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In the Name of Allah the Compassionate, the Merciful


????? ?????? ????? ???????????? ???? ?????. Medical Malpractice. M.H.Ghadiani,M.D. ... The Holy Qur'an, Surah: Al-M idah(Part of 32) ???? ????? ????? ?????. 5 ... – PowerPoint PPT presentation

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Title: In the Name of Allah the Compassionate, the Merciful

  • In the Name of Allah the
    Compassionate, the Merciful

?? ??????The God Is Healing
Medical MalpracticeM.H.Ghadiani,M.D.Internist
Fellowship of NephrologyAssistant Professor of
Legal Medicine Organization of Iran
  • And he who saves a man,s life shall be considered
    as one who has saved the life of mankind as a
  • (?? ??? ??????? ????????? ??????????? ???????)
  • The Holy Quran,
    Surah Al-Mâidah(Part of 32)

Every physician must be answerable to three
  • Allah almighty or divine justice court
  • His/her conscience or internal judge
  • External judge or authorized courts

  • The main principle in medicine is that whatever a
    physician does for a patient is to be a benefit
    but not to be harm for him/her. So, when a harm
    is created by physician, it has occurred against
    his/her will. In condition that the physician
    does it according to medical and scientific
    rules, has not made a mistake or error and he/she
    will not be considered as culpable.

  • Physician is free to do whatever
  • is deemed to be right and justified and hence
    he is not obliged to act without knowledge or
    insight, if he/she is not certain about what to
    do, he/she can consult with his/her colleagues or
    refer to valid scientific centers. Whenever there
    is freedom, the responsibility is also with it,
    therefore the physician is liable for his/her
    deeds (right or wrong).

When a physician doesnt do whichever of
diagnosis and remedial stages well, he/she
commits a medical malpractice, such
asHistory taking, Clinical and Para clinical
examinations, On time diagnosis, Correct remedy,
Post- treatment follow- up, Counseling and
necessary guidance according to medical
scientific rules
Authorized courts which considering complaints
and medical errors in Islamic Republic of Iran
  • Medical council organization
  • Legal Medicine organization (L.M.O)
  • Inspection organization of Iran-subunit of the
  • Governmental punishments organization- subunit of
    Ministry of Justice
  • Ministry of Health, Treatment and Medical
  • University of Medical Sciences
  • Judicial courts of justice

  • Types of medical malpractice
  • Carelessness
  • Improvidence
  • Lack of proficiency
  • Inattention to governmental rules
  • Mixed

  • Carelessness
  • Abandonment of an indispensable action such as
  • Not to give Oxygen or Salbutamole spray to the
    asthmatic patient in emergency situation
  • Not to take ECG in a patient with sustained
    chest pain suspected to IHD (Ischemic Heart
  • Not doing Necessary consultation
  • Not taking blood pressure in hypertensive patient

  • Improvidence
  • Commit a wrong action without careful attention
    such as
  • Administration of Prostaglandin instead of
    Progesterone in a pregnant woman with spotting
  • Ureter is blocked instead of uterine artery in
    the course of hysterectomy
  • Remain sterile gas in abdominal cavity during
  • Operation on normal leg instead of injured one

  • Lack of proficiency
  • 1. Scientific
  • Unawareness regarding to the routes of drug
  • Unawareness regarding to a specific method of
  • 2. Practical
  • Mismanagement of normal vaginal delivery
  • Using wrong cast or splint resulted in
    compartment syndrome

  • Inattention to governmental rules
  • Non acceptance of emergency patient
  • Establishment of clinic without license
  • Performing some of the surgical operations which
    must not be done in private offices
  • Not sending biopsy sample to pathologist

  • Conditions of negligence attribution to the
    physician act
  • The duty of patient's treatment would be with
  • The scientific rules and technical methods in
    diagnosis and treatment of patient would not be
  • Followed by these, the patient would be injured
    physically, psychologically, financially or

  • Physician with having large scale of great
    knowledge, sufficient information, proficiency in
    his/her specialty, good intention in his/her
    manners and with respect to related laws and
    rules, he/she is sometimes, unsuccessful in
    his/her patient's management.

  • Despite of advances in diagnostic
  • and therapeutic fields of medicine,
    dissatisfaction of the patients from physicians
    is increasing.
  • This subject has a significant role in health and
    medical care systems in all of the world.

  • An investigation in England showed that there are
    one hundred oral complaints for every written
    complaint and 4 dissatisfied patients for every
    oral complaint, Consequently every written
    complaint is followed by nearly 400 dissatisfied

  • A study at New York hospitals shows that 1 of
    hospitalized patients suffer from physical
    injuries arising from medical malpractice.

  • Physician
  • Patient
  • judge
  • form a triangle.

  • Different types of relationship
  • between physicians and the law
  • Forensic medicine specialist
  • Consultant (usually specialist in other fields of
  • Witness
  • Defendant
  • Plaintiff

The causes of increasing of complaints against
  • Increase in population
  • Increasing of physicians
  • Inattention to medical ethics and relationship
    between physician and patient
  • Inattention to proper history taking and
    physical examination
  • Increasing of patient's awareness about their
  • Complexity and diversity of diseases
  • Use of invasive diagnostic and treatment

The causes of increasing of complaints against
  • Lack of proficiency of physicians
  • Inattention to governmental rules
  • Not explanation of patients by physicians about
    diagnostic and treatment procedures

  • Some of the complications are both predictable
    and preventable
  • Some of them are predictable but not preventable
  • Some of them are neither predictable nor

  • Complication is different from malpractice.
    Malpractice means the errors which have been
    caused to avoidable injuries and damages.
  • Complaint can be against physician, remedial
    system or medical staff.
  • Non ideal conclusion on treatment of a patient,
    is not necessarily meaning malpractice

  • The physicians legal responsibility may
    have various aspects
  • Patients motive for complaining is only
    compensation of financial loss. In these cases
    the physician can benefit from insurance that
    covers such losses.
  • physician may be criminally liable in cases such
    as illegal abortion that would be punishable and
    is not covered by insurance contracts.
  • Both legal and criminal liability cases exist,
    for example when a patient dies because of
    illegal abortion. In these cases the legal part
    can be covered by insurance, but the criminal
    part is not covered.

Main topics for medical malpractice prevention
  • 1. Notice to medical ethics especially based on
    teaching of Islam
  • 2. Improvement of relationship between physician
    and patient
  • 3. Increase of knowledge and practical skills of
  • 4. Necessity of organizing the retraining
    seminars and congregations for quantity and
    quality promotion of medical services

  • 5. Increasing constant supervision on medical
  • 6. Paying attention to governmental rules
  • 7. Promotion of technical and medical equipments
    of hospitals, remedial and diagnostic centers
  • 8. Patients education regarding to the
    complications of diagnostic and therapeutic

  • The surveys show that, among different kinds of
    malpractices, inexperienced physicians most
    involved in carelessness and lack of proficiency
    Whereas, experienced physicians most involved
    in improvidence and inattention to governmental

  • Whatever you can, be in the service of the needy,
  • With a bit of advice, or a help or a penny