Alliance for Patient Safety

Tami Karni:

I am the Head of the ethics committee of the Association.

The Chairperson, Karin Elharar:

Briefly, madam;

Tami Karni:

I shall try.

The Chairperson, Karin Elharar:

No, two minutes.

Tami Karni:

The principle of telling the truth is really a corner stone in the sensitive relationships between the physician and his patient, and this principle is getting a very clear expression both legally and in the medical ethics regulations, which rule that the physician is obliged to a complete disclosure to his patient. And even so, we have placed this obligation and wrote a very very clear paper about our position on this matter in 2004, we certainly know that physicians conceal and that part of the things said here are true. I have heard now for the first time the story of Dr. Milglater —

Aviva Milglater:

But he also alerted the Medical Association, and nothing was done — no, when we are talking about systems, this physician has nowhere to go. He didn't have anyone to turn to; everything was closed for him, the Medical Association as well—

Tami Karni:

Then I want to express great appreciation to you, Karin Elharar, that you brought this topic here really with the aim to resolve these matters for the future, and not to accuse, time and time again, to shame and punish the one that was; but really to open another way and this is the purpose of what I want to say, to propose another legal way to resolve this issue. The ethics chamber is committed, of  course, to tell the truth, as we have said; but there is a concern of translating the medical factual truth to legal truth which could be used against him, and is the reason that stops many physicians, most of the physicians, from telling the truth. And the second reason is the fear of violence. All of us are under the heavy cloud of what has happened only two days ago. In the studies made by the Medical Association, in the last half year, 70% of the physicians are reporting about violence against them, verbal or other, emanating also from the work conditions occurring there; but definitely we are not working in a relaxed atmosphere. It is compared all the time to flying; it is not that we fly and 99% of the flights are in order and once in a – there will be an error, and then let's investigate it. We work day in and day out under crisis. The Emergency Departments look like a daily war. Obviously we still demand from ourselves a level of professionalism and a level ethical conduct of the highest standard, and nothing is a reason for not acting this way.

It should be understood that the first casualty when truth is not told is the patient and his family and those close to him, and no doubt when it occurs that it is terrible, but it is necessary to understand that the second casualty in these events are the physicians. There are studies that say to what extent these events harm the physicians; the concealment that they are compelled to, the shame that they experience, the recovery and the blame and everything that happens, and many a time their retirement from work.

To this we have related in the medical ethics regulations in 2004 and said; I would like to read it to you. "The physician has the ethical obligation to reveal to the patient that a mishap took place during his treatment. The disclosure of the mishap will be done as soon as possible". We have made it public quite a few times. "Tell the truth and tell it as soon as possible, while expressing empathy and regret about the occurred mishap." We have written there that "The attending physician has to advise the patient personally about the mishap by providing comprehensive information about the mishap and its effect on the medical condition of the patient" —

Amiad Taub:

They probably did not read it.

Tami Karni:

Just a moment, let me read to the end "… and the steps taken in order to prevent its reoccurring in the future."

The Chairperson, Karin Elharar:

A summary sentence;

Tami Karni:

The summary sentence; then I shall go to the end. We are proposing time and again the Apology Law proposal. It had been submitted few times to the Knesset, at least twice. The law is an amendment to the evidence ordinance which says that the reference of a medical team member will not serve as evidence against him, in the part of the apology. The first conversation is concerned with not leaving the patient in the desert of the no – knowledge and the illness. Illness is loneliness by definition, and even worse when an error occurs and you are not told about it, it is a terrible loneliness. We acknowledge this situation; we are asking for an amendment to the Evidence Ordinance Act.

The Chairperson, Karin Elharar:

I am asking to convey to the committee the draft of the law proposal in order t —

Tami Karni:

Ok, so we shall have first of all an opening to apologize. In part of the countries of the world, in 37 states in the U.S it has two more links, one of which also says about compensating the patient on damage caused and bearing the costs derived without proof of negligence. This matter, we assume, will assist us in that the physicians could t —