የጤና ወግ_ሥነ ምግባርdonoteadhfhhhfbfjjjjfjjj.ppt

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1. Ethics in Medicine
Presented in
“Yetena Weg”
Dr. Alemayehu Mekonnen
September 08, 2024
1

2. CRC is National movement, launched by the
Minsters

3. CONCERNS
The total number and complexity of complaints has
shown progressive increase in the last few years.
Could CRC prevent some cases?
No Uniform application of the Laws & Procedures??
Are health care professionals protected to practice?
Does it increase awareness?
Investigative Capability of the Nation ( Autopsy,
toxicology, forensic medicine…)
Media bias? Accessibility of committees?
 Is there really an increase in malpractice/Error??

4. FACTS
 Published studies
 Findings of the Federal Health Professionals Ethics
Committee Proceedings
Millions of Birr is paid as compensation for medical
errors by court decisions
What have you personally observed?
4

5. GAP in COMMUNICATION!
Daniel Zewdneh, Kifle W/Michael, Sosena Kebede (2009)
Ethiopia Journal Health Development: 25 (1). ‘Communication
skills during patient interaction in an in-patient setting at (TASH)’
Observation on 98 consultants, 205 residents, 169 interns
from all the major clinical departments.
The medical practice at TASH shows obvious communication skill
deficiency among ALL categories of physicians.
Medical faculty should take the lead towards addressing the
problem through curricular review and other relevant approaches
at institutional level.
5

6. Study at Kotebe HC, 2012, AAU
6

7. WHY?
Why medical professionals do not talk more like an
ordinary person, i.e. a patient?
Busy?
Fatigued?
Deficient skills of communication
The way they are thought?
Attitude problem? Disrespect?
Unaware of its importance?
7

8. Poor Documentation !
“It is what is recorded in the chart goes to the court”
 Name? Signature?
Unclear words & Poor handwriting
Lost charts
Deletions, missing pages
Consent, Operation notes….
Problems with Digital records
8

9. Every Doctor Must Know!!!
The LAWS of the Land used in Medico-legal Ethics:-
The FDRE CONSTITUTION
PROCLAMATION NO 661/2009 ( Jan 13, 2010)
COM REGULATION NO 299/2013 ( Jan 24, 2014)
 Proclammation no 1112/2024 (establishment of FDA)
 THE 2004 CRIMINAL CODE, Proclamation No.414/2004
THE 1960 CIVIL CODE OF ETHIOPIA

10. Why Surgical Errors?
“To Error Is Human!”
To Correct is Divine!”
Complex pathology
Surgeon factors (Inexperience, Fatigue…)
Awareness, Access to lawyers
Other Doctors!
Lack of equipment
Negligence?
10

11. Statistics, USA
In the USA, 60% the doctors will be sued by the time they
reach age 55.
 
By the age of 65 years, 75% of physicians in low-risk
specialties had faced a malpractice claim, as compared
with 99% of Drs in high-risk specialties ( All are
Surgical).
 7.4% of physicians annually had a claim, whereas 1.6%
made an indemnity payment.
 
78% of all claims did not result in payments to claimants/
Plaintiff
11

12. Statistics, USA, Continued…
Only 10% of physicians directly confront
their colleague malpractice
92% of physicians make some decisions
based on fear from being sued.
In the ICU, 1.7 medical errors per day.
12

13. Lots of cash, lots of lawyers!
Surgery is a high-risk specialty to be sued for
malpractice! Top 5!
Preventable errors are 3
rd
leading cause of death
Leads to high chance of indemnity payment to
the plaintiff!
Time for SURGICAL Malpractice
INSURANCE
13

14. 14

15. The Situation in Ethiopia
Medical ethics issue/complaint applications
alarmingly increasing!
Is there a genuine increase or is it artificial?
Need a research!
FACTORS for this increase may be listed….
Which official data can possibly be our
reference?
15

16. Compliant Handling Procedure
of the Federal Health
Professionals Ethics Committee
of Ethiopia
A Health Professional shall be reviewed
by a group of Health Professionals!

17. Procedures
 Anyone who has an Ethical claim against any H.I. or H.P
may lodge an administrative claim to the Federal or the
Relevant Regional HPs Ethics Committee.
 The claim may be filed by:
- the ‘victim’
- family/spouse
- police
- MOH or any Health administrative organ
- the Court
- or Anyone interested (since it is a public health issue.)

18. Algorism/Flow of the claim process

19. Cont’d…
BA

20. DECISION
Involve Societies, Senior Specialists,
Lawyers…..
Consider many factors and circumstances
Try best to RECONCIL!
RECONCILATION IS THE BEST POLICY!
Dr. Biruk, Addis-Ababa University
20

21. 1.
IMPLCATIONS of Health Professional Regulation in Ethiopia
Currently, in Ethiopia, medical malpractice/negligence claims against
H.P may be raised based on;
 1. Administrative law: regarding the license;
2. Civil law: either from contractual obligation or Extra-contractual
obligation; or
 3. Criminal law: criminal liability of the H.P or H.I
4. Labor (civil service) law: related with the futurity of his job

22. Analysis of the last 100 ethics files on Health
Professionals
These are cases seen at Federal level
Health professional Ethics issues seen at Regional level
are NOT included
But we know that as of today, the Addis Ababa City
Administration Health Professionals Ethics committee
has reviewed close to same (>150) complaints,
Now there are well established 08 regional committees

23. H.P Distribution of the latest 100 Files

በየትኛው ባለሙያ ላይ ቅሬታ ይበዛል
? 23
#ተ.ቁSpecialty-
የባለሙያ ዓይነት
ብዛት ፐርሰንት
1 OBGY (
የማህጸንና ጽንስ ሀኪም
) 35 35%
2 Gen. SURG (
የጠቅላላ ቀዶ ህክምና ሀኪም
) 13 13%
3 Ortho. SURG (
የአጥንት ቀዶ ህክምና ሀኪም
) 11 11%
4 Ophthalmologist (
የዓይን ሀኪም
) 4 4%
5 Cardiothoracic Surgeon 3 3%
6 Neurosurgeon (
የነርቭ ቀዶ ህክምና ሀኪም
) 2 2%
7 Plastic Surgeon 1 1%
8 Resident (
የስፔሻላይዜሽን ህክምና ተማሪ
) 1 1%
9 G.P (
ጠቅላላ ሀኪም
) 6 6%
10 Nurses in Surgery (ነርስ) 6 6%
11 Anesthetist (አንስቴዝያ) 5 5%
12 Laboratory (ላቦራቶሪ) 2 2%
13 Cataract surgeon (
ካታራክት ሰርጅን
) 1 1%

24. 90 % of Ethics issues are from surgical
Specialties
90
10
0
5
10
15
20
25
30
35
40
45
Surgical Non-Surgical
Specialty

25. THE OR!
IS A BATTLE
PLACE!
Needs attention!
25

26. Who filed the complaint?

ቅሬታውንወይምአቤቱታውንማንአቀረበው
?
26
ተ.ቁ ቅሬታ/
አቤቱታ አቅራቢ
ፐርሰንት
1 ታካሚ/ቤተሰብ 23%
2 ፖሊስ/
ፍርድ ቤት
43%
3
አዲስ አበባ ጤና ቢሮ
18%
4
ጤና ጥበቃ ሚኒስቴር
8%
5
ሌሎች
(
ጤና ባለሙያዎች ወይም ታዛቢዎች
) 8%

27. …
የጤናሙያስነምግባር
..

የቀረቡት ቅሬታዎች ምን ዓይነት ናቸው
?
27
ተ.ቁ ፐርሰንት
1 ሞት 65%
2
የአካል ጉዳት
25%
3
ሌሎች
(
የክፍያና ሌሎች

አስተዳደራዊ ጉዳዮች
)
10%

28. Types of complaints
ALL SORTS!
-
-
-
-
-
MOST ARE AVOIDABLE, CRC helps!

29. Lessons to Share!
BECAREFUL!
KNOW THE RULES
READ & DISCUSS Ethics

30. OBSERVATIONS so far…..
The single most common Specialty filed upon is OBGY
Misunderstandings and “little” knowing patients (e)
Role of professional associations and societies?
Serious communication gap between patients and HPs is observed
Documentation and record keeping is another area that needs
improvement
False accusations of prominent professionals!
“Specialists ‘accusing’ each other” for popularity…. Wrong way of
giving opinions!

31. OBSERVATIONS…
Undefined Scope of Practice…….Finalizing
The Media bias observed? Court decisions?
Administrative/Criminal case Vs Medical Ethics
When significant Money is involved in the care
Treats to professionals/ Patients? Council members!
Is it only the trained Health Professional that takes care of patients?
How about the Institutions?
31

32. OBSERVATIONS so far…..
More and more cases are getting filed at the Council
The single most common Specialty filed upon is OBGY
Misunderstandings and “little” knowing patients (e)
Role of professional associations and societies?
Serious communication gap between patients and Surgeons is
observed
Documentation and record keeping is another area that needs
improvement
False accusations of prominent professionals!
“Specialists ‘fighting’ each other” for popularity…. Wrong way of giving
opinions!
Denials and accusatory ideas. Subjectivity?

33. የህክምናና
ጤና
ሙያተማሪዎችጥፋት

በበቂያልተመለሱጉዳዮች


ተማሪ ይቀጣ
?
ተማሪ ሆኖ ከአመታት በፊት ለተፈጠረው

የህክምና ስህተት ከተመረቀ በኋላ ሙያውን በስልጠና

እንዲያጎለብትበቅጣቱይወሰናል፡፡

በአንድ የጤና ዘርፍ ከዓመታት በፊት ጥፋት ይሰራና በአሁኑ

ወቅት ግን ባለሙያው በሌላ የጤና ዘርፍ እየሰራ ሲገኝ በምን

መልክሙያውንእንዲያጎለብትይቀጣ
?

33

34. የህክምናስህተቱበውጭሃገርሲፈጸም
ታይላንድ

ደቡብሱዳን
 ህንድ
 ዱባይ
34

35. የሕክምናተቋማት

ኦሪጂናልየታካሚንካርድበተጠየቀጊዜአለመላክ

የታካሚካርድ
/
ህክምናሰነድመጥፋትመሰረዝመደለዝ

ባለሙያንብቻነጥሎአሳልፎመስጠት

የሚመችየስራቦታሲስተምናአሰራርአለመዘርጋት

የህክምና ስህተትን ለመከላከል እና ለመቀነስ ስልጠናዎችን

አለመስጠትእንዲሁምሰራተኞቹንበህግእውቀትአለማዘጋጀት

35

36. የአስከሬንምርመራውጤቶች

ለኮሚቴውውሳኔ እጅግበጣምወሳኝግብአትነው
!

ሆኖምግን፡
-

የተቋሙብቃት

የተቋሙቅልጥፍናናተባባሪነት

የምርመራውጤቱተአማኒነት

የቋንቋናየትርጉምክፍተት

ተቋሙላይያለውየስራጫናናብዛት

የተቋሙየምርመራክፍልየቴክኖሎጂደረጃ
36

37. COULD CRC help?
YES!
Its principles avoid
most of these issues.
Dr. Biruk, Addis-Ababa University
37

38. 38