JOINT PROGRAM B/N UNIVERSITY OF GONDER AND AMANUEL MENTAL

SPECIALIZED HOSPITAL

GROUP ASSIGNMENT

Medical Malpractice in Ward 9

GROUP MEMBERS
NEBIYU MENGISTU

SEID SHUMYE

SINTAYEHU ASNAKEW

SOLOMON ESHETE

TADESSE MISGANA

Submitted to:

Zegeye Yohannis (MSc, PhD Fellow, AAU)

July, 2017

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Outline

1. Introduction

2. Objective

3. Data gathering procedures

4. Results

5. Conclusion

6. Recommendation

7. Limitation of the assessment

8. Referance

Introduction
Medical Malpractice
Medical malpractice is a tort, or civil wrong. It is a wrong resulting from a physician's negligence.
Simply put, negligence means doing something that a physician with a duty to care for the patient should
not have done or failing to do something that should have been done as defined by current medical
practice. Usually, the standard of care in malpractice cases is established by expert witnesses. The
standard of care is also determined by reference to journal articles, professional textbooks, such as the
Comprehensive Textbook of Psychiatry, professional practice guidelines, and ethical practices
promulgated by professional organizations.
To prove malpractice, the plaintiff (e.g., patient, family, or estate) must establish by a preponderance of
evidence that (1) a doctor patient relationship existed that created a duty of care, (2) a deviation from the
standard of care occurred, (3) the patient was damaged, and (4) the deviation directly caused the damage.
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These elements of a malpractice claim are sometimes referred to as the 4 Ds (duty, deviation, damage,
direct causation). Each of the four elements of a malpractice claim must be present or there can be no
finding of liability. For example, a psychiatrist whose negligence is the direct cause of harm to an
individual (physical, psychological, or both) is not liable for malpractice if no doctor patient relationship
existed to create a duty of care. Psychiatrists are not likely to be sued successfully if they give advice on a
radio program that is harmful to a caller, particularly if a caveat was given to the caller that no doctor
patient relationship was being created. No malpractice claim will be sustained against a psychiatrist if a
patient's worsening condition is unrelated to negligent care. Not every bad outcome is the result of
negligence. Psychiatrists cannot guarantee correct diagnoses and treatments. When the psychiatrist
provides due care, mistakes may be made without necessarily incurring liability. Most psychiatric cases
are complicated. Psychiatrists make judgment calls when selecting a particular treatment course among
the many options that may exist. In hindsight, the decision may prove wrong, but not be a deviation in the
standard of care.
In addition to negligence suits, psychiatrists can be sued for the intentional torts of assault, battery, false
imprisonment, defamation, fraud or misrepresentation, invasion of privacy, and intentional infliction of
emotional distress. In an intentional tort, wrongdoers are motivated by the intent to harm another person
or realize, or should have realized, that such harm is likely to result from their actions. For example,
telling a patient that sex with the therapist is therapeutic perpetrates a fraud. Most malpractice policies do
not provide coverage for intentional torts.

Other areas of negligence involving medication that have resulted in malpractice actions include:
1. Failure to treat adverse effects that have, or should have, been recognized;
2. Failure to monitor a patient's compliance with prescription limits;
3. Failure to prescribe medication or appropriate levels of medication according to the treatment
needs of the patient;
4. Prescribing addictive drugs to vulnerable patients;
5. Failure to refer a patient for consultation or treatment by a specialist; and
6. Negligent withdrawal of medication treatment.

Objective
To assess medical malpractice in ward 9 at Amanuel Specialized Mental Health Hospital, June 2017
Data collection procedures (methodology)
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The group prepared Data abstraction check list based on points specified in a course entitled Medical
Ethics and legal issue in psychiatry. Then each members of the group separately systematically observed
and interviewed the patient and care givers in ward 9 and OPD 40 using the check list. The group
compiled the data, discussed on it and written the report

The data abstraction checklist contains the points related to:

• Practice of using DSM or ICD Protocols

• Prescription related practices
• Patient management
• Ethical principles
• Practice Preventing high risk situation

Limitation of the report

• The results of this work may not be used to compare the ward with other wards
• Since all variables that measure the ward performance were not incorporated and data that that
can show strength were not gathered and analyzed, the ward should not be judged by this result.

Result

All observers reported the presence of good performance in the following areas of practice at ward 9:
 Medications are being Prescribed only when indicated
 Adverse effects that have, or should have, been recognized are being treated
 Giving fair service
 Addictive drugs are not being Prescribed to vulnerable patients
 a reasonable assessments are being performed of a suicidal patient's risk for suicide or implement
an appropriate precautionary plan
 Potentially violent and aggressive patients are not discharged to before controlling their behavior

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Malpractice
The most common malpractice in ward 9 are:
1. Mal Practice related to using DSM or ICD Protocols

 Bio psycho social formulations were not stated in process of diagnosis and management
 Name of the disorder written illegibly
E.g. major depressive disorder as depression, even in some practice diagnosis were not written
 Onset specifiers (full remission, partial remission..) are not written in most cards
Eg of MDD, psychotic disorder
 Severity specifiers are not being stated

2. Prescription related malpractices

 Drugs are mixed unnecessarily and not based on guidelines
 Exceeding recommended dosages and then failing to adjust the medication level to therapeutic
levels
 Explanations are not given about diagnosis, risks, and benefits of the drug for patients routinely
 a patient's compliances are not monitored and prescriptions are not limited accordingly
 Withdrawal of medication treatments are neglected

3. Malpractice related to Patient management

 Appropriate levels of medications were not prescribed according to the treatment needs of the
patient
 Patient’s are not referred for consultation or treatment by a specialist when necessary
4. Mal practice related to ethical principles

Informed Consent:
 Diagnosis – failure to describe the condition or problem to the patients or caregivers
 Treatment -nature and purpose of proposed treatment were not described
 Consequences -risks and benefits of the proposed treatment are also not discussed with pt and
caregivers
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  Failure to describe alternatives to the proposed treatment including risks and benefits
 Prognosis –failed to projected outcome with and without treatment
 Not Keeping privacy/ confidentiality of the patient.
 Practice unnecessary and repeated sedating
 Not Giving good hygiene for self-neglect patient

5. Mal Practice of preventing High-Risk Clinical Situations

 Patients are not evaluated a properly each visit and monitored for Tardive Dyskinesia and other
severe side effect of the treatment
 Informed consent were not obtained from patients at risk

Conclusion

According to our systematical observation and reviewing of patient card in ward 9 , there are many
malpractice with the commonest of Mal Practice related to

 using DSM or ICD Protocols

 Prescription of medication
 Patient management
 ethical principles

Recommendation

To hospital administration
• To give regular training for the professional regarding medical malpractice and ethical principles
• To Strengthening monitoring and evaluation
• To take appropriate ethical measures

References
• Ethiopian civil code , 1952

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 • Kaplan & Sadock’s synopsis 11th ed ,2015 Wolters Kluwer
• Zegeye Yohannis (MSc, PhD Fellow, AAU), “Medical Ethics and legal issue in psychiatry for
ICCMH, MSc students, 2017

Annex
Table: 1 Data Abstraction check list
Area of Verification criteria Yes No N
malpractice A
Practice of using Biopsychosocial formulations are stated in 1
DSM or ICD process of diagnosis and management
Protocols Name of the disorder written legibly 2
Onset specifiers (full remission, partial 3
remission..) are written
Severity specifiers are being stated 4
Prescription Exceeding recommended dosages and then 5
related practices failing to adjust the medication level to
therapeutic levels
Drugs are mixed when only necessary and 6
based on guidelines
Medications are being Prescribed only when 7
indicated
Explanations are given about diagnosis, risks, 8
and benefits of the drug for patients routinely
Adverse effects that have, or should have, been 9
recognized are being treated
a patient's compliances are monitored and 10
prescriptions are limited accordingly
Patient Appropriate levels of medications are 11
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management prescribed according to the treatment needs
of the patient
Addictive drugs are not being Prescribed to 12
vulnerable patients
Patient’s are referred for consultation or 13
treatment by a specialist when necessary
Withdrawal of medication treatments are not 14
neglected
Informed Diagnosis -description of the condition or 15
Consent: problem
Content of Treatment -nature and purpose of proposed 16
Information on treatment
consent form Consequences -risks and benefits of the 17
proposed treatment
Alternatives -viable alternatives to the 18
proposed treatment including risks and
benefits

Prognosis -projected outcome with and 19

without treatment
Practice of preventing High-Risk Clinical Situations
Tardive Patients are evaluated a properly each visit 20
Dyskinesia and monitored for TD
Informed consent obtained from patients at 21
risk

Suicidal Patients a reasonable assessments are being 22

performed of a suicidal patient's risk for
suicide or implement an appropriate
precautionary plan
Violent Patients Potentially violent and aggressive patients 23
are not discharged to before controlling their

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 behavior

Annex 2

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