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Background: Adverse events are frequent in clinical practice, but only a few studies in Saudi Arabia have addressed them. Preventable medical errors may lead to far more patient deaths each year than previously accepted estimates, according to a new report published in the Journal of Patient Safety.
James based the estimate on four recent studies that identified avoidable harm to patients. By combining the studies and extrapolating across 34 million hospitalizations in 2007, James estimated that medical mistakes cause 210,00 deaths of hospital patients each year.
If the findings are accurate, medical errors would rank as the third leading cause of death in the United States, behind heart disease and cancer, according to ProPublica, a respected investigative journalism group. Several recognized patient safety experts who reviewed the new study agreed that the research methods used by James and his findings were credible. James created the advocacy group Patient Safety First in honor of his son, who died in 2002 at age 19 as the result of what he describes as negligent hospital care. The medical malpractice lawyers at Morrow Kidman Tinker Macey-Cushman, PLLC represent victims of medical negligence by doctors, nurses, technicians, and other medical personnel in Seattle and across Washington. Our Seattle personal injury attorneys have years of experience representing families harmed by preventable medical errors.
The gap in life expectancy at birth between white persons and black persons persists but has narrowed since 1990. Between 2000 and 2010, the all-cause age-adjusted death rate decreased 16% among males and 13% among females.
During this 10-year period, age-adjusted death rates among males declined 37% for stroke, 30% for heart disease, 16% for cancer, and 13% for chronic lower respiratory diseases, while the age-adjusted death rate for Alzheimer's disease increased 38%, and the age-adjusted death rate for unintentional injury was stable. Between 2000 and 2010, motor vehicle-related death rates declined among males and females aged 15a€“19 and 20a€“24. Motor vehicle-related deaths are a significant cause of preventable death, accounting for 35,332 deaths in the United States in 2010 across all ages (3).
During 2001a€“2002 through 2011a€“2012, heart disease prevalence remained stable among men and women in most age groups. Heart disease is the leading cause of death in the United States for both males and females, accounting for 307,384 deaths among males and 290,305 deaths among females across all ages in 2010 (Table 22). During 2002 through 2012, the percentage of the noninstitutionalized population with basic actions difficulty and the percentage of the noninstitutionalized population with complex activity limitation increased with age. Basic actions difficulty and complex activity limitation are two constructs for defining and measuring disability status (4). Smoking is associated with an increased risk of heart disease, stroke, lung and other types of cancers, and chronic lung diseases (5). Although control of high blood pressure has improved since 1988a€“1994, nearly one-half of adults with hypertension had uncontrolled high blood pressure in 2009a€“2012.
Hypertension increases the risk for cardiovascular disease, including heart attack and stroke (6). Between 2003a€“2004 and 2011a€“2012, the prevalence of obesity among children aged 2a€“5 decreased, while the prevalence of obesity among older children and adolescents remained stable. Excess body weight in children is associated with excess morbidity in childhood and adulthood (7,8). In 2009a€“2012, the percentage of adults aged 20 and over with Grade 1 obesity was higher for men than women, and the percentage with Grade 2 or Grade 3 obesity was higher for women than men. Reducing the prevalence of obesity is a public health priority because obesity is correlated with excess morbidity and mortality (9a€“12). NOTE: See Table 82 for a definition of the high-risk category for pneumococcal vaccination.
During 2002 through 2012, influenza vaccination in the past 12 months increased among adults under age 65, while remaining stable among those aged 65 and over. Vaccination of persons at risk for complications from influenza and invasive pneumococcal disease is an important public health strategy (14). Early adolescence (ages 11a€“12) is the recommended time for adolescents to catch up on missed childhood vaccinations and to receive three vaccines specifically recommended for thema€”Tetanus and diphtheria toxoids (Tdap), Meningococcal conjugate (MenACWY), and Human papillomavirus (HPV) (16,17). During 2002 through 2012, the percentage of adults aged 18a€“44 and 45a€“64 with private health insurance coverage decreased, while the percentage with Medicaid and the percentage uninsured increased. NOTE: Adults categorized as having Medicaid or private coverage may have additional types of health insurance coverage. Children and adults aged 18a€“64 with Medicaid coverage were more likely to have at least one emergency department visit in the past year, compared with the uninsured and those with private coverage. During 2002 through 2012, the percentage of children under age 18 with at least one emergency department visit in the past year declined for those with private coverage and for children with Medicaid coverage, while remaining stable for uninsured children. NOTE: Persons who reported the emergency department as their usual source of care were classified as not having a usual source of care. Uninsured children under age 18 were more likely than those with Medicaid and private coverage to lack a usual source of care. Children benefit from having a usual source of health care for the provision of preventive services and treatment of acute and chronic conditions (24). During 2002 through 2012, the percentage of adults aged 18a€“64 who delayed or did not receive needed medical care in the past 12 months due to cost increased for those living below 400% of the poverty level; the percentage of adults who did not receive needed dental care due to cost increased for all family income groups. Out-of-pocket spending for personal health care expenditures grew less rapidly than Medicare, federal and state Medicaid, and private insurance spending between 2001 and 2011.
The introduction and widespread use of vaccines in the 20th century contributed to the control of infectious diseases such as measles, polio, and diphtheria, and the discovery of antibiotics led to significant declines in mortality from bacterial infections (28).
With the decline of infectious disease morbidity and mortality in the United States, prescription drug development and investment in the second half of the 20th century focused on chronic diseases such as cancer, heart disease, diabetes, and mental health. Although prescription drugs have been instrumental in improving health outcomes, misuse of some prescription drugs has resulted in serious public health problems. In 2007a€“2010, almost one-half of all Americans reported taking one or more prescription drugs in the past 30 days; use increased with age, from 1 in 4 children to 9 in 10 persons aged 65 and over. Drugs are a frequently used therapy for reducing morbidity and mortality and improving the quality of life of Americans (29,51). In 2007a€“2010, cardiovascular agents (used to treat high blood pressure, heart disease, or kidney disease) and cholesterol-lowering (antihyperlipidemic) drugs were two of the most commonly used classes of prescription drugs among adults aged 18a€“64 and 65 and over. Drugs increasingly play a role in the long-term treatment and control of chronic conditions, including hypertension, high cholesterol, and diabetes, which are major risk factors for heart disease (6,31a€“34). NOTES: Cardiovascular agents include drug classes such as angiotensin-converting enzyme (ACE) inhibitors, beta blockers, calcium channel blockers, and diuretics. In 2007a€“2010, adults taking five or more drugs in the past 30 days were more likely to be aged 65 and over and in fair or poor health than those taking one to four drugs. Drugs offer the opportunity to prevent, treat, and control many acute and chronic conditions. NOTES: Race and Hispanic origin estimates do not sum to 100% because of respondents in other racial and ethnic groups. In 2012, adults aged 18a€“64 who were uninsured for all or part of the past year were more than four times as likely to report not getting needed prescription drugs due to cost as adults who were insured for the whole year. Uninsured adults are more likely to delay or forego needed care, are less likely to receive needed medical care and prescription drugs due to cost, and are less likely to seek preventive care than the insured (20,56). During 2002 through 2012, the percentage of adults aged 18a€“64 who did not get prescription drugs in the past 12 months due to cost was at least four times as high for those who were uninsured for all or part of the past year as for those who were insured for the whole year.
In 2011a€“2012, prescription drug access problems due to cost decreased as family income increased for both the insured and uninsured. The introduction of highly active antiretroviral therapy (HAART) led to substantial declines in mortality from HIV disease, including a 73% decline among non-Hispanic white males and a 54% decline among non-Hispanic black males between 1995 and 1997. Human immunodeficiency virus (HIV) disease, and the related acquired immunodeficiency syndrome (AIDS), emerged as a leading cause of death among adults aged 25a€“44 in the United States in the 1980s (59), and the death rate for HIV disease among this age group increased steadily through the early 1990s (60).
After HAART became the standard of care in 1996, there were marked reductions in morbidity and mortality associated with HIV disease (63a€“67).
Depression is a common and serious illness that takes a toll on functional status, productivity, quality of life, and physical health (35,68a€“70).
In 2007a€“2010, the use of prescription antidepressants was higher among women than among men overall, and for each age group.
NOTE: The 1988a€“1994 estimates for men are considered unreliable because the estimates have relative standard errors of 20%a€“30%. Between 1995a€“1996 and 2009a€“2010, the prescribing of antibiotics during ambulatory care visits for cold symptoms declined 39%. Antibiotics are a mainstay of treating bacterial infections, and the control of infectious diseases using antibiotics is considered one of the major public health achievements of the 20th century (28,46). Throughout the time period, prescribing of antibiotics for ambulatory care visits for the sole diagnosis of cold symptoms was higher for visits by adults aged 18 and over than for children.
EHRs and e-prescription software are thought to improve caregivers' decisions, coordination of care, health care safety, and patients' outcomes, and to make health care delivery systems more efficient (73,74). To promote health care providers' adoption of EHRs, the Health Information Technology for Economic and Clinical Health Act (HITECH) authorized incentive payments through Medicare and Medicaid to providers who implement EHRs with specific elements that are thought to improve processes and outcomes (73,75).
In 2010, about one-half of physician offices and OPDs, 58.1% of EDs, and one-fifth of RCFs reported having a computerized system for ordering prescription drugs.
Opioid analgesics are prescription pain relievers, such as oxycodone and hydrocodone, and they play an important role in the appropriate management of both acute and chronic pain, which are often difficult to treat (76). The growth in spending on prescription drugs was in the double digits from the mid-1990s through the mid-2000s, when it fell below 10% (Table 115). Spending on prescription drugs is projected to grow slowly through 2012 and 2013 (77a€“79).
In 2011, private health insurance, out-of-pocket spending, and Medicare paid for almost 90% of all prescription drug spending.
The current study was designed to review the lawsuits against healthcare professionals by analyzing records of the cases dealt with by the Medico-legal Committees (MLC) in various provinces in Saudi Arabia, in order to determine the pattern of medical errors and litigations in the country. The Canadian Adverse events study: The incidence of adverse events among hospital patients in Canada.
The threats to Australian Patient Safety (TAPS) study incidence of reported errors in general practice. The nature of adverse events in hospitalized patients: Results of the Harvard Medical Practice Study II.
Incidence of adverse events and negligence in hospitalized patients: Results of the Harvard Medical Practice Study I.
Effective intervention and implementations strategies to reduce adverse drug events in the veterans affairs (VA) system.
James, a toxicologist and founder of Patient Safety First, concluded that medical errors cause between 210,000 and 410,000 preventable deaths of hospital patients every year.
He said that this number is a baseline and that the actual number is almost certainly much higher because the records analyzed did not take into account diagnostic errors. Lucian Leape, a physician at Harvard and author of the earlier Institute of Medicine report, who told ProPublica that he had confidence in James’s estimate. Marty Makary, a Johns Hopkins Hospital surgeon who has urged greater transparency in medical care, said the numbers suggest that focusing on eliminating medical errors should be a national priority. The 2010 infant mortality rate of 6.15 per 1,000 live birthsa€”a historically low valuea€”was 11% lower than in 2000.
Among females, age-adjusted death rates declined 35% for stroke, 32% for heart disease, and 12% for cancer while the age adjusted death rates increased 41% for Alzheimer's disease, and 16% for unintentional injuries. Motor vehicle-related death rates were higher for males and females aged 15a€“24 than for most other age groups (Table 33).

Between 2002 and 2012, birth rates declined 39% for teenagers aged 15a€“17 and 29% for women aged 18a€“19 (Table 3).
During 2001a€“2002 through 2011a€“2012, heart disease prevalence remained stable among men and women in all age groups except among women aged 65 and over, where the prevalence declined. Basic actions difficulty captures limitations in movement, emotional, sensory, or cognitive functioning associated with a health problem. Data from the National Health Interview Survey (NHIS) and the Monitoring the Future (MTF) Study. Between 1988a€“1994 and 2009a€“2012, the prevalence of uncontrolled high blood pressure (defined as an average systolic blood pressure of 140 mm Hg or higher, or an average diastolic pressure of 90 mm Hg or higher, among those with hypertension) declined for all age groups of men and women. Obesity among children is defined as a body mass index at or above the sex-and age-specific 95th percentile of the CDC growth charts. In particular, Grade 2 or higher obesity [a body mass index (BMI) of 35 or higher] significantly increases the risk of death (13). The percentage of adults aged 65 and over who had ever received a pneumococcal vaccination increased during this period.
During 2002 through 2012, influenza vaccination in the past 12 months for noninstitutionalized adults increased among those aged 18a€“49 and 50a€“64 but was stable among those aged 65 and over. Data from the National Center for Immunization and Respiratory Diseases, National Immunization Surveya€“Teen.
During 2001a€“2002 through 2011a€“2012, the percentage of children without a usual source of care was stable for uninsured children and for those with private coverage, and decreased for those with Medicaid coverage.
Data from the Centers for Medicare & Medicaid Services, National Health Expenditure Accounts (NHEA). Drugs to treat these chronic conditions were among the most commonly used by adults (Figure 21) (29). These include the growth of third-party insurance coverage over the past few decades, which has made drugs more affordable (37,38).
For example, antibiotics continue to be prescribed to treat viral infections, even though they are ineffective for this purpose.
In 2007a€“2010, 17.7% of adults aged 18a€“64 took at least one cardiovascular agent in the past 30 days (29).
Other commonly used classes for this age group include anti-acid reflux, antidiabetics, anticoagulants, and analgesics. Evidence suggests that underuse of medications due to cost concerns is associated with poorer health and increased use of other health care services (57,58).
Among adults insured for the whole year, those with family income levels below 200% of the poverty level were more likely to report problems getting needed prescription drugs due to cost than those with higher incomes.
During the early years of HIV, there were few treatment options and mortality was high (61,62).
Increased use of antidepressants during this time period was seen for each of the age groups examined: 18a€“44, 45a€“64, and 65 and over. For both men and women, antidepressant use was higher for those aged 45 and over compared with younger adults. But unnecessary antibiotic use can lead to adverse effects and contributes to antibiotic resistance, which may lead to longer hospital stays and unnecessary deaths (45,46,72).
See Appendix I, National Ambulatory Medical Care Survey (NAMCS); National Hospital Ambulatory Medical Care Survey (NHAMCS). Several of these elements relate to prescription drugs, and in 2010, physician offices, OPDs, EDs, and RCFs were surveyed about their EHR systems, including questions about specific elements related to prescription drugs. Poisoning death rates involving opioid analgesics in the past decade increased for both males and females, for all age groups aged 15 and over, and for all racial and Hispanic origin groups examined. Drug poisoning deaths with the drug type unspecified (up to 25% of the total) are not included. Starting in 2014, spending is expected to pick up due to expanded insurance coverage as a result of the Affordable Care Act (ACA) and because fewer drugs are expected to lose patent protection in 2013 compared with 2012 (21,78). A decade earlier, in 2001, private health insurance, out-of-pocket spending, and Medicaid paid the biggest share of all prescription drug spending.
Materials and Methods: A pre-designed data sheet was used to collect data from the records of the Medical Violation Committee (MVC) and the Medical Jurisprudence Committee (MJC). Ferrell International Journal of Health Care Quality Assurance. The number far exceeds the estimate of a widely cited 1999 report by the Institute of Medicine, which concluded that approximately 98,000 people died annually as a result of medical errors.
Medical researchers found serious adverse events in up to a fifth of cases and fatal adverse events in up to 1.4 percent of cases.
Racial disparities in life expectancy at birth persisted for both males and females in 2010 but have narrowed since 1990 (1).
For males and females aged 15a€“19, motor vehicle-related death rates declined 47% from 2000 to 2010.
Birth rates were higher among Hispanic and non-Hispanic black teenagers than among other racial and ethnic groups. In 2011a€“2012, the prevalence of respondent-reported heart disease among adults aged 18a€“54 was similar for men and women; among adults aged 55 and over, the prevalence was higher for men than for women.
Complex activity limitation is the inability to function successfully in certain social roles, such as working, maintaining a household, living independently, or participating in community activities. During 2002 through 2012, the percentage of adults who smoked cigarettes declined for men and women aged 18a€“44 and for women aged 45a€“64, while remaining stable for men aged 45a€“64 and for men and women aged 65 and over. However, nearly one-half (47.4%) of adults aged 20 and over with hypertension continued to have uncontrolled high blood pressure in 2009a€“2012 (Table 65).
Between 1988a€“1994 and 2009a€“2012, the percentage of men and women aged 20 and over who were overweight but not obese (BMI greater than or equal to 25 but less than 30) was stable. Decreases in influenza vaccination coverage in 2005 were related to a vaccine shortage (15).
The HPV vaccination series was recommended for females starting in June 2006 and for males in October 2011 (18,19).
The section of the Patient Protection and Affordable Care Act (ACA) that allows most young adults to remain on their parent's coverage until age 26 came into effect with the policy year that began after September 23, 2010 (21a€“23). During 2002 through 2012, the percentage of adults aged 18a€“64 with at least one emergency department visit was stable for those with Medicaid and for the uninsured. Throughout this period, uninsured children were more likely to lack a usual source of care than those with Medicaid or private coverage. For millions of Americans, prescription drugs have saved lives, prevented or delayed the onset of chronic disease and disability, controlled or cured disease, and provided relief from pain (25).
The widespread use of chemotherapy and other biologics contributed to raising the 5-year, all-sites cancer survival rates to 67% in 2009 (30). In 2006, Medicare Part D was introduced, offering a drug benefit as part of the insurance program relied on by most persons aged 65 and over. This misuse contributes to the development of antibiotic-resistant bacterial infections (45,46). Access problemsa€”those who did not get prescription drugs in the past 12 months due to costa€”are presented by insurance and poverty status. Prescription drug use is related to many factors, including health status, prescription drug coverage, and the availability of drug therapies.
Other commonly used prescription drug classes among this age group were cholesterol-lowering drugs, analgesics, and antidepressants. The use of cholesterol-lowering drugs by this age group has increased more than seven-fold since 1988a€“1994. This is known as polypharmacy, which may increase the likelihood of drug interactions, adverse effects, and dosing and compliance issues.
Among those uninsured for any part of the past year, access problems due to cost declined as family income increased.
The first antiretroviral medication to treat HIV disease was approved in 1987 (62) and was soon followed by the introduction of other antiretroviral drugs.
The decline ranged from 54% for non-Hispanic black males, to 66% for Hispanic males, to 73% for non-Hispanic white males and Asian or Pacific Islander males (see data table for Figure 24). The increased use of prescription antidepressants may be the result of several factors, including the introduction of a new class of drugs known as selective serotonin reuptake inhibitors (SSRIs) in 1988, improved public attitudes about seeking care for mental health issues, increased direct-to-consumer marketing of antidepressants, and expanded recommendations for the use of antidepressants for conditions other than depression (71). Of particular concern is the prescribing of antibiotics for colds and viral respiratory infections, because antibiotics are ineffective in treating these conditions (72). Misuse of opioid analgesics is increasingly seen as a significant public health concern because poisoning death rates involving opioid analgesics more than tripled between 2000 and 2010 (Table 32 ) (47,49,50). This recent slowdown is the result of a variety of factors, including cost control efforts introduced by insurers, such as copays, formularies, tiered pricing, generic substitution, and the use of mail order pharmacies. The shift in spending from Medicaid to Medicare between 2001 and 2011 is largely the result of the introduction of Medicare Part D in 2006 (39,80). The data sheets consisted of information on details of the cases, details on where the error had occurred, and details of the errors.
Motor vehicle-related death rates declined 31% for males aged 20a€“24 and 26% for females in the same age group during this 10-year period. Since 2002, birth rates have decreased 48% for Hispanic teenagers aged 15a€“17 and 46% for non-Hispanic black teenagers in the same age group.
The prevalence of obesity among children aged 6a€“11 and adolescents aged 12a€“19 was stable between 2003a€“2004 and 2011a€“2012. During this period, the percentage of adults aged 20 and over with Grade 1 obesity (BMI greater than or equal to 30 but less than 35), Grade 2 obesity (BMI greater than or equal to 35 but less than 40), and Grade 3 obesity (BMI of 40 or higher) increased among both men and women. During 2002 through 2012, the percentage of noninstitutionalized adults who had ever received pneumococcal vaccination was stable among high-risk persons aged 18a€“64, and increased among those aged 65a€“74 and 75 and over. For adults with private coverage, the percentage with an emergency department visit declined during 2002 through 2012. Drug research has also led to better treatment and control of the risk factors for heart disease, such as hypertension, high cholesterol, and diabetes (6,31a€“34). Discounts and other savings under the Affordable Care Act have already helped more than 6 million Medicare Part D enrollees save over $6 billion on prescription drugs since its introduction in 2010 (39).
Educational outreach to physicians and patients has helped decrease the use of antibiotics for colds and other viral conditions (Figure 26). For many conditions, such as high cholesterol, high blood pressure, diabetes, and asthma, emphasis on treatment with evidence-based medications has increased (6,32a€“34,37,38).
The use of cholesterol-lowering drugs among those aged 18a€“64 has increased more than six-fold since 1988a€“1994, due in part to the introduction and acceptance of statin drugs to lower cholesterol.
In some cases, multiple physicians may be prescribing for the patient and be unaware of all drugs the patient is taking. The health of individuals living with HIV improved when clinicians began to treat individuals with combinations of multiple antiretroviral drugs that act at different stages of the HIV disease cycle (63)a€”regimens known as HAART. Declines in HIV death rates also were seen for females in each of the racial and ethnic groups examined.
In addition to depression, antidepressants are used to treat obsessive-compulsive disorder, panic disorder, anxiety disorders, and perimenopausal and menopausal symptoms (71). In addition, several popular drugs ended their patent protection during this time frame (43,44). Dual eligibles (people with both Medicare and Medicaid) who enrolled in a Medicare Part D plan had much of their drug spending paid for in 2011 by Medicare instead of Medicaid.
Results: The review of records revealed 642 cases, most of which were from hospitals run by the Ministry of Health (MOH).

Also during this period, birth rates for those aged 18a€“19 decreased 39% for Hispanic teenagers and 32% for non-Hispanic black teenagers. Among males, 6.8% of those aged 13a€“17 had completed the HPV series in 2012a€”the first year following the recommendation for males.
With the adoption of antiretroviral therapies, the death rate from human immunodeficiency virus (HIV) disease has decreased almost 80% since 1996 (Table 31 and Figure 24).
The percentage of Americans with poor control of blood pressure, cholesterol, and diabetes is down since 1988a€“1994 (Tables 46, 65, and 66). Another factor increasing the demand for drugs is more drug marketing to physicians and consumers since companies began promoting their prescription drug products directly to consumers by means of direct-to-consumer advertising in the 1980s. In response, many insurers instituted cost control efforts, including copays, cost-sharing, formularies, tiered pricing, and mail order pharmacies (43).
Opioid analgesic pain relievers play an important role in appropriate pain management, but their misuse is a growing public health problem (47). Polypharmacy is important because patients taking multiple drugs are more likely to confuse medication, dose, and timing (52,53).
After 1997, the rate of decline for HIV mortality slowed across all groups, although gender and racial and ethnic differences in HIV mortality persist. In 2010, Hispanic males and females had longer life expectancy at birth than non-Hispanic white or non-Hispanic black males and females.
Prescription drugs are an important component in the treatment of mental health disorders and have helped many patients avoid hospitalization (35,36).
Although the vast majority of promotional spending for all drugs is targeted toward physicians, spending on direct-to-consumer advertising for all drugs more than tripled between 1996 and 2005, to $4.2 billion (40a€“42). These efforts, along with other factors including the ending of patent protection for a number of popular drugs, has led to slower growth in prescription drug spending in recent years (44). Opioid analgesic consumption increased 300% between 1999 and 2010 (48), and death rates for poisoning involving opioid analgesics more than tripled between 2000 and 2010 (Table 32 and Figure 28) (49,50). Polypharmacy is of particular concern for the elderly, who may be more at risk for significant side effects with some commonly prescribed medicines (54).
Americans' use of prescription drugs has grown over the past half-century due to many factors, including the development of new and innovative drug therapies to treat infectious and chronic conditions, the expansion of prescription drug coverage by public and private payers, and the growth of marketing by pharmaceutical companies (25a€“27). About 85% of people who received treatment for mental health conditions in 2009 received prescription drugs. This group of charts provides an overview of the role of prescriptions drugs in the United States. In 2007a€“2010, 13.9% of Americans aged 18 and over took five or more prescription drugs in the past 30 days (Figure 20) (55). Most of the deaths occurred in surgery and obstetrics (about 25% for each), followed by other medical specialties (17%).
About half of the lawsuit cases studied (46.5%) involved patients belonging to a relatively young age group (20-50 years). Conclusion: Most of the medical error litigations involved surgeons and obstetricians especially in MOH hospitals. The process of litigations and documentation need to be improved, and access to the records for research and education need to be made easier.
Though Samarkandi studied individual malpractice claims of the MLC, his study was restricted to anesthesia. The main responsibility of the committee is to interview both the plaintiff and the defendant and to scrutinize the medical records to find out if there was an error.
The committee then sends a written report and recommendations to the person authorizing the investigation, if there was an error. If the committee thinks that there was no error, they discuss their findings with the plaintiff. These committees are supposed to investigate any malpractice suits and violations of the regulations. They also have to verify medical errors and send all documents to the Medical Jurisprudence Committee (MJC) if any errors are found. The committee headed by a judge, includes three physicians (medical teaching staff from a medical school and two physicians from the Ministry of Health, MOH), as well as a legal expert.
In the case of a malpractice suit against a pharmacists, the committee also has two pharmacists, one of whom is a member of the teaching staff of a pharmacy college and the other a pharmacist nominated by the Minister of Health. The committee is allowed to consult any expert in the field or specialty related to the case under scrutiny.
The committee looks into all cases in which there is a claim for compensation (indemnity) because of death (blood money or Diah) or loss of an organ (indemnity). The decision of this committee is independent, final, and can only be appealed through the Council of Governance within 60 days of its issue.The MVC and the MJC are two distinct committees with different jurisdictions. However, in the case of death or loss of an organ or its functions, the MVC refers the case to the MJC.
A pre-designed, pre-coded, and tested data sheet was used by research assistants trained by the investigators to collect and record data from the records of the MVC and MJC. The data collectors were individuals working with the said committees, either as undersecretaries or coordinators.
The data sheets consisted of information on demographic and clinical details of the case, who the plaintiffs and the defendants were, details of where the error had taken place, where the lawsuit was filed, and details of the error itself.
Chi-square test was used for comparisons and correlation and P value of 0.05 or less was considered significant. In the majority of these (56%), no error was identified and very few complaints were lodged in the office of the Deputy Minister of Health (0.8%). First, access to the records of the various committees was difficult and was only possible on the order of his Excellency the Ex-Minister of Health. The possible reasons for these reservations are the ever increasing media focus interest on medical errors and the prevailing blame culture, which certainly makes people hesitant to discuss them.
The discrepancy in the total number of cases registered yearly between our study and other studies, [28] can only be explained by the lack of accurate documentation. In addition, one of the regions did not submit any documentation of their cases.The process of litigation against healthcare professionals in Saudi Arabia is unique. While it is easy for patients and or patient's relatives to file their complaint at any administrative level in the health care hierarchy, resolution may take several months and sometimes years, especially if there is a request for compensation.This bureaucratic system affects not only the patients and patient's relatives, but also the healthcare professional, for whom the long wait for a verdict can be most agonizing. An increase in number of the committees may hasten the litigation process.Lack of good documentation was an obvious problem in all MLC.
Extending this process to the other committees will probably improve the collection of information.It is clear that one of the main reasons for complaints related to administrative action, indicating that patients and relatives were dissatisfied with the quality of care provided to them. Their main reason for filing these cases was to have the healthcare professional warned for the misconduct or error. Patients and their relatives have the right to know all details of the disease, the intervention, and the possible complications of both.One-fifth of the reasons for filing the complaints was to demand compensations. The MJC is a Judicial Committee responsible for determining the amount of compensation to be paid based on Islamic Shariah Law. The fact that more suits were filed against the private sector for compensations may reflect the lack of satisfaction with healthcare paid for by patients or relatives. This makes the private sector very vulnerable.In about half of the litigations, no errors were found by either the MCV and or the MJC. This may indicate that the local media has made the public overly sensitive to medical errors.
This situation tends to lead to a misunderstanding and misinterpretation of the medical and surgical complications as medical errors. More collaborative work between healthcare professionals and healthcare authorities and the media is required to help improve journalists' knowledge, promote an understanding, and resolve the differences in attitudes in order to regenerate confidence in healthcare professionals in the Kingdom. However, the 50% rate of errors found in the cases investigated demands that all possible means should be used to address the issue.More lawsuits were filed for permanent disability than any others. A patient's death is tragic, especially if it was unexpected or unforeseen as a possible outcome of the medical or surgical intervention, thus triggering a complaint of a medical error. Similarly, living with a permanent disability as a result of a medical intervention is tragic and difficult to accept and naturally impels the patient and or the family to complain.The main two specialties that were most liable to litigation in this study were surgery including various sub-specialties (25%) and obstetrics and gynecology (22%), and they also contributed to more deaths and delays in cure.
This may have resulted from the high rate of interventional procedures and the need for prompt and immediate decision and actions in these specialties.
This is a finding in accord with the results of previous studies in the Kingdom, [27],[28] and elsewhere.
Any shortcomings in any of these competencies may result in adverse consequences and errors.
What is urgently required is an improvement of the organizational structure and systems to help minimize errors in these specialties. This finding may not reflect the true picture since the exact figures for all the clinical activities and procedures in these hospitals were not available.
Unfortunately, some of these hospitals, especially in remote areas, are more prone to errors because of the lack of technical facilities and appropriate training and surgical expertise.
This can only be remedied with a better understanding of errors, how they occur, and the appropriate interventions to prevent them. Some authors have advocated a system of training that includes monitoring and counseling, surgical courses, and simulations on animal tissue and cadaveric tissue to improve surgical skills [19] and prevent errors. The new regulation in the Kingdom regarding standardization and accreditation of hospitals by a central body could perhaps improve the situation and help hospitals and healthcare authorities' to contend with the rising rate of medical errors.Patient's relatives, especially the next of kin, initiate most of the complaints.
This is not surprising since the Saudi community is family oriented, the family's contribution to patient's care is enormous, and the interest generated by the result of healthcare is equally great. Moreover, there is the added weight of the responsibility on the shoulders of the patient's guardian or next of kin.The Director Generals of Health Affairs in the different regions receive most of the complaints. The Minister of Health plays a major role here by bearing the responsibility of processing the complaint.What is surprising is that the Deputy Minister of Health received the least number of complaints. It is possible that most of the public are unaware that complaints may be lodged at this level.It seems that the public should be made aware that complaints may be filed at this level, rather than at the higher levels. This study found that about two-thirds of the complaints filed at the office of the Minister of Health, and more than half of those lodged at the Royal Cabinets revealed no errors.
To save the time of the high official, we believe that complaints should be filed at a lower level in the hierarchy, unless it is absolutely necessary.Doctors involved in medical errors, in which blood money or compensation was demanded, have to pay from their own resources, which places a great burden on them. Recently, the Saudi government made it compulsory that all doctors should be insured against medical errors, even if they are not practicing. This hopefully will ease the burden on doctors and other healthcare professionals.In conclusion, this study explored the pattern of medical errors and litigations in Saudi Arabia based on the records of the MLG. Surgeons and obstetricians, especially in MOH hospitals, were involved in most of the medical errors and litigations.The process of litigations and documentation need to be improved and access to the records for research and education should be made easier. It is hoped that this study would stimulate other prospective studies on the prevalence of medical errors in Saudi Arabia-the reasons behind discontent and the rising rate of litigations.
Hamad Al-Manea, Ex-minister of Health, for his permission to access the data, and the Ministry of Health in Saudi Arabia for financial support for the study.

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