Investigation of Medical Complaint Dr. Layla Al Marzouqi Head of Clinical Governance

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

2. 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.

3. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. Preventing medical errors will lower health care costs reduce doctors’ insurance premiums protect the health and well-being of patients & reduce hospital stay

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

14. After an error has occurred, what action to take?

15. How to conduct an investigation

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

17. Types of complaint • Health complaints • Non health complaints • Insurance • Criminal • Financial • Behavior

18. Medical complaint in the emirate of Dubai- accepted

19. Degree/Severity of health complaints Major Moderate Minor

20. 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

21. 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.

22. 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.

23. Investigation Major Complaint

24. Clinical Governance Office Decision to investigate Select investigation committee member ( private/public) Facilitate their work Conclude any member Review investigation report

25. 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

27. 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

28. 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

29. 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

39. 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

40. New DefinitionMalpractice 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

41. 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

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

43. 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

44. 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

45. Criteria Appeal Decisions shall be final One appeal per case

46. 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

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

48. Contact Us Business village Building B third floor Office number 333-335 04-5022956/53 cg@dha.gov.ae www.dha.gov.ae

49. THANK YOU