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Investigation of Medical Complaint Dr. Layla Al Marzouqi Head of Clinical Governance Health Regulation Department (HRD). Medical Complaint. Expressions of dissatisfaction or concerns about a health care service made by consumers.

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Investigation of Medical Complaint Dr. Layla Al MarzouqiHead of Clinical Governance

Health Regulation Department (HRD)

medical complaint
Medical Complaint
  • Expressions of dissatisfaction or concerns about a health care service made by consumers.
  • All complaints & concerns are included, whether they are formal written complaints, a concern expressed during discussions with a health care professional, or views expressed as part of a consumer feedback survey.
institute of medicine in us
Institute of Medicine in US

preventable medical errors kill 98,000 /year

100,0000 excess injure preventable medical errors : sixth leading cause of death in America

Aggressive case finding may identify injuries and errors that are not documented in a patient's chart

bureau of justice statistics
Bureau of Justice Statistics

25% of all the doctors in USA get sued / annual

50 & 65% all doctors in USA sued at least once in their career

½ adverse events occurring inpatients resulted from surgery.

Complications from drug treatment, therapeutic mishaps, and diagnostic errors were the most common non-operative events.


Despite shocking number of medical errors

  • few injured patients ever file a medical negligence lawsuit
  • fewer file frivolous claims

epidemic of medical malpractice, not of malpractice lawsuits

risk factors for error
Risk factors for error
  • Healthcare Complexity
  • Complicated technologies, powerful drugs
  • Intensive care
  • prolonged hospital stay adverse event increased by 6% /day in hospital
  • emergency department
        • part time doctors not trained in emergency care;
        • fluctuating demand for services, which results in uneven and sometimes abbreviated care;
        • limited time available to arrive at a definitive diagnosis;
        • emergency department is the point of entry for acutely ill patients
risk factors for error1
Risk factors for error
  • System and Process Design

Problem in medical errors is not bad people in health care—it is that good people are working in bad systems that need to be made safer

  • Poor communication/documentation
  • Disconnected reporting systems within a hospital: fragmented systems in which numerous hand-offs of patients results in lack of coordination and errors
  • Cost-cutting measures/staff shortage
risk factors for error2
Risk factors for error

JCIA report :

  • root cause >1/2 the serious adverse events in accredited hospitals was poor communication
  • Other leading causes :
      • inadequate assessment of the patient's condition
      • poor leadership or training
risk factors for error3
Risk factors for error
  • Competency, Education, and Training

Variations in healthcare provider training & experience

  • Failure to acknowledge the prevalence and seriousness of medical errors
  • July effect
risk factors for error4
Risk factors for error

Human Factors

Sleep deprivation

  • Fatigue
  • Depression and burnout
  • Diverse patients
      • Age -64
      • patient's underlying illnesses
  • Unfamiliar settings
  • time pressures
  • Complications increase as patient to nurse staffing ratio increases
preventing medical errors will
Preventing medical errors will

lower health care costs

reduce doctors’ insurance premiums

protect the health and well-being of patients & reduce hospital stay


How to conduct

an investigation


To protect public health & safety by resolving investigation and prosecuting complaints about health care.

types of complaint
Types of complaint
  • Health complaints
  • Non health complaints
    • Insurance
    • Criminal
    • Financial
    • Behavior
severity of complaints
Severity of complaints

Minor complaints

Complaints that can be resolved based on the assessment findings

Example: Patients with no injury or increased length of stay

severity of complaints1
Severity of complaints

Moderate complaints

Complaints require only assessment & might need to be investigated based on assessment findings.

Example: Increased length of stay as a result of incident, Surgical intervention required as a result of an incident.

severity of complaints2
Severity of complaints

Major complaints

Complaints that need to be investigated immediately by an investigation committee without assessment.

Example: Procedure involving wrong patient or body, part, Medication error leading to death.


Major Complaint

clinical governance office
Clinical Governance Office

Decision to investigate

Select investigation committee member ( private/public)

Facilitate their work

Conclude any member

Review investigation report

investigation committee
Investigation committee

Each case will consists of following committee members from the same speciality of the case:

  • One Chairperson
  • At least 2 Health Professionals registered and licensed
  • Legal representative will be consulted upon need

Decide on the meeting and send invitation

Lead the meeting / Distribute the role

Prepare investigation report

Sign all document

Interview is singed by doctors & complainant

Available to discuss/clarify out


chair person member
Chair Person/Member

Sign conflict of interest and confidentiality form

Review files

Attend all meetings

Respect/ introduction ( name. complaint)

Conduct Interviews- venue, time, date , attendee

Investigate medical aspect

No result to be given to complainant

Not interfere with each other decision

Ask question equally

Disclosure to third party

chair person member1
Chair Person/Member

Consult other specialty

If compliant or healthcare professionals is not contactable

Malpractice definition-law

Reasons for decision

Mobiles not allowed

Recorder use


Sign the report

old definition
Old definition


  • Failure to act with prudence a reasonable person with similar training & experience would exercise under same circumstances.
  • Includes medical error in diagnosis, treatment or illness management


  • When negligence act or omission by a doctor or other medical professional results in damage or harm to a patient.
  • Act or omission by a healthcare provider which deviates from accepted standards of practice & causes injury to the patient
new definition malpractice
New DefinitionMalpractice


Is an error occurs due to

Unfamiliarity of the practitioner with technical aspects which each practitioner assumed to be familiar with


Paying insufficient efforts

not malpractice
Not Malpractice

The following shall not be considered medical liability, if:

damage was sustained due to the action of the patient

physician followed certain medical method in treatment

medical side effect & complications know in medical practice


Appeal occurs when the complainant or treating doctor is not satisfied with the outcome of the complaint

Appeals will be forwarded to higher authority for further action

Appeal decision not the disciplinary action

criteria appeal
Criteria Appeal

Appeal should fulfill the following conditions;

Whiting 15 days of receiving the final result of the investigation

New evidence


appoints appeal committee members-three members at least

Reject the appeal

criteria appeal1
Criteria Appeal

Decisions shall be final

One appeal per case

writing an appeal
Writing an appeal

Be professional

More evidence

Disciplinary action implemented after 15 days

How effective ?

Rejected / submission of the license/ assessment

Assessment panel

Decision of assessment panel ( same post/ privilege/ downgrade/ under supervision)

Return the license

applying for reassessment
Applying for reassessment


Assessment icon

Schedule assessment date

On line assessment ( 10 specialties) /interview


contact us
Contact Us

Business village Building B third floor Office number 333-335