتعامل أتعهد أنني كما

التحقيق) لجنة خارج شخص ألي بها بأي اإلفصاح وعدم تامة بسرية المعلومات

Investigation committee member الطبية التحقيق لجنة عضو

Name:االسم

Signature:التوقيع

Employment Title:

الوظيفي المسمى

  License Number:

الرخصة رقم

Facility Name :المنشأه اسم

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

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

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

Old definitionNegligence

•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

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

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

• Recommendation from the medical complaint committee reviewed HRD

• Disciplinary action -law

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

Criteria Appeal

Appeal should fulfill the following conditions;

1. Whiting 15 days of receiving the final result of the investigation

2. New evidence

Either• appoints appeal committee members-three members at

least • Reject the appeal

Criteria Appeal

• Decisions shall be final • One appeal per case

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

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

Contact Us

• Business village Building B third floor Office number 333-335

• 04-5022956/53• cg@dha.gov.ae• www.dha.gov.ae

THANK YOU