Margarida  Eiras,  Adjunct  Professor,  School  of  Health  Technologies  of  Lisbon,  Portugal  (margarida.eiras@estesl.ipl.pt)  

Paula  Bruno,  Alves  &  Associados,  Sociedade  de  Advogados,  Lawyer,  Portugal  (paula.bruno.marDns@gmail.com)  

Background  and  purpose  PublicaDons   and   internaDonal   conferences   dedicated   to   the   topic   of   PaDent   Safety,  have   been   highlighDng   the   problem   of   blaming   physicians   and   healthcare  professionals   when   an   adverse   event   or   incident   occurs,   with   a   strong   and   direct  relaDon  with  the  inherent  fear  of  legal  consequences.  Acknowledging   that   there   is   a   huge   discrepancy   between   the   Law   and   the   PaDent  Safety   principles   regarding   blame/fault,   this   poster   will   cover   the   main   differences  observed.  

Results  

Conclusion  NormaDve  principles  are  not  compaDble  with   the  principles  of  paDent  safety.  All   the  recommendaDons,   publicaDons   and   lectures   worldwide   proclaim   a   blame   free  environment.   The   legal   tradiDonal   regimen  of   subjecDve   liability,   based  on   fault,   the  fundamental  principle  of  PaDent  Safety  –  a  no  (individual)  blame  culture.  In   order   to   improve   PaDent   Safety,   we   would   suggest   the   adopDon   of   a   objecDve  liability   (no   fault)   in   the  Portuguese   legal   system,   allowing   for   the   analysis   of   advert  events  and  moDvaDng  a  proacDve  aLtude.  References  Bruno,  P.,    Registo  de  Incidentes  e  Eventos  Adversos:  Implicações  Jurídicas  da  implementação  em  Portugal  (20),  Wolters  Kluwer/Coimbra  Editora,  2010  Commi\ee  on  Quality  of  Health  Care  in  America,  IOM,  (2001).  Crossing  the  quality  chasm:  a  new  health  system  for  the  21st  Centuary.  Washington,DC:The  naDonal  Academy  Press.;  Hindle,  D,;  Braithwaite,  J.and  Ledema,  R.  (2005).  PaDent  Safety  Research  –  a  review  of  technical  literature.  Sydney  NSW.;    Kohn,L.T.;  Corrigan,J.M  &  Donaldson,  M.S.(2000).  To  err  is  human.  Washington  DC:  NaDonal  Academy  of  Sciences;  Morath,  J.  M.  &  Turnbull  (2004).  To  do  no  harm  –    Ensuring  paDent  safety  in  health  care  organizaDon.  San  Francisco:Jossey-­‐Bass.;  Portuguese  LegislaDon;  JOUE,  (2009/C151/01)  

FAULT:  TWO  FACES  OF  THE  SAME  COIN  

Methods  A  literature  review  was  conducted  through  two  searches  of  Medline  and  Embase  database.  Selected  government  and  paDent  safety  organisaDon  websites  were  also  searched  for  relevant  literature.  In  addiDon  to  journal  arDcles  and  reports,  technical  and  working  papers   and   other   forms   of   literature  were   also   idenDfied   through   hand   searching   of   the   references   of   key   publicaDons   and   by  searching  of  selected  websites.  

Blame    and    Fault    

PaEent  Safety  principles  •  Adverse  event  •  Risk  management:  Root  Cause  

Analysis,  Failure  Mode  and  Effect  Analysis  •  Disclose  •  ReporDng  systems  •  System  approach  

   

Law  -­‐  normaEve  principles  •  Harm  (physical  and  moral)  •  Civil  liability:  

•  SubjecDve  liability  • AssumpDons  of  liability:    …,  fault,  …  

•  Criminal  liability:  …,  fault,  …  •  Disciplinary  liability  •  Guilt?