Epidemiology of medico-legal litigations and related medical errors in Central and Northern Saudi Arabia. A retrospective prevalence study

OBJECTIVE

To study medico-legal litigations and related medical errors in Central (Al-Qassim), and Northern (Hael) districts in the Kingdom of Saudi Arabia (KSA), and to identify types and causes of errors to reduce medical errors and patient harm.

METHODS

This retrospective prevalence study was carried out between May 2010 and December 2011 to analyze medico-legal litigations in Al-Qassim and Hael districts that were investigated by the Al-Qassim Medico-Legal Committee, Al-Qassim, KSA. Final verdicts issued between 1992 and 2009 included 293 cases.

RESULTS

The patient`s mean age was 29.5 years. Fifty-seven percent of the patients were females, and 92% were Saudis. The Obstetric and Gynecology department was involved in 29.7% of litigations followed by General Surgery, and Pediatrics (11.3% each). Of the 635 defendants, 90% were physicians, and 7.6% were nurses. Investigations showed no error in 47.1% of cases, error but no harm in 11.9%, and error resulted in harm in 39.6%. Errors were negligence (45.8%), wrong diagnosis (14.2%), surgical error (10.3%), and administrative error (5.2%). The average total duration of litigations was 13.9 months. Type of harm was the most significant predictor to determine a guilty decision (p<0.001).

CONCLUSION

Obstetric practice in Al-Qassim and Hael districts and provider negligence contribute to a large portion of medico-legal litigations, and therefore this has to be further studied to recognize the specific causes and possible interventions. A systematic review of the medico-legal committee is needed to shorten the long duration of litigation.

Nurses, midwives and the requirement for "appropriate" professional indemnity insurance

The Health Practitioner Regulation National Law Act 2009 (the National Law) imposes the obligation on nurses and midwives to have appropriate professional indemnity insurance coverage as a condition of applying for, or renewing, their registration to practise in Australia. The National Law also empowers the Nursing and Midwifery Board of Australia to develop a registration standard and guidelines in relation to professional indemnity insurance and to enforce compliance through the registration process. Though not previously a requirement for their registration, nurses and midwives must now understand the nature and extent of the professional indemnity insurance under which they practise and declare that they will not practise their profession unless they have appropriate professional indemnity insurance arrangements which cover the full scope of their practice. This column provides an overview of the obligations and responsibilities imposed on nurses and midwives under the National Law and the Nursing and Midwifery Board of Australia's registration standard and guidelines. It is imperative that nurses and midwives understand the National Law provisions and the standard and guidelines developed by the Board before making decisions about their professional indemnity insurance and self-declaring that they have "appropriate" professional indemnity arrangements in place.

Sairey Gamps, feminine nurses and greedy monopolists: discourses of gender and professional identity in the Lancet and the British Medical Journal, 1886-1902

The British debate over midwife registration in the late 19th and early 20th centuries was highly gendered. Focusing on the period between the 1886 Medical Act and the 1902 Midwives Act, this article uses the content from the Lancet and the British Medical Journal, the two main general medical publications of the time, to explore the complex ways that gender works through other categories such as class and race to create professional identity. Specifically this article demonstrates how man-midwives used gendered language to help create identities for themselves, female midwives, and other rivals in order to legitimize their own professional identity and practice and to delegitimize the professional identities of their competition.

Transnational spaces of care: migrant nurses in Norway

This article argues that international nurse recruitment from Latvia to Norway is not a win–win situation. The gains and losses of nurse migration are unevenly distributed between sender and receiver countries. On the basis of empirical research and interviews with Latvian nurses and families they left behind, this article argues that nurse migration transforms families and communities and that national health services now become global workplaces. Some decades ago feminist research pointed to the fact that the welfare state was based on a male breadwinner family and women’s unpaid production of care work at home. Today this production of unpaid care is “outsourced” from richer to poorer countries and is related to an emergence of transnational spaces of care. International nurse recruitment and global nurse care chains in Norway increasingly provide the labor that prevents the new adult worker model and gender equality politics from being disrupted in times where families are overloaded with elder care loads.

The growing role of carers in the administration of medications

The roles of registered nurses, enrolled nurses, nurse practitioners and midwives in the administration of medications are subject to the legislation and regulation in their respective States and Territories in Australia. Underpinning this regulatory framework is a presumption that health professionals who come under the relevant legislation and regulations have attained the levels of competency, skill and knowledge consistent with professional standards and the protection of the public. This column considers the provisions of the Health (Drugs and Poisons) Regulation 1996 (Qld) addressing the administration of controlled and restricted drugs in light of a recent Queensland Civil and Administrative Tribunal decision.

Nursing and midwifery education, practice, and issues in Israel

Nurses deliver most of Israel's healthcare services, yet its nurse per population ratio is only 5.9 per 1000, one of the lowest in the developed world. For several years, the managers of the profession have been pushing to upgrade nursing and to move it into the academic sphere. The semiskilled qualification of the practical nurse has been eliminated and training programs for registered nurses are being transformed from diploma training to academic degree programs. A midwifery license is accessible only to registered nurses who take a further 1 year of advanced training and sit the State Midwifery Licensing Examination. Most deliveries in Israel are carried out by midwives. Alongside the Western-standard hospital system there operates both a well-developed community nursing network and a strong mother-and-child clinic system. The acute shortage of nurses in Israel is now coinciding with a rising number of academic job-seekers, which has encouraged the Ministry of Health to offer university graduates a career-change program. Special scholarships are on offer in return for a 4 year commitment to work in nursing after completing an accelerated training curriculum (2.5 years instead of the usual 3 years), plus a starting monthly wage that is higher than the national average wage.

Professional indemnity and its importance: a legal overview

The purpose of this article is to highlight the importance of professional indemnity to protect an individual's healthcare practice. Healthcare professionals should ensure that they have appropriate indemnity to cover all their professional activities. This may be arranged through their employer, professional organisation or by private arrangement, or a combination of these methods. The various types and forms of indemnity are discussed.

[Medical-social aspects of medical staff migration]

The migration of the medical staff represents an increasingly worring reason for romanian health policy-makers. According to the Ministry of Health, in 2009 year, the human resources indicators pointed out 26.5 physicians/ 10,000 inhabitants (whereas the European Union average was 32.8) and 60.4 nurses and midwives (whereas the European Union average was 108.5). Between 2007-2010, over 9000 physicians requested professional certificates in order to practice abroad and the majority have left the country. This phenomenon is related to the Romania's entrance in European Union and it is supposed to continue in the coming years. The direct consequences of the migration of the medical staff consist of significant differences between the country's regions in the health workforce distribution, the most affected by the critical shortage of health service providers being the North-Eastern region, especially in rural area. In order to limit the migration phenomenon, the Ministry of Health elaborated some strategies and workforce policies on medium and long-term, but the results will be difficult to assess.

Access to enforcement and disciplinary data: information practices of state health professional regulatory boards of dentistry, medicine and nursing

This article describes a study of public access to enforcement and disciplinary information provided by the websites of health professional regulatory boards. The study explored the current state of transparency by specifically examining the availability of disciplinary data on the websites of state boards of medicine, nursing and dentistry. Web sites were reviewed regarding availability of enforcement and disciplinary data on the aforementioned state boards in each of the 50 states and the District of Columbia. The study found that there is more information about individual practitioners available from the boards than ever before. On the other hand, there has not been a comparable increase in information about the administrative practices and the work of the boards. Increased availability of this information would allow public administration and policy researchers to develop performance indicators of state boards and assist in improving policy decisions and allocation of resources.

What you see may not be what you get: beware of patients bearing gifts

The professional boundaries of practice for nurses and midwives are specifically addressed in professional codes of ethics and conduct, employer policies and guidelines and more frequently in the professional literature. There are many forms in which boundary violations and boundary crossings may present or circumstances in which they may occur. This column considers a recent case (involving a bequest to a registered nurse under a will) which came before the Queensland Nursing Tribunal. The decisions of the tribunal, the District Court and the Court of Appeal provide practical guidance to nurses and midwives on the importance of establishing and maintaining the professional boundaries essential to the therapeutic relationship with their patients and clients.