Legal Implications for Actions Considered Iatrogenic: Knowledge and Practices of the Surgical Team, Valledupar, Cesar/Colombia

Abstract

Introduction:The errors considered iatrogenic are caused by different causes that are mostly considered foreseeable, including inaccuracy, recklessness and ignorance, all these actions with ethical-legal repercussions. In Colombia, despite not having studies that position iatrogeny as one of the main causes of death. It is estimated that in Colombia 180,000 people die each year for this reason. Iatrogeny is described in the USA as the third leading cause of death. Objective: To evaluate the knowledge and aspects related to negligence, inexperience, recklessness, that the surgical team has in regard to its ethical-legal responsibilities. Methodology:Descriptive cross-sectional study. A total of 93 professionals were surveyed who are part of the surgical team of two health-care institutions in the department of Cesar, Colombia during 2019. Results:Surveyed professionals showed a 100% ignorance about the process to follow during an adverse event. It was identified that 32 % of the professionals and technicians surveyed do not have insurance to back them up legally. In addition, 31% said that errors such as negligence, recklessness and inexperience can occur in parallel with criminal and civil repercussions. The surgical team considers that the most frequent error are elements and instruments left in the cavity (oblites) in 64%. Conclusions:For surgical personnel, negligence is the error with the greatest penal repercussion if it is related to the death of the patient, surgery on the wrong patient and wrong side of the body, in addition to oblites or foreign bodies left in the cavity.

Perceptions of a Surgical Team About the Ethical and Legal Responsibilities of Forgetting Foreign Bodies in Patient Bodies and Other Errors

“…These conceptual elements were linked to the fact that many of the members of the surgical team, despite knowing how to perform their functions, limit themselves to what they consider humanly possible, leading them to commit errors, including those considered customary, such as not reading the clinical records or the limits between professional secrecy and complicity, among others. Several studies have mentioned that collaborative work is an important factor in reducing errors, as well as adherence to standards or protocols that promote patient safety in a surgical case [1,9,11,12,19,21,42].…”

“…In Colombia, surgeons as well as surgical technicians must carefully count the materials placed on an instrument table, especially gauzes [11]. The mechanisms or processes mostly used to avoid medical errors such as RSIs are as follows: periodic and constant counting during a surgery, depending on its type and duration; discarding incomplete or excess packages, maintaining a constant number of gauzes that is known to all members of the surgical team; and maintaining a tidy instrument table throughout the surgery to facilitate the counting of surgical materials and instruments [11].…”

“…It is important to consider that any medical act related to an adverse event occurred during a surgical procedure, such as forgetting a foreign body inside a patient after surgery, implies administrative, deontological, civil, and even criminal liabilities of the surgical team. These liabilities can be individual or combined [11,[17][18][19].…”