Professor Milan Milanov, Chairman of the Central Ethics Committee with the BMA: Standards of health care risk must be introduced

- Professor Milanov, the recent deaths of the two women in labour prompted once again the debates on the probable medical errors and on whether doctors are legally untouchable. When can we actually talk of a medical error and is there a precise definition of this concept?
- This is not only a problem in Bulgaria alone but a global one. This fact, however, does not make the negligence of doctors acceptable. There is not a single medical employee who has not committed a fault. There is no doctor who regrets not errors committed. The reason might be their insufficient medical qualification or fatigue. There might be many reasons. It is more important to have medical errors systematised. A roundtable discussion of BMA (Bulgarian Medical Association) was held on April 7, 2011. The event, apart from BMA, was attended by an audit agency, representatives of the General Prosecutor's Office, the judiciary, as well as law-makers. At that time, medical errors were systematised as a concept and as criteria.

Medical errors can be systematic and personal. The World Medical Association is fighting against systematic errors. In Bulgaria, this is implemented by three institutions - the Ministry of Health, the financial system and the healthcare professional association.

For example, the systematic errors of drivers in Bulgaria are due to bad road conditions, while personal errors are attributed solely to individual actions. Every driver knows that accidents are the result of distraction. Likewise, in our profession, the huge number of medical errors is a result of shortcomings in the rules of good medical practice. Statistics show that the ratio of systematic errors to personal ones is 80 : 20.

- How can we determine whether the death of a patient occurred as a result of a personal fault on the part of the doctor?
- We must distinguish between a bone fides error, on the one hand, and a doctor's negligence and poor qualifications, on the other. Let me give you an example. There is a bona fides error if I, as a physician, have implemented everything in good faith after examining the patient and diagnosing him/her initially with bronchopneumonia, for instance, but the subsequent laboratory test results and X-ray screening tests prove that he/she has another disease. What is the other medical error resulting from medical negligence and low qualifications? I can give you an example with a wrong kidney surgery when the wrong or the sole kidney was removed. In fact, these are not professional examples and I give them just to illustrate the different kinds of medical errors. Worldwide, doctors are being sued in the second case. Therefore, at our meeting with the Chief Prosecutor, we agreed on several points. First, the General Prosecutor's Office should initiate legislative amendments referring to medical risk. In fact, there is an effective Law on Business Risk. Let me give you an example with our medical practice in the Pirogov hospital in Sofia. Two days ago, a woman in an extremely serious health condition was brought to us from a certain provincial hospital. You cannot imagine the inconceivable degree of mental, physical and physical tension to which we were subjected during the 8-9 hour operation. Not to mention the fact, how much energy this took. We were a team of 15-20 medical professionals fighting for the life of this woman. Had we complied with the existing fear among doctors in our country, we could have refused to operate on this woman. There are two options in this case. First, if we operate on a patient and he/she dies, we might be sued, but if we refuse to perform surgery on the patient and he/she dies, we might justify our motives with his/her poor health condition. And we could have actually chosen the latter option because the woman's condition was really bad. However, we relied on that 1% chance that she will survive, even if the chance was 1 :1,000 and therefore we decided to operate on her. Ultimately, the woman died six hours after the surgery. I strongly wish that the fiercest critics of doctors had attended this 8-9 hour exhausting struggle for a single human life. They would have seen that the professional level of physicians in Bulgaria is very high, indeed. Therefore, besides the introduction of legislative amendments to medical risk standards, we demanded from the Chief Prosecutor Office to undertake further measures. Since medical error is not a layman's but a medical term, we want it to be defined by experts, in short, by medical specialists. We are handling a complex matter, we are treating people. The knowledge of doctors worldwide is not sufficient - we are not gods. Therefore, we demanded the setting up of medical expert committees to determine in each specific medical case, whether there is a medical error or not. And if no medical error is detected, no criminal proceedings should be launched. This, of course, does not mean that people cannot file a civil claim with the Criminal Court because they have the civil legal right to do so.

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