Medical Negligence in Egypt: Causes, Consequences, and Calls for Accountability

Like other people, Muhammad Kamal used to read from time to time about an accident that claimed the life of a citizen or left him disabled as a result of medical negligence in a hospital, but the young man who had recently completed his university studies and was preparing to start his working life did not know that he would also be exposed to medical negligence that eventually caused amputation. One of his fingers after he had an accident, the consequences of which could have been remedied had it not been for the negligence of the attending physician in a hospital in the city of Assiut (380 km south of Cairo).

Finally, the death of the former Egyptian Minister of Health, Ahmed Emad El-Din, after he underwent heart surgery during the current month, renewed the talk about medical errors, their causes, and who bears their consequences, while official statistics on the rates of medical error incidents in Egypt are completely absent, although some officials attributed their occurrence to a lack of capabilities and a decline Training levels for new doctors.

Major cause of death

Medical errors are the third leading cause of death in the United States after cardiovascular disease and cancer, claiming about 250,000 lives annually, according to calculations by researchers Martin McCurry and Michael Daniel of the Johns Hopkins University School of Medicine, who prepared their study of deaths that occurred in Hospitals only, while it is estimated that 400,000 people die annually due to medical errors.

Absence of training

A member of the Council of the General Syndicate of Egyptian Doctors, Rania El-Essawy, says that the Medical Syndicate immediately investigates complaints of medical negligence that it receives from the patient, his family, or the concerned authorities, so that the complaint is submitted to the investigation committee to discuss the incident, which is a committee that includes a number of judges, and in the event that medical negligence is proven. The doctor is referred to the Disciplinary Committee, which assesses the punishment commensurate with the extent of the damage and is imposed on the doctor. These penalties range from “drawing attention” to “suspension from work or removal” from the lists of the Medical Association. The removal is in the event that he commits a serious mistake or because he is unqualified. To treat or perform surgeries for patients.

Al-Essawy explained to “Independent Arabia” that the recurrence of medical errors is due to the lack of training for doctors and working conditions, including the lack of doctors and the lack of capabilities and tools that enable the doctor to carry out his duty to the fullest, pointing out that medical error is a major cause of death in the United States of America after deaths Chronic diseases such as diabetes, heart disease, and tumors confirm that the phenomenon is not only Egyptian.

Regarding the efforts of the General Syndicate of Physicians to protect its members in cases of medical error, a member of the Council of the Syndicate revealed the submission of a draft law known as the “Medical Liability Regulation Law” that includes a proposal to issue insurance policies for doctors against medical errors that patients are exposed to, so that the patient is compensated directly through Insurance companies after investigations are completed and an error has been proven by the attending physician, and the syndicate is the only body entrusted with the investigation of these incidents.

Rania Al-Essawy indicated that there are rates of medical error that are acceptable to occur in the health sector globally, but they differ according to the type of surgery and the pathological condition. And the gross negligence that requires the doctor to be held accountable.

More than 400 complaints annually

In April 2014, Dr. Khaled Samir, then head of the Investigation Committee of the Medical Syndicate, said that the Professional Ethics Committee investigates all complaints it receives from patients, doctors, and legal persons, indicating that the number of complaints reached 413 complaints during the year 2013.

Samir attributed the high rate of medical errors to the absence of quality medical education in Egypt, especially with the presence of private universities that attract students who pay huge sums of money to obtain the certificate, pointing out that some of these colleges believe that the ease of exams is part of the factors that attract students, while some medical colleges adopt The government is quite the opposite, offering the most difficult exams.

In October 2014, the Egyptian Medical Syndicate appealed to the families whose families were subjected to cases of medical negligence to submit complaints to the Syndicate to refer the accused to investigation.

And in September (September) 2019, the Director-General of the World Health Organization, Tedros Adhanom Ghebreyesus, said that millions of people around the world are harmed due to incorrect treatment, adding, “Every minute, five people die due to an error in treatment, which is a number that exceeds the deaths of suicides, wars, or fatal diseases.” .

dangerous specialties

A member of the Council of the General Syndicate of Physicians, Rania El-Essawy, identified the departments of anesthesiology, heart and chest surgeries, and intensive care as the most vulnerable to medical errors, which prompts doctors to refrain from these specialties worldwide due to the problems they suffer from and accusing them of negligence in the event of the death of the patient.

She pointed out that emergency operations allow for higher death rates than the operations that the patient undergoes at a predetermined date, as in emergency cases the rates of saving the patient’s life are 50 percent due to his need for sudden surgical intervention.

The rate of doctors in Egypt is 8.6 doctors per 10,000 citizens, less than one doctor per 500 citizens, while the global average of doctors is about 23 doctors per 10,000 citizens, which indicates a large deficit in the number of doctors in Egypt.

The rate of human error tables in a census of the World Health Organization showed that 10 percent of patients are affected by medical errors, and the organization indicated that the world witnesses 43 million medical errors annually.

In April 2022, a court in the Red Sea Governorate (452 ​​km north of Cairo) punished two nurses for a month on charges of medical negligence in a communication submitted by the artist, Menna Shalaby, accusing them of medical negligence while caring for her mother.

medical malpractice penalty

For his part, Egyptian lawyer Mohamed Ragab says that a medical error is criminalized by a general text, indicating that a medical error is a transgressive act on the part of the doctor. Commitment to the doctor’s instructions, which is decided by forensic medicine, which determines the pathological condition and the method that should have been followed to treat it, and then proves whether or not an error occurred.

And he explained in special statements that there are three pillars that must be met in order for the medical error to occur, which is the occurrence of an actual error, and this is not proven except with the issuance of a final criminal judgment in the incident, the second pillar is the actual occurrence of damage, and the last pillar is the causal relationship that the doctor’s behavior is the cause of this harm.

In October 2014, the Egyptian Medical Syndicate appealed to the families whose relatives were subjected to cases of medical negligence to file complaints in order to refer the accused to investigation (AFP)

Ragab emphasized that the doctor’s deviation from scientific principles in treating the patient, whether through negligence or non-compliance with the laws, is dealt with in Article 244 of the Egyptian Penal Code, which stipulates that “whoever accidentally causes injury or harm to a person, if that was a result of his negligence, recklessness, lack of precaution, or lack of care.” Observing laws and regulations, he shall be punished with imprisonment for a period not exceeding one year and a fine not exceeding two hundred pounds, or one of these two penalties.

And he continued, “In the event that the injury resulted in a permanent disability, or if it was proven that the injury occurred due to the doctor’s serious breach of what is imposed on him by the origins of his job or profession, or if he failed at the time of the accident to help the person on whom the crime was committed, or to seek help for him even though he was able to do so, then the penalty shall be Imprisonment for a period not exceeding two years and a fine not exceeding three hundred pounds, or one of these two penalties.

Ragab indicated that if more than three persons were injured as a result of medical negligence, the penalty shall be imprisonment for a period of no less than one year and no more than five years.

For his part, Abu Bakr Al-Qadi, the treasurer of the Federation of Medical Professions Syndicates, says that the numbers of graduates of medical schools are sufficient to cover the needs of the state, stressing the need to conduct a study to find out Egypt’s actual needs in the future in every specialization of the human medicine profession.

He explained in previous press statements that the number of doctors registered in the records of the General Medical Syndicate is about 380,000 doctors, of whom only 125,000 work in the government, while most of them work abroad due to the low financial compensation in Egypt.

Financial allocations

The data of the Ministry of Finance showed an increase in government spending allocations for the health sector in the new general budget 2023/2024 by 30.4 percent, to reach about 397 billion pounds, compared to 304.5 billion pounds during the fiscal year 2022/2023, which contributes to improving the quality of health services provided to citizens.

In June 2020, the Plan and Budget Committee in the Egyptian Parliament recommended improving the health service, the necessity of reviewing salaries and training, and conducting a comprehensive, integrated, and not temporary review of the wages and allowances received by workers in the health sector in Egypt.

The committee also recommended the development and introduction of the means and methods necessary for the production of pharmaceutical preparations and the increase of funds allocated to the Egyptian Medicines Authority to enable it to play its role.

Exodus of doctors

The emigration of doctors to work outside Egypt is one of the most prominent manifestations of the weakness of the health system, which was evident during the crisis of the spread of the new Corona virus, as the Egyptian Minister of Health, Khaled Abdel Ghaffar, decided to form a committee headed by him to study improving the conditions of doctors, stopping their emigration abroad, and quickly issuing a medical liability law.

The year 2022 witnessed the highest rate of resignations of male and female doctors, with a total of 4,261 doctors, at a rate of 12 male and female doctors per day, according to data from the Doctors Syndicate, which confirmed that the number increases annually, as it quadrupled from 1,044 resignations in 2016 to 4,127 resignations in 2021.

The income of Egyptian doctors is the lowest among a large number of countries in the world, as the average doctor’s income reaches $170 per month, which may be equivalent to only one hour’s wages in other countries, in addition to the lack of financial incentives that take into account the doctors’ expertise and scientific contributions from research and studies that doctors bear. Alone, despite its high cost.

Victims of medical error

In January 2007, the Egyptian artist, Souad Nasr, died as a result of a mistake by the anesthesiologist while she was undergoing liposuction, but she died after a wrong injection, and the court punished the doctor with a one-year suspended sentence.

In December 2016, the artist, Ahmed Ratib, died due to a wrong prescription from the attending physician, as he was suffering from water on the lung, and he was given medications that caused his regularity in taking them to cause death.

Marina Salah is another victim of a medical error. In May 2022, she went to perform an x-ray on the eye, but the hospital did not subject her to the necessary examinations before starting x-rays that would detect sensitivity in the eye towards this type of radiation, which resulted in her death instantly. .

Medical liability law

The “Medical Responsibility Regulation Law” draft that has been circulating in the corridors of the Egyptian parliament for years is a serious step to reduce the consequences of medical error incidents in treatment institutions. Five draft laws were submitted in this regard with the aim of regulating medical liability in Egypt.

He pointed out that the aim of the law is to protect the patient’s right to obtain treatment and compensation in the event of a medical error, as well as to protect the doctor who provides the health service by being scientifically qualified and working through a place licensed to provide medical services, pointing out that surgery departments in general are the most vulnerable. medical error problems.

The draft medical liability law includes several points, the most prominent of which is the abolition of the prison sentence for medical harm, which is something that the General Syndicate of Doctors adheres to, as well as the approval of financial compensation according to the percentage of damage if this error is from the doctor and the medical facility and is not medically recognized complications, or because the patient did not follow instructions. Doctor and to be through a committee formed for this purpose.

The Egyptian Medical Syndicate has announced several times its rejection of pretrial detention for its members in relation to medical error cases, explaining that medical service providers may not be arrested or precautionary in cases related to actions attributed to them during or on the occasion of performing their work, unless the Medical Liability Reporting Authority acknowledges the existence of Suspicion of criminal liability necessitates this, provided that penalties in these cases are limited to civil compensation and not imprisonment.

The syndicate also proposed the establishment of a fund for compensation for medical damage, the resources of which would be deductions from service providers and medical facilities as part of a compulsory medical malpractice insurance policy.