Saudi Arabia – Dr. Erfan says doctors are not guilty of malpractice in patient’s death case

JEDDAH: The director general of Dr. Erfan & Bagedo General Hospital in Jeddah has denied nine doctors at his hospital have been found guilty of malpractice in the case of a dentist, Dr. Tariq Al-Johani, who died after being administered anesthesia for a gastric bypass operation.

The hospital’s director general and co-owner, Dr. Muhammad Erfan, denied the allegations saying, “The case is still under consideration by the Shariah Medical Committee.”

Following his death, a lawyer representing Al-Johani’s father demanded the team of doctors who conducted the operation be charged with committing a medical mistake. “We have asked to see the list of charges and requested time to reply. Hence, that is why the case was postponed until March 1,” said Dr. Erfan. He added that he could not absolve the hospital from the mistake of allowing an anesthetist who does not have a license from the Saudi Commission for Health Specialties (SCHS) to work.

He, however, said the anesthetist had applied for a license and could not obtain one because of “delays” at SCHS and the unnatural way it behaves toward private hospitals in the region. “There are only two doctors at SCHS offices in Jeddah. They cannot respond to everyone’s needs and requirements,” he said. Dr. Erfan said the SCHS had closed down its office in Jeddah following the Nov. 25 floods. “The floods destroyed all paper at the commission’s office, including the anesthetist’s application for a license. The office was located at the King Abdulaziz University campus which was very badly damaged by rain and floods,” he added.

Excerpts from the interview:

Q. Can you tell us about what happened to Dr. Tariq Al-Johani?

A. He came to the hospital to undergo a gastric bypass operation. That was at the time of Haj. Four of our eight anesthetists were in Makkah for Haj. We usually do not schedule operations when our team of anesthetists is reduced by 50 percent but because he was a friend of the operating doctor, we overlooked this regulation. All of the pre-operation procedures were done. Once the anesthesia was given, some complications, which were not unusual, occurred. As the health minister has said, medical mistakes happen even in the world’s best hospitals. In advanced countries, medical mistakes happen on the ratio of 4:1,000. This ratio doubles in developing countries. During the last 20 years, more than 200,000 surgical operations were conducted in our hospital and only two patients have died of medical mistakes. Dr. Tariq’s case was considered a high risk one and embodied difficulties in anesthesia because he weighed 182 kg and had diseases we did not know about including asthma, high blood pressure and gland deficiency. The female anesthetist only came to know about this when the investigation committee asked her if she knew he suffered from these illnesses. The doctors did their best to save him, but his difficulties in breathing affected his brain and he died 15 days later at King Faisal Specialist Hospital.

Q. It is a common medical practice to let patients undergo tests prior to surgical operations to see whether they are allergic to certain medicines. Why did you not do this?

A. This happens when the operating doctor knows about the patient’s chronic diseases. None of these diseases were registered in his file. When the doctor asked him if he had any of these diseases, Dr. Tariq answered in the negative.

Q. His father denies that his son had asthma.

A. We do not confirm that he had asthma. We came to know about this from the investigation committee.

Q. The director of health affairs in Jeddah confirmed that the hospital committed a medical mistake. What is your response to this?

A. Yes there was a medical mistake but that does not justify making this case a criminal one? We had no previous knowledge of his other chronic diseases.

Q. Is it true that the said anesthetist does not have a license to practice?

A. The basic point here is not that she does not have a license but the question should be: Is she capable of doing this work or not? She has had a doctorate degree in anesthesia for seven years and practiced as an anesthetist in her country for 15 years. She does not have a license because of an administrative error not because of professional or technical errors. There is no reason to doubt her professional ability. It is true that she does not have a license but thousands of other doctors in the Kingdom do not have licenses.

Q. But the system will not allow her to practice without a license?

A. This is true, but this system is new and there is no mechanism for its implementation. The SCHS office in Jeddah has been closed for two months because of the floods. We have 120 members of staff who lost their papers in the office because of the floods. They have applied for licenses and passed the examination but their licenses were not issued.

Q. Why did you allow her to work? Did the hospital sign a contract with her?

A. It would take her more than six months to obtain the license. We allowed her to practice so that work could continue naturally. The concerned government department would not help us obtain the license in time. The SCHS only asks private hospitals to obtain licenses. All doctors in government hospitals are working without them. It is only after we complained to the minister that government hospitals were also asked to obtain licenses for their medical staff.

Q. Are you justifying your mistake?

A. I am not, but the private sector is forced to commit mistakes. If a doctor in my hospital resigns, it will take me more than six months to replace him while I am obliged to provide medical services to our patients who number 2,000 every day.

Q. Did you use your authority in the Ministry of Health to influence the case?

A. The committee is headed by a category “A” judge. I was outside the Kingdom and returned 10 days after the incident. Intervening in the case is out of the question. Neither does the government nor our religion or conscience allow this.

Q. Are you admitting that there was a medical mistake?

A. I say there was a medical mistake but who was responsible? Was it the anesthetist or the absence of information about Dr. Tariq’s other chronic diseases?

Q. Your hospital is accused of committing numerous medical mistakes. What is your response to this?

A. There is no proof for this claim. We have the ISO quality certificate from the International American Board. Dr. Tariq chose to take his operation at our hospital because he was confident in it.

Q. Quality means that the anesthetist makes all necessary arrangements before the operation, something that she did not?

A. When the doctor asks the patient if he has any chronic diseases and the patient answers in the negative, this will be recorded in his file. This is what is recorded in Dr. Tariq’s file. From the medical point of view, our procedures were correct but we have committed the administrative mistake of allowing the anesthetist to practice without a license. We admit this.

Q. Are you saddened by the death of Dr. Tariq?

A. Very much. This is really saddening. We have paid our condolences to his family. I sat with his brother and the husband of his sister. It is painful. We have lost a great man.

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