Caracterización de la responsabilidad profesional medica, Dirección de Medicina Forense de Tegucigalpa / Characterization of complaints of medical professional responsibility, issued by Dirección de Medicina Forense in Tegucigalpa

Justificación:Las fallas relacionadas a la actuación profesional, impactan negativamente a los pacientes e incluso pueden conducirlos a la muerte. Las denuncias constituyen un mecanismo por el que los pacientes o sus familiares expresan insatisfacción, y cuando se analizan, sistemáticamente, no solo desde la perspectiva legal, constituyen una oportunidad de mejora continua. Objetivo:Caracterizar las denuncias por responsabilidad profesional médica dictaminadas en la Dirección de Medicina Forense de Tegucigalpa. Metodología:Se realizó un estudio descriptivo de 89 denuncias por responsabilidad profesional médica, entre el 2010 y el 2015 dictaminadas en la Dirección de Medicina Forense de Tegucigalpa, siendo las variables de estudio: De las víctimas: edad, sexo, escolaridad. De los denunciantes: edad, sexo, motivo de la denuncia, relación con la víctima, procedencia. Del denunciado: Edad, sexo, centro donde laboraba, tiempo de laborar y especialidad ejercida. Resultados:El 5,61% de las denuncias correspondieron a casos de responsabilidad profesional médica, 20% de las cuales fueron por desconocimiento inexcusable y 80% por omisión de cuidados. Ginecobstetricia fue la especialidad más denunciada con el 30%. Los médicos más denunciados (77,6%) trabajaban en una institución pública, y el conflicto en la relación médico-paciente fue la causa de denuncia más frecuente (40.4%). Conclusión:Los médicos del sexomasculino, cercanos a los 50 años de edad y con más de 15 años de experiencia, que laboraban encentros públicos y que ejercían las especialidadesde Ginecobstetricia, OrtopediayCirugía General, fueron los más denunciados; entre los motivos más frecuentes dedenuncia se citaron losconflictos en la relación médico-paciente-familiar, la inconformidad en el diagnóstico y falta de ética profesional de otros profesionales con comentarios adversos hacia sus colegas o las instituciones...(AU)

Institutional Betrayal and Gaslighting: Why Whistle-Blowers Are So Traumatized.

Despite whistle-blower protection legislation and healthcare codes of conduct, retaliation against nurses who report misconduct is common, as are outcomes of sadness, anxiety, and a pervasive loss of sense of worth in the whistle-blower. Literature in the field of institutional betrayal and intimate partner violence describes processes of abuse strikingly similar to those experienced by whistle-blowers. The literature supports the argument that although whistle-blowers suffer reprisals, they are traumatized by the emotional manipulation many employers routinely use to discredit and punish employees who report misconduct. "Whistle-blower gaslighting" creates a situation where the whistle-blower doubts her perceptions, competence, and mental state. These outcomes are accomplished when the institution enables reprisals, explains them away, and then pronounces that the whistle-blower is irrationally overreacting to normal everyday interactions. Over time, these strategies trap the whistle-blower in a maze of enforced helplessness. Ways to avoid being a victim of whistle-blower gaslighting, and possible sources of support for victims of whistle-blower gaslighting are provided.

The Risk of Speaking Up.

Whistleblowing may be ethical, but physician protections for it could stand to improve.

¿Comunicar el error médico o esconderlo? A propósito de las memorias de Henry Marsh / Communicate medical error sor hide them? In relation to the henry marsh's memoirs

"Do no harm" es la obra de Henry Marsh, neurocirujano inglés que en el epílogo de su carrera profesional en el National Health Service, hace memoria no tanto de sus éxitos profesionales como de sus fracasos, lo que nos sirve de punto de partida para plantear un sistema de notificación de errores médicos en España que permita cumplir con la máxima hipocrática que da título al libro: "primum non nocere". Con ese objetivo propuesto nos planteamos primero analizar hasta qué punto existe un conflicto de lealtades en la actuación profesional del médico (institución vs. paciente) que condicione la posibilidad de comunicar los errores que se produzcan, concluyendo que existen contrapesos normativos para cumplir con la máxima de informar al paciente respetando otros derechos en conflicto. El equilibrio entre el derecho a estar informado y el derecho a defenderse frente a ulteriores acciones de responsabilidad tiene el fiel de esa imaginaria balanza en la idea canónica de que para aprender del error lo primero es reconocerlo y lo segundo analizar porqué se produjo. Sólo desde el aprendizaje puede evitarse que el error se repita y con ello mejorar la calidad de la asistencia. En el análisis que hacemos del sistema español de comunicación de efectos adversos (SiNASP) llegamos a la conclusión de que no cumple los estándares que nos planteamos, y no sólo desde un análisis ético y jurídico, sino tomando como referencia los sistemas que con el mismo objetivo existen en nuestro entorno europeo, con las referencias de los tratados y acuerdos internacionales en esta materia. La conclusión final a la que llegamos como colofón de toda la reflexión previa es que para que un sistema de comunicación de errores funciones realmente, tiene que ser obligatorio y anónimo para el informante, transparente y concluyente para el informado y, sobre todo, reflexivo y didáctico para la institución, de modo que se cumpla no sólo con el deber de informar sino también con el de evitar que el error se repita

"Do no harm" is the work of Henry Marsh, an English neurosurgeon who, in the epilogue of his professional career at the National Health Service, remembers not only his professional successes but also his failures. This is the starting point to propose a system of notification of medical errors in Spain that allows to comply with the hippocratic key principle that gives title to the book: "primum non nocere". With this objective, our proposal is, in first place, to analyze the extent to which there is a conflict of loyalties in the professional performance of any doctor (institution vs. patient) that conditions the possibility of communicating the errors that may occur, concluding that there are normative counterweights to comply with this principle: to inform the patient respecting other rights in conflict. The balance between the right to be informed and the right to defend oneself against further actions of responsibility has the faithful of that imaginary balance in the canonical idea that to learn from error the starting point is to recognize it, and the second to analyze why it occurred. Only from learning can the error be avoided and, thus, improved the quality of care assistance. In our analysis of the Spanish system of adverse effects communication (SiNASP), we conclude that it does not meet the standards we set ourselves, and not only from an ethical and legal analysis, but also taking as reference the systems with the same Objective in our European environment - including the references of treaties and international agreements in this area. The final conclusion to which we arrive as the culmination of all the previous reflection is that for a system of communication of errors to actually function, it has to be obligatory and anonymous for the informant, transparent and conclusive for the informed and, above all, reflexive and didactic for the institution, so that it fulfils with the duty to inform and it also avoids that the error is repeated

Protecting whistleblowers against discrimination in the NHS.

Emeritus Professor Alan Glasper, from the University of Southampton, discusses new Department of Health proposals to prohibit discrimination against former whistleblowers when they apply for another job in the NHS.

Legislating for advocacy: The case of whistleblowing.

BACKGROUND: The role of nurses as patient advocates is one which is well recognised, supported and the subject of a broad body of literature. One of the key impediments to the role of the nurse as patient advocate is the lack of support and legislative frameworks. Within a broad range of activities constituting advocacy, whistleblowing is currently the subject of much discussion in the light of the Mid Staffordshire inquiry in the United Kingdom (UK) and other instances of patient mistreatment. As a result steps to amend existing whistleblowing legislation where it exists or introduce it where it does not are underway. OBJECTIVE: This paper traces the development of legislation for advocacy. CONCLUSION: The authors argue that while any legislation supporting advocacy is welcome, legislation on its own will not encourage or enable nurses to whistleblow.

Procedures for Handling Retaliation Complaints Under Section 31307 of the Moving Ahead for Progress in the 21st Century Act (MAP-21). Final rule.

On March 16, 2016, the Occupational Safety and Health Administration (OSHA) of the U.S. Department of Labor (Department) issued an interim final rule (IFR) that provided procedures for the Department's processing of complaints under the employee protection (retaliation or whistleblower) provisions of Section 31307 of the Moving Ahead for Progress in the 21st Century Act (MAP-21). The IFR established procedures and time frames for the handling of retaliation complaints under MAP-21, including procedures and time frames for employee complaints to OSHA, investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor) and judicial review of the Secretary's final decision. It also set forth the Department's interpretations of the MAP-21 whistleblower provisions on certain matters. This final rule adopts, without change, the IFR.

Views on mandatory reporting of impaired health practitioners by their treating practitioners: a qualitative study from Australia.

OBJECTIVE: To explore the views and experiences of health sector professionals in Australia regarding a new national law requiring treating practitioners to report impaired health practitioners whose impairments came to their attention in the course of providing treatment. METHOD: We conducted a thematic analysis of in-depth, semistructured interviews with 18 health practitioners and 4 medicolegal advisors from Australia's 6 states, each of whom had experience with applying the new mandatory reporting law in practice. RESULTS: Interviewees perceived the introduction of a mandatory reporting law as a response to failures of the profession to adequately protect the public from impaired practitioners. Mandatory reporting of impaired practitioners was reported to have several benefits: it provides treating practitioners with a 'lever' to influence behaviour, offers protections to those who make reports and underscores the duty to protect the public from harm. However, many viewed it as a blunt instrument that did not sufficiently take account of the realities of clinical practice. In deciding whether or not to make a report, interviewees reported exercising clinical discretion, and being influenced by three competing considerations: protection of the public, confidentiality of patient information and loyalty to their profession. CONCLUSIONS: Competing ethical considerations limit the willingness of Australian health practitioners to report impaired practitioner-patients under a mandatory reporting law. Improved understanding and implementation of the law may bolster the public protection offered by mandatory reports, reduce the need to breach practitioner-patient confidentiality and help align the law with the loyalty that practitioners feel to support, rather than punish, their impaired colleagues.

Procedures for the Handling of Retaliation Complaints Under Section 1558 of the Affordable Care Act. Final rule.

This document provides the final text of regulations governing employee protection (retaliation or whistleblower) claims under section 1558 of the Affordable Care Act, which added section 18C to the Fair Labor Standards Act to provide protections to employees who may have been subject to retaliation for seeking assistance under certain affordability assistance provisions (for example, health insurance premium tax credits) or for reporting potential violations of the Affordable Care Act's consumer protections (for example, the prohibition on rescissions). An interim final rule (IFR) governing these provisions and request for comments was published in the Federal Register on February 27, 2013. Thirteen comments were received; eleven were responsive to the IFR. This rule responds to those comments and establishes the final procedures and time frames for the handling of retaliation complaints under section 18C, including procedures and time frames for employee complaints to the Occupational Safety and Health Administration (OSHA), investigations by OSHA, appeals of OSHA determinations to an administrative law judge (ALJ) for a hearing de novo, hearings by ALJs, review of ALJ decisions by the Administrative Review Board (ARB) (acting on behalf of the Secretary of Labor), and judicial review of the Secretary of Labor's (Secretary's) final decision. It also sets forth the Secretary's interpretations of the Affordable Care Act whistleblower provision on certain matters.