In last Thursday's Saudi Gazette, Mr. Abdullah Abu Al-Sahm and Dr. Mansour Al-Tobaiqi opined that errant hospitals should not be closed, because Jeddah lacks enough hospitals to serve our community's needs. While Jeddah may need more hospitals, we should realize that allowing negligent hospitals to remain open can further the possibility of future malpractice incidents. This was the case at Erfan and Bagedo Hospital, where, in recent years, several deaths due to medical error preceded the tragic death of eight-year-old Salah-Aldin Yousef Jameel. The prior malpractice deaths at Erfan and Bagedo Hospital were apparently insufficient motivation for that institution to implement more effective measures and precautions toward preventing further tragedy. It could also be surmised that the prior deaths did not sufficiently provoke authorities into taking stronger action toward adequately monitoring and regulating errant hospitals in Jeddah. If hospitals with track records of medical negligence are allowed to remain open, who or what can motivate their administrators to take the crucial actions needed to prevent similar occurrences? Lack of accountability — not lack of hospitals — is the most serious health care crisis in Jeddah today. In the developed world, medical facilities are made accountable by both government regulation and penalties. Fear of serious reprisals, including severe regulatory actions and heavy financial penalties, makes hospitals in first-world nations proceed with great caution in their treatment of patients. Though first-world hospitals are not entirely free of medical error, their high standards of medical care and track record in preventing malpractice, per capita, are far superior to the general performance of hospitals in Jeddah. If that is not so, then why do so many of our affluent citizens go abroad for medical treatment? Mr. Abu Al-Sahm acknowledges that Jeddah hospitals are in need of reform, and yet he categorizes the closures of hospitals in response to malpractice as “punishment.” I am both appalled and deeply offended by the seeming implication that Salah-Aldin Jameel's family might have wanted the closure of any hospital as a “punishment.” Rather, the family simply hopes and prays that no other child or resident of Jeddah becomes another victim of preventable medical negligence. If a hospital closure is a necessary step toward that end, then so be it; though I sincerely regret any inconvenience to patients due to the abrupt action, without a proper transition. It must not be forgotten that Erfan and Bagedo Hospital was allowed to remain open after previous malpractice incidents there and given the chance to improve its standards, but, nevertheless, did not use that opportunity toward achieving greater vigilance in patient care. That hospital now blames “technical error” for the malpractice death of Salah-Aldin Jameel, passing the blame for the incident to the company that maintained the equipment implicated in his death. However, new evidence has cast doubt upon their claim that the maintenance company was at fault. Whatever the circumstances, ultimate responsibility for the child's death remains with the hospital, which was obligated to ensure that any procedures and equipment on their premises were utilized in compliance with recognized safety standards. Perhaps hospital closures are necessary toward achieving future accountability and compliance with world standards in medical care here, until government sanctions and supervision are better able to force Jeddah hospitals to comply with such standards and ensure patient safety. Every Muslim will agree that our deaths are “destined,” as Mr. Abu Al-Sahm reminds us. Yet, does that mean we should do nothing to try to protect our citizens' health and lives, including holding hospitals accountable? If that were true, then there would be no need for hospitals — we would more properly sit at home when illness strikes and simply await our fates. Islam asks us to be proactive in protecting life and health. The Holy Qur'an informs us that saving the life of one person, is equal to saving the lives of every person in the world. We are obligated to do our best in protecting human life and safety, and then, after that, must put our trust in Allah and accept His Wisdom in the destinies he has chosen for us. Both Mr. Abu Al-Sahm and Dr. Al-Tobaiqi made commendable suggestions toward preventing medical error. In his conclusion, Dr. Al-Tobaiqi asked, whom will we hold accountable for the poor supervision and monitoring of our hospitals? This is firstly the role of our government agencies, which must review their own performance and take more stringent action to ensure that Jeddah's medical facilities are more closely monitored and supervised, and made liable for providing health care services compliant with current world standards of excellence and safety in treatment. Procedures and policies must also be put in place to allow and assist patients and their families to seek transparency and redress in the event of suspected medical error and negligence. Informed consent is the first step. Patients and their families must be fully notified, before treatment, of their rights and of the full details and risks involved. They must also be informed about whom to contact in the event of apparent medical negligence. When a suspected malpractice incident leads to patient injury or death, affected families must have the right to an immediate and thorough investigation of their grievance, initiated by the hospital where the incident took place. A board of qualified and impartial physicians should then review the complaint and the investigation's findings. Further, all persons involved in the malpractice event must be prevented from leaving the Kingdom, and they must each be required to make a formal deposition before a physicians' review board and the courts. In the event of death by suspected malpractice, a forensic autopsy by a qualified and impartial medical examiner should be required. Further, families must have the right to have an independent pathologist conduct a clinical autopsy, paid for by the government, with the payment reimbursed by the hospital if they are found at fault. To better ensure transparency, medical files should be electronic, and software should be installed that would prevent the alteration or deletion of any data from patients' files. In addition, if any doctors or hospital personnel, from the highest to the lowest positions in any medical facility, are found guilty of withholding or concealing evidence in malpractice cases, they must be dismissed from their posts immediately, receive appropriate punishment through the courts, and have their medical licenses, if any, permanently revoked. Hospitals must also be held responsible for self-reporting any instances of medical error. If they fail to inform the authorities, severe penalties must be imposed upon them. Dr. Al-Tobaiqi suggests a penalty for medical negligence that requires hospitals to halve their costs to patients. But, since most Jeddah patients are insured and pay minimal fees toward their own medical expenses, I feel a better penalty would be to compel errant hospitals to make large contributions to a fund for families throughout the Kingdom who have been affected by malpractice. This is especially important for families who have been deprived of income because a family wage earner has been disabled or killed. In the case of the death of Salah-Aldin Jameel, perhaps an appropriate partial penalty would be for Erfan and Bagedo Hospital to also continue paying full salaries to their workers who have been rendered jobless as a result of the hospital's closure, for which the hospital alone is responsible, and no one else. (Note — it was reported that the hospital has voluntarily done so.) But penalties and punishments are simply a means, not an end. If we love Saudi Arabia and its people, we must not hesitate to institute any needed reforms and do whatever is necessary to protect the health and safety of all its citizens and residents. Patriotism and human decency demand that. Most important, providing for the safety of all residents of Jeddah is an amana and a sacred trust. Beyond accountability to our fellow man and our duty to our country, we will be held accountable for any negligence in this by God Himself.
Constance Conklin, Stepmother of Salah-Aldin Jameel
