Ethical responsibility of medical doctors in Uruguay
six-year term results in the functioning of the Medical Ethics Tribunal
Abstract
The Medical Ethics Tribunal has been functioning since 2012 when it was created by Act 18,591 for all cases in connection with medical ethics, deontology and diceology required by the government, individuals or legal persons, or members of the Uruguayan Medical Association. The study aims to inform about the first experience in Uruguay in the judging of the ethical responsibility of medical doctors ruled by law.
Objective:
General:
To present the first report on ethical responsibility of medical doctors in Uruguay.
Specific:
a) To describe a few characteristics of the complaints, the people who report the cases and those who are accused for alleged violation of medical ethics in the first two terms of the Tribunal’s functioning.
b) To systematize the characteristics and results of the procedures developed.
Method:
The public access sources of information were analysed: a) judgements by the Ethics Tribunal and the Appeals Court; b) Memories of the Medical Ethics Tribunal. A few characteristics of the reports were systematized, as well as those in connection with the people who report the cases and those who are accused for alleged violation, the procedures and the judgements.
Results:
101 complaints were received, 56 of which were accepted (FR: 0.55). Ethical offences by members of the health team were the most frequent reason. Complaints involved 68 doctors, mainly male (FR: 0.62) average age being 52.8 years old. Over half the complaints originated in specific situations where medical services were being provided, in particular in the ER context. Surgical procedures were highly represented. Most accused doctors appeared before the tribunal. Average time between the acceptance of the complaint and the final judgement was 9.6 months. According to the final judgments, in most cases (FR: 0.6) there was no offence or the offence could not be proved. 27 doctors were punished and 4 of them were temporarily excluded from the registry. Most offences involved a bad relationship with colleagues, although the most serious ones consisted in abusing the clinical relationship.
Conclusions:
The number of complaints received was stable. Most complaints and the punishments applied originated in problems within the health team. All greater punishments originated in conflicts with patients or their families. The profile of doctors reported is somehow more aged and male individuals than the polymorph average. Activity in the ER and/or the OR would imply being more exposed to complaints, just like it is seen in civil and criminal liability cases.
References
(1) Rodríguez Almada H. Introducción a la responsabilidad profesional de los médicos y las instituciones asistenciales. En: Medicina Legal. Derecho Médico. Montevideo: Oficina del Libro-FEFMUR, 2017:101-10.
(2) Turnes A. Desarrollo de la Colegiación Médica en Uruguay. Noticias 2009; (153):32-3. Disponible en: https://www. smu.org.uy/publicaciones/noticias/noticias153/art18.pdf (Consulta: 1 de febrero 2019).
(3) França O. Hacia el primer código uruguayo de ética médica. Rev Méd Urug 1989; (5):3-10.
(4) Rodríguez Almada H. Ley N°19.286: un hito para la profesión médica y la sociedad uruguaya. Rev Méd Urug 2014; 30(4):217.
(5) Torres Calvete J. Colegio Médico del Uruguay. Rev Méd Urug 2012; 28(2):87-8.
(6) Giuiria F. Roles de la Colegiación. En: Jornada de Prevención de la Malpraxis Médica, I (1992). Montevideo: SMU, 1993:59-61.
(7) Carámbula M. Perspectivas parlamentarias del proyecto de Colegiación. En: Jornada de Prevención de la Malpraxis Médica, I (junio). Montevideo: SMU, 1993:62-4.
(8) Lombardi R. Colegiación médica. Noticias 2010; (156):29-30. Disponible en: https://www.smu.org.uy/publicaciones/noticias/noticias156/art9.pdf (Consulta: 2 de marzo 2019).
(9) Adriasola G. La autorregulación corporativa en el Uruguay. En: Responsabilidad médica y ley penal. Montevideo: Del Foro, 1998:35-7.
(10) Colegio Médico del Uruguay. Fallos emitidos por el Tribunal de Ética. 2018 Disponible en: https://www.colegiomedico.org.uy/fallos-emitidos-por-el-tribunal-de-etica/ (Consulta: 1 de febrero 2019).
(11) Colegio Médico del Uruguay. Memoria ejercicio 2012-2015. 2016 Disponible en: https://www.colegiomedico.org.uy/wp-content/uploads/2018/07/ejercicio-2012-2015-1-1.pdf (Consulta: 1 de febrero 2019).
(12) Colegio Médico del Uruguay. Memoria del CMU 2015-2018. Montevideo: CMU, 2018. Disponible en: https://www.colegiomedico.org.uy/wp-content/uploads/2018/08/Memoria-del-CMU-2015-2018.pdf (Consulta: 1 de febrero 2019).
(13) Godino M, Barbato M, Ramos L, Otero M, Briozzo L. Encuesta Nacional de Comportamientos Disruptivos en el Equipo de Salud. Rev Méd Urug 2014; 30(4):235-46.
(14) Sindicato Médico del Uruguay, Comisión de Legislación Sanitaria y Derecho Médico. Métodos alternativos para la resolución de conflictos entre usuarios y prestadores de servicios de salud: conciliación y mediación. Montevideo: SMU, 2001.
(15) Comisión Nacional de Arbitraje Médico. Memorias del V Simposio Internacional: por la calidad de los servicios médicos y la mejoría de la relación médico-paciente. México D.F.: CONAMED, 2000.
(16) Etxeberría Gabilondo F. Alternativas extrajudiciales en la responsabilidad médica: la experiencia del arbitraje médico en España. En: Rodríguez Almada H, coord. Derecho Médico. Montevideo: Bdef, 2001:305-15.
(17) Ramírez A. La experiencia de la Comisión Nacional de Arbitraje Médico de México. En: Rodríguez Almada H, coord. Derecho Médico. Montevideo: Bdef, 2001:331-42.
(18) Rodríguez Almada H. Los aspectos críticos de la responsabilidad médica y su prevención. Rev Méd Urug 2001; 17:17-23.
(19) Rodríguez Almada H. De la medicina defensiva a la medicina asertiva. Rev Méd Urug 2006; 22(3):167-8.
(20) González Mora F, Barbero Portela M, Barrero Salgado G, Batthyany Dighiero K, coord. La profesión médica en Uruguay: caracterización del perfil profesional y la inserción laboral de los médicos en Uruguay. Montevideo: Colegio Médico del Uruguay, 2018:121p.
(21) Gomes JC, Drumund JG, França GV. Erro Médico. 3 ed. Montes Claros: Unimontes, 2001:222 p.
(22) Sindicato Médico del Uruguay. Demografía médica en el Uruguay. 2010 Disponible en: https://www.smu.org.uy/sindicales/documentos/demografia.html (Consulta: 8 de oct 2018).
(23) Caja de Jubilaciones y Pensiones de Profesionales Universitarios. Afiliados activos al 31.12.2017, por edad sexo y profesión. Disponible en: http://www.cjppu.org.uy/download.php?m=g&i=886 (Consulta: 8 de marzo 2019).