Alliance for Patient Safety

Bezalel Smotrich (Habait Hayehudi):

First of all, I am joining also the congratulations to you, Madam Chairperson, about the discussion, and, that I really was impressed with in your introduction of the matters, to follow-up the changes it is — Knesset member German knows very well because she knows how things were, I can be less impressed, because I was impressed from the frankness. Usually people come here and try to explain why everything is in order with them; the willingness to say that today also there is where to advance and improve; I think that it is a great virtue.

One word of preamble about the dilemma in which we are daydreaming here in the room and it is the dilemma which exists in every auditing institution in every area, between the will to really create a very very effective auditing system and draw the conclusions etc… and the cost that this matter creates. Cost not in the financial sense; to each of these matters there is a price; it has an effect — and quite often there are dilemmas. In ethics, say medical, these are dilemmas which are much discussed; whether the price that I pay in order to prevent a mistake is not higher, and I am talking now of the price in human life; say that now a failure has been created, and as a result of same you want to issue a new procedure, and the price of this procedure is life risking, because at the end this procedure is making the system cumbersome, and makes it harder on us and prolongs the queues and creates a need for human resources, and since we are in a system whose whole designated essence was to save life, then the tension is real tension.

I only want that all of us here put it on the table. Over auditing and over procedures and over rigorousness in order to prevent a case which happens once in —, which is terrible and horrific; it is terrible and horrific and no one takes this one lightly, but it is necessary to know that for preventing this one, at times it has a very very high price to the whole wide spectrum until this specific one occurs. It is a tension that has to exist. I am sure that you live it and we too have to live with it.

I want to emphasize two points which I think bypass this tension. I have no decision on this tension; I am really saying that it is an existing tension, and shortly I shall touch it in the third point, in the context of the location dilemma, where should the commission be located; but I see at the moment two points that I think that should be agreed upon by everybody here. One is the issue of immunity. You talked about it here, the State Comptroller; it came up also in the previous discussion. You in the Ministry of Health said in the previous discussion; I admit that I did not understand that it has been resolved today. What I have learned is that it has not. Today the problem is what the physicians will say, be it in the internal debriefing within the hospital or be it in front of you which could be used against them.

Boaz Lev:

No, I want to explain. In a debriefing which in fact is a quality and control committee, it is totally confidential. It cannot be taken —

Bezalel Smotrich (Habait Hayehudi)

It is a process t —

Boaz Lev:

It's not us; it cannot be taken to a Court of Law or for evidence, or for any other matter. It is only for the sake of quality.

Bezalel Smotrich (Habait Hayehudi):

No, I am talking now. One more time, had an event occurred within the hospital and now they are doing a debriefing and the physician is at the moment inside the hospital —

Boaz Lev:

It is not confidential when it is a specific event with an injured, individual; not confidential.

Bezalel Smotrich (Habait Hayehudi):

Then this what I am talking about. In my view it is a very problematic gap. When you have talked before about the difference between the debriefing in the air force, incidentally, the truth should be admitted that in the IDF also there is large erosion as a result of two amendments made to the Military Legal Law; there is large erosion in this immunity, and there too, they didn't leave much of it, and it is very very bad. It hurts, I am saying this also from my familiarity with the army; it is hurting badly the debriefing capability. And incidentally, there is tension here as well, I admit, since on the one hand we also want, part of doing —since there are two roles to the auditing array; one role and that's the main one, it is to improve the system. On the other hand, we also want to do justice, and justice at times is also to punish the one that should be punished. These are two objectives which at this point are contradictory; the wish to do justice, which requires that we could later use the material; it hurts the capability to debrief for the sake of learning. In my humble opinion, in the tension between these two objectives, the more important one is the internal improvement since it saves life. Justice, in the sense of retribution etc. is less important. Again, in my opinion; and then it means that a mechanism must be created.

We have talked about it in the previous discussion; if it will not get an expression in the Memorandum of Law by the Ministry of Health we shall need to do it in a private manner, as a private law proposal, and ensure that those investigating processes intended for the internal improvement will be completely confidential so that people will not think about themselves and not bring a lawyer into this phase. This phase, in its entirety is for learning purposes only. And again, I want to hear one of you as to where it stands in the memorandum. In my view, if it isn't fulfilled, then we shall do it as a private law proposal. We have spoken about it the last time; I presume that all of us will join in this matter.

Schedules; this is a malaise that exists also in the criminal law and in many other places. Again, as everything here it is in tension and we want to keep the rights, however a late justice is no justice. But not only justice, here it is much more important, because we want to improve, and to try to draw the lesson three years later is not serious. We have to think very well, to create administrative work, how do we shorten the time table. Again, within the tension, between the will to keep — — and incidentally, it could be slightly connected one to the other; if we separate between the investigating process intended for the sake of efficiency and between the other processes intended for doing justice, then we should need less in this balance; It will interest me less at this moment to keep the rights of the defendant, because he is not the point. No problem, since I shall create another process intended exclusively for the sake of learning and it has to be fast and there are no defendant rights in it within this context, since I am not going to hurt you. It is confidential, not protecting your rights and no nothing. Incidentally, the medical immunity in my view as well; here it has to be moved aside, since it is confidential; it will be opened for your eyes only, for the eyes of those professional parties who need to draw the conclusions at the end and give the recommendations. In short, in my view we have to shorten the time table and it might be that it connected; that's what I have said; we separate between the systems, the investigation for the sake of learning and then the exhaustion of the law. The exhaustion of the law; rights must be protected; it will take time; there is nothing to do as the investigation must be considerably faster.

The issue of transparency; it will also be very very beneficial, as we have said earlier; here I am slightly differing from you; I am saying it as a citizen. I am a Knesset member for a very short time. I have complete trust in the medical system. Thanks God we are healthy people, but we had a problem with one of the children and we were in need of the medical system through not a simple period and we have received a good and wonderful service. I only want to say, that you should not walk around with feelings of —; I am saying it as a citizen and from what I hear from people around me. I have complete faith; not everything is ok in the medical system; I would like to improve many things, also as a Knesset member, however I don't a have problem of trust in the medical system.

Now I only want to touch with a last sentence, sorry for the length of my words, on the location dilemma. I came to the discussion with a very clear position that the commission should be taken out of the Ministry of Health, not to the Ministry of Justice; I am not ready for that as of yet, but to think positively whether there is a possibility to create — on the other hand I must say that what Boaz said opened with me a will for reconsidering of the issue. Since, at the end, again, I will be, pretty soon arriving to the point I have made earlier. We are at the moment in a world of learning and correction, not in a world of exhaustion of the law. The world of the exhaustion of the law must be separate, disconnected; there is a great advantage to a world of learning and correction — and again, it opened in me to the point where I can say, I have no position in that matter. I want to think. I came in with a consolidated position, which is, incidentally, as Yael's came to me from other systems. There is no doubt that audit are a usually necessary in order to be — it needs — there will be a price to pay. It should be known. If we take it out, then there will be a price to pay. There will probably also be a price to pay at the level of concern, but there will be a price to pay in the capability to immediately translate and implement the insight into a practical recommendation and the investigation that this recommendation is calling for.

Again, I suggest that we think about it one more time. I truly admit, I came with a pretty consolidated position that it must be taken out, because again, I come from other models. I don't know models in which it exists — where there are models that leave it inside the system; it doesn't work well, as was with the Audit Commission on the Prosecution system and Representatives of the State in the courts of Law. Incidentally, in the Audit Commission on the Prosecution system and Representatives of the State in the courts of Law as well, I think, Yael please correct me if I am wrong, the objective of the auditing body was a bit different. The auditing body on the prosecution is not —

Yael German (Yesh Atid):

Same thing; It is not about punishment.

Bezalel Smotrich (Habait Hayehudi):

It does not punish, but —

Yael German (Yesh Atid):

It clarifies a complaint.

Bezalel Smotrich (Habait Hayehudi):

It does not punish, it clarifies a complaint. It is less intended that in its next step a procedure will be written that will force all the hospitals to conduct audits which they are not doing today.

Yael German (Yesh Atid):

No, it is absolutely. Certainly —

Bezalel Smotrich (Habait Hayehudi):

Less; this, incidentally, is part of the difference between a specific auditing to a general auditing, so they have separated it.

Yael German (Yesh Atid):

In the auditing reports of the Audit Commission on the Prosecution system and Representatives of the State in the courts of Law that Hilla managed to extract; seems to me five audits; in each there were conclusions.

Bezalel Smotrich (Habait Hayehudi):

Fine; as I said, I am in a dilemma. It is obvious that there will be a price to pay. There is price to it when it is inside; there is a price to it when it is outside. On the question who is heading it, I am certain that it should be a physician. I think that a retired judge should be alongside him, so it is must be a physician, because this is a discipline that without a physician you don't understand anything. And one more time, these are dilemmas that are not bound together. It can be a physician who is not connected. This means that even if it is decided to take the auditing body outside of the Ministry of Health, I suntil think that a physician should be heading it, because we will not let a physician check a problem in the garage, and we will not let a mechanic check on a failure in medicine.

The Chairperson, Karin Elharar:

Well, even if it will be —

Bezalel Smotrich (Habait Hayehudi):

Incidentally, in the auditing authority on the judges —

Yael German (Yesh Atid):

I beg to differ.

Bezalel Smotrich (Habait Hayehudi):

I am just saying, the auditing authority on the judges is headed by a judge —

Yael German (Yesh Atid):

That is correct, this is because a judge really knows how to consider all t —

Bezalel Smotrich (Habait Hayehudi):

Then on this I disagree with you. Judges are not angels and they are not familiar in all aspects of life. They are knowledgeable in the legal area and it is a very specific area in life.

The Chairperson, Karin Elharar:

Now, I, as a Knesset member, not as a Chairperson —

Bezalel Smotrich (Habait Hayehudi):

Sorry for the length of my words.

The Chairperson, Karin Elharar:

No, it's all right. I say, look, at the bottom line, even if it will be a judge; a physician will have to sit with him.

Yael Germa (Yesh Atid):

Right.

Bezalel Smotrich (Habait Hayehudi):

Then the question is who should be leading.