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
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
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 DHAHealth Regulation Department will remain confidential; this includes the process of investigation and complainant / healthcare
provider information
‫ هيئة الصحة بدبي‬-‫ مما قد يؤثر على أداء مهمة التحقيق المكلفة إلي من قبل إدارة التنظيم الصحي‬،‫أنا الموقع أدناه اقر بعدم وجود أي مصالح شخصية أو مادية أو غيرها‬
‫كما أنني أتعهد بالتعامل مع جميع المعلومات ( إجراءات التحقيق ومعلومات المشتكي والمشتكي عليه وغيرها من المعلومات) بسرية تامة وعدم اإلفصاح بأي بها ألي‬
‫شخص خارج لجنة التحقيق‬
Investigation committee member‫عضو لجنة التحقيق الطبية‬
Name:
‫االسم‬
Signature:
‫التوقيع‬
Employment Title:
‫المسمى الوظيفي‬
License Number:
‫رقم الرخصة‬
Facility Name :
‫اسم المنشأه‬
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 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
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.
2.
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
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