Ministry moves to fix medical accountability in UAE 

A woman patient went into a vegetative state following a medical treatment. A 12-year-old boy ended up brain damaged after being administered an incorrect dose of anaesthesia during a surgical procedure which eventually proved fatal. A hearing-impaired girl who required a follow-up surgery on the cochlear implants she had received in 2002 as a child, ended up with an implant only in one ear and not in both as was required. The surgeon also failed to carry out a post-operative X-ray which could have spotted his error.

In all three instances, the victims were awarded compensation by the UAE federal court in view of the medical malpractice that severely damaged their quality of life.

The UAE federal court granted Dh3 million to the woman who was rendered vegetative and, in January 2012, it granted Dh7 million compensation to the parents of the 12-year-old boy. The hospital was directed to pay Dh200,000 as diya (blood money) and Dh10,000 in fines in the latter case.

In 2014, the parents of a hearing-impaired girl were granted Dh100,000 in compensation by the UAE Federal Court.

Also in 2014, the Dubai Civil Court awarded a compensation of Dh1 million to an Emirati man who underwent a botched left hip replacement surgery at a Dubai hospital. Following the surgery, the complainant was bound to a wheelchair, suffered paralysis in his left leg and his left limb became 4cm shorter than the right one.

These landmark judgments that upheld the rights of the patient, in addition to many other cases being redressed, have ushered in a new era of medical accountability in the country as the UAE is increasingly addressing the rights of patients to safe and proper medical treatment and defining medical liability and negligence as a fundamental aspect of its health-care system.

Medical malpractice cases, liability and compensation claims are gaining speed as the UAE moves towards Vision 2021 of excellence in the health sector.

The Ministry of Health and Prevention covers private and government hospitals in all the northern emirates and some in Dubai too. The ministry’s medical licensing committee, which handles medical complaints, convenes every two weeks.

Dr Ameen Hussain Al Amiri, who is the assistant undersecretary for public health and medical licensing, oversees the medical malpractices cases.

Dr Al Amiri told : “We have been receiving complaints of medical malpractice and these vary from the attitude of medical staff to inadequate treatment, or lack of a service promised by the hospital or treatment that worsened or complicated the condition of the patient. We have been very responsive to any such complaints and take action as soon as anyone registers a complaint.”

He listed the kind of complaints they received. “Patients have reported their dissatisfaction with the treatment and with the physician themselves. On other occasions, a patient has complained of pain or a disease that goes undiscovered or untreated by his doctor. The patient learns from another doctor that their illness should have been diagnosed earlier and comes to us to ask what went wrong. In these cases, we take up the complaint.”

However, he specified the conditions where a hospital or doctor cannot be held liable for negligence. “Some of the grounds when an outcome may not be considered a malpractice is if a complication that can be expected as a side-effect of a treatment or medication occurs, if the patient fails to follow the advice or medication regimen prescribed by the doctor. But we examine all the aspects,” he explained.

“After due diligence, if we find there is substance to a case, a medical committee is appointed to launch the inquiry. The committee includes specialists from the same discipline from the ministry as well as peers from outside. We take care to invite impartial outside specialists or peers who can examine the case. It is a very comprehensive practice to make sure any judgement against any person is without bias at the highest level of probity,” added Dr Al Amiri.

Dr Al Amiri pointed out that if the committee holds a hospital or doctor guilty, then the punitive action ranges from a warning in lighter cases where the ministry issues about two to three warnings. If the malpractice continues, then the next step is suspension of the hospital or individual’s licence from one to six months. In extreme cases licences have been revoked and the strongest was blacklisting the facility or the doctor, he said.The ministry issues about two to three warnings every two weeks, he said.

Ministry of Health and Prevention-governed hospitals: What the complainant has to do?

1) Aggrieved complainants can lodge complaints via the Ministry of Health and Prevention’s website, www.moh.gov.ae, or call their toll-free number 80011111.

2) Once the inquiry has been completed by the ministry officials and the complaint is found to be valid, the patient is informed and the medical malpractice committee takes the necessary action against the establishment. The patient can, with this ruling, file a criminal complaint against the hospital or doctor with the relevant police authority and/or file a civil case claiming compensation for emotional, psychological suffering and loss of life in case of death that is directly linked to the malpractice.

Role of Dubai Health Authority (DHA)

This health authority has regulatory jurisdiction over all public and private hospitals within the emirate of Dubai and has a special clinical governance department that looks into medical liability and malpractices.

Dr Laila Al Marzouqi, director of the health regulation and medical tourism department at DHA, told  “There is a core medical committee which examines all the cases of medical malpractice found to be genuine. In 2015, we had a total of 533 complaints lodged, of which 133 complaints were found to be genuine. Of these, 19 were malpractice cases relating to 18 private hospitals and one government hospital. We work under the UAE federal law of medical malpractices. Once a case is filed we first conduct our own inquiry.”

The medical committee, comprising a minimum of three specialists from the branch of medicine that the case deals with, has external members to ensure an impartial inquiry. The members examine the case that includes the compilation of treatment and procedures, ensures the hospital and the doctor were licensed to carry out the procedure and also makes sure that the complication did not arise out of non-compliance with orders on medicine dosage and other precautions that the patient was instructed to follow.

Dr Al Marzouqi added: “We divide the complaints into minor or moderate [in terms of the duration of the surgical treatment required for the redressal] and major depending on the consequences suffered. The doctor or facility is given 30 days to appeal before the committee and provide their defence. All evidence is meticulously examined. The committee gives the ruling and notice to the erring doctor or facility is issued. The punishments typically could be warning letters, suspension or revocation of licence letters. We share the information with other UAE and GCC health regulatory arms.”

Dr Al Marzouqi clarified that the DHA does not arbitrate on compensation claims made by the patient. “We are the intermediate party that conducts the inquiry and facilitates civil and criminal complaints the patient has to file separately with the court as per the law. We do not decide on the compensation which is decided by the Dubai courts.”

 

Medical liability decisions in 2015

Warning letters issued: 20

Letter of Notice: 9

Suspension letters: 19

Revocation of Licence: 2

 

As a patient, these are your rights to information

Since 2011, the DHA has come up with an elaborate Patient Bill of Rights. It is mandatory for all hospitals, public and private, to put up this bill of rights and also provide it to the patient. Under the Charter of Rights and responsibilities of the patient:

A full disclosure of costs will be provided to the patient before he has to undergo a surgery

He must be given access to all his medical records

He must be provided the full identity of the doctor who is treating him

The doctor must inform the patient about his complete diagnosis and proposed treatment for the same

Patients are entitled to immediate care in case of emergency treatments.

In cases where language is a barrier, the services of a translator will be provided

If the doctor is adding a new surgical procedure to an existing one, he must take the informed consent of the patient in a written form.

If a patient feels his medical rights have been violated, he has every right to file a complaint with DHA.

 

DHA-governed hospitals and facilities: How to complain

You can download the complaints form from www.dubai.ae and email it to their clinical governance department cg@dha.ae or personally submit a hard copy between 8am and 2pm at the DHA clinical governance office in Deira Business Village, third floor, office 332-335.

Call for further clarifications at 800DHA (342).

Alternatively, the Dubai Smart Government has created a unified portal for all complaints about any Dubai Government departments. Log on to the eComplain portal and file your complaint.

Conditions wherein complaints will not be entertained

In an attempt to check any mindless harassment, Article 14 (2) of the Medical Liability Law states the conditions under which a physician or facility will not be held liable for malpractice.

If damage sustained is due to action of patient refusing medical treatment.

If complication occurs due to external circumstances

If the physician followed a certain method which is not generally accepted but recognised

If the medical side-effects and complications are known to occur with such procedures

Insurance cover for medical liability

The Medical Liability Law of December 2008 states that all health-care institutions in the UAE are obliged to have a medical malpractice insurance that facilitates payout in case of compensation litigation.

The DHA has also provided for a special medical tourism insurance for inbound traffic of medical tourists coming to UAE for medical procedures. Apart from their medical cover, they are provided with a special malpractice cover that is valid for up to a month after the patient has left the UAE. “In case a patient is dissatisfied with a procedure or develops complications after he returns to his country, if he files a complaint which is found to be valid, he can return within that month for redressal. The insurance covers his flight back, his stay when he returns and also the procedure or treatment that is prescribed to redress his complaint,” said Dr Al Marzouqi.

Defining medical malpractice

The UAE Federal Law of December 2008 clearly defines medical malpractice.

Article 14 of the law defines medical malpractice as an error that occurs during a treatment or procedure due to negligence by a doctor or a health-care institution. This could be a wrong diagnosis, medication, surgery or carelessness or lack of professional knowledge.

The law enunciates three aspects — the error committed, the damage that the error caused and the loss suffered by the patient /complainant as a result of the damage caused.

Besides this, the UAE Civil Code has a general theory of tort that states that the person who commits the harm shall bear the responsibility of the loss regardless of whether the loss implies damage to property or a personal injury.

 

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