Alliance for Patient Safety

Preface

Errors in medical diagnosis and treatment, which cause damages to patients and occur in both, hospitals and medical institutions in the community, are one of the challenges that the medical systems worldwide are facing[1].  From the professional literature it transpires that the term "medical error" includes: an unintentional doing or action that did not achieve its planned objective; failure to complete a planned action (execution error); use of an unsuitable plan to achieve the objective (error in planning) or deviation from the treatment process which may (or may not) cause damage to the patient[2]. According to estimates, errors as a result of medical activity are the third cause of death in the United States, responsible for the deaths of some 251 thousand people a year on average. Nonetheless, as per the investigators this estimate is an underestimation of the actual scope of the phenomenon[3].

The rules of ethical conduct of the Medical Association in Israel relate to the obligation of the physician to act in order to prevent such incidents and it has been determined, inter alia, that: the physician will assist, to the best of his ability, to protect the safety of the patient and prevent errors in the medical treatment; the physician will report to the appropriate professional body about errors occurred in the medical treatment; the physician will respect the rights of the patient to receive reliable and complete information concerning the circumstances of the medical treatment he received, including error that may have taken place during the course of this treatment, if it has an implication on the medical condition of the patient or on the continuation of his medical treatment; the physician will explain the nature of the error that occurred in his treatment to the patient, the steps taken to correct it and the processes executed in order to prevent making this error again in the future[4]. In addition, clause 21 of the Patient Rights Act 5756 – 1996 determines the setup of an investigation committees for checking exceptional event concerning the provision of medical treatment whose objective is to clarify what has happened to the patient during the medical treatment, draw conclusions, correct the flaws and to locate those who are responsible for them through checking whether there is a need to initiate a disciplinary or any other process.

In the State's Comptroller report 62 of 2011 the Comptroller mentioned few factors which might bring about failures and errors in the medical system, among them: Risk factors, some of which are not under the control of the medical system (such as unpredicted response of the patient to the medical treatment);  work burden put on the treating staff or the lack of environmental conditions enabling the process and input of large data involved in the treatment of the patient; errors of the treating staff, errors in judgment and human errors; negligence in the medical treatment which does not reach disciplinary violation; severe negligence which contains disciplinary violation; criminal negligence which in fact is a criminal violation[5].

According the State Comptroller, "only a fraction of the total exceptional events and the medical failures are emanating from negligence"[6]. That is, not every error or medical failure is a result of medical negligence, however in the Comptroller's report the scope of these occurrences in Israel was not mentioned.

Notwithstanding, according to the State Comptroller, in the years that preceded this report a significant and constant increase occurred in the scope of the financial demands and claims against the state submitted to the Courts and insurers due to medical negligence in Israel. The State Comptroller attributes this increase not necessarily to the increase of the scope of medical injury due to negligence, but, inter alia, to the increase in awareness within the public to medical negligence and to standing on its rights to submit claims, as well as the increase in the number of lawyers[7]. This trend has led the state to setup two committees to handle the issue of medical negligence. The committee for examination of the responsibility for damage in the medical treatment, headed by judge Dr. Gabriel Kling, which has submitted its recommendations to the Director General of the Ministry of Health in 1999, and The inter-disciplinary committee for examination of the ways to reduce the public spending due to medical negligence headed my Ms. Tana Shapnitz which has submitted its recommendations to the Ministry of Justice in 2005. These committees dealt with the various aspects of the medical negligence issue, and among them the increase of the legal claims due to this negligence. However, even with the data brought fourth in these reports, as well as the stated State Comptroller report, it is not possible to learn the scope of the medical negligence occurrences in Israel over time.

We wanted to introduce in this document the scope of the medical negligence in Israel and for that purpose we approached various relevant bodies, among them the Ministry of Health, the Ministry of Finance, the Medical Association of Israel, the Central Bureau of Statistics, the Israeli Police, The Israel Bar Association, the Management of the Courts , and the Nurses Association. From the information received from the Ministry of Health and the various bodies (except for the Nurses Association that until now has not replied to our application) it transpires that there is no complete information about the number of medical negligence incidents in Israel, but only partial data which is insufficient to determine and reflect the scope of the actual phenomenon.

In the first chapter of the document we shall introduce the Ministry of Health’s definitions of medical negligence as well as the partial data about the prevalence of the phenomenon in Israel, the sources of which are in the Management of the Courts, the Ministry of Health, The Ministry of Finance and the Central Bureau of Statistics. In the second and third chapters we shall introduce the various bodies entrusted with the examination of exceptional occurrences in the medical treatment in the Ministry of Health (The Medical Administration, the Public Service Commission for the Medical Professions and the Disciplinary Unit) and the data about deaths and incidents requiring report to the Ministry of Health and examining the complaints due to medical negligence by the Office. In the fourth chapter we shall introduce the data of the Ministry of Health and the Ministry of Finance concerning the economic burden due to medical negligence claims against governmental medical institutions and in the last chapter of the document we shall introduce the model used in Denmark for the handling of medical negligence claims against the health system.

[1] Gaby Bin-Noon, Yitzhak Berlovitz, Mordechai Shani, 2010 The Medical System in Israel, Ms. Bin-Noon, Yitzhak Berlovitz, Mordechai Shani, 2010.

[2] The BMI, Medical- error-the third leading cause of death in the U.S Martin A. Makari, Michael Daniel, May 16, 2016.

[3] there

[4] The Medical Association in Israel, The Ethics Rules 2014, chapter 1, clause 19, entrance: 30^th March 2017

[5] The State Comptroller's Office, Report 62 for 2011, May 2012.

[6] The State Comptroller's Office, Report 62 for 2011, page 209, May 2012

[7] The State Comptroller's Office, Report 62 for 2011, May 2012