x Abu Dhabi, UAEWednesday 24 January 2018

Karabus case puts UAE medical liability law in focus

The Karabus proceedings expose grey areas in the present legislation and highlight some doctors' fears about being sued by patients.

ABU DHABI // The case of Cyril Karabus has underscored the confusion surrounding the medical liability laws in Dubai and Abu Dhabi, and the bodies that oversee them, a decade afterSara Al Ajaily died.

Many medical professionals believe the 2008 federal law, as it stands, doesn't favour them if it comes to a dispute with a patient, and often their licence to practise is in the balance.

Health officials say they are aware of the law's problems, and discussions were held last summer between Dubai Health Authority (DHA) and the Executive Committee with a view to amending parts of the legislation.

There is also confusion as a result of the different health authorities and their jurisdictions.

Part of the problem is due to the country's bid to emulate US standards without considering the need to adapt them to local dynamics.

"Their system is very advanced and the society is very educated," said one doctor who practises at a private hospital in Abu Dhabi. "Here, they have implemented all the rules and regulations without thinking of social changes. That is creating a lot of problems, especially for surgeons."

At the private hospital where the doctor works, doctor-patient relationships have crumbled as a result, he added. One recent case is emblematic of this.

"A few months ago, one lady came and told me that she wanted a gastric band," he said.

With a Body Mass Index of 34, the woman was told she did not meet the criteria to have the operation.

"After persuasion, I told her we can do some alternate procedure, like a gastric balloon. I was explaining to her what complications can happen, so she's telling me 'if a complication happens, I'll sue you'. The relationship goes down immediately."

"People are thinking that it's a five-star hotel and they all have the right to complain," he said of the hospital. "They are not even thinking before threatening a doctor. I can say, in a nutshell, they are misusing the right to complain. People need to be educated not to misuse their right."

Another issue with the current legislation is that different health authorities across the Emirates deal with cases of medical negligence differently, said Dr Rolf Hartung, associate professor of surgery at Dubai Medical College and a consultant and head of general surgery for DHA.

The overriding fear among healthcare workers is the impact a case of medical negligence could have on their licence, he said. An investigation could result in passports being taken, pending findings. And doctors might shy away from reporting incidents fearing prosecution.

Medical professionals should feel able to report incidents - regardless of their severity - without fear of retribution, said Al Anoud Salman, a medical laboratory technologist and quality coordinator at Dubai's Al Baraha Hospital.

"People don't feel free to report such incidents because they are scared. From a quality perspective, the most important thing for us is to grab these malpractices and to find the gap. One of the ways to encourage people to report is not to give names," she said.

The Health Authority - Abu Dhabi is on the right path by allowing people to report anonymously, said Ms Salman.

However, instead of blaming the system for everything, doctors and other healthcare workers must also be aware of the law, said Dr Khaldoon Nabhan, who works for the legal affairs department at DHA.

"A basic knowledge of law is required to avoid pitfalls, and it safeguards errors arising as a result of ignorance," he said.

Dr Nabhan added: "We are reviewing this law and we are very proud to have such a law in the UAE, the medical liability law. It's not a perfect law but we are working to make it one of the state-of-the-art medical liability laws in the region."

Stephen Ballantine, a medical malpractice lawyer with Galadari Advocates and Legal Consultants, in Dubai, said the law may not need updating as it is only a few years old, but he said local health authorities across the country must push for better reporting of unintended, so-called sentinel events that occur in a hospital setting.

Hospitals, clinics and doctors should all be obliged to report instances of malpractice, he said.