Medical Malpractice in Morocco

Medical Malpractice in Morocco

Introduction:
According to the Canadian Bar Association “Doctors or health care providers are negligent if they fail to give their patients the standard quality of care that a reasonable doctor or health care provider would give in similar circumstances”. When a person has a disease, automatically, that person thinks about going to a hospital or seeing a professional health provider in hopes of finding help. In fact, people usually think that they can rely on doctors' capacities since those one's are supposed to have years of experience and training that will result in excellent treatment. However, patients end up disappointed by the doctors' treatments and sometimes their health situations become even worse than what they used to be. The wrong treatment given by a medical practitioner because of his negligence is what we call medical malpractice. It could be represented by a failure to diagnose the disease, a misdiagnosis of a disease, not providing the right treatment, or an unreasonable delay in the treatment.

Morocco is a developing country where medical malpractice is a serious issue that is not enough discussed. As Moroccan citizens, we are strongly concerned about this problem because of the huge number of people dying every day due to outrageous and unacceptable medical errors, especially when we think that someday those victims could be ourselves or our relatives.

Because of lack of materials, a shortage of doctors and inadequate training, medical malpractice is a serious issue that Morocco must urgently deal with.

Causes of medical malpractice in Morocco:
When there are medical errors there are certainly causes of committing these mistakes. Being a doctor is like having the life of patients in their hands. When a patient comes to see a doctor he or she wants to feel better and take the pain away, not to have more problems or pass away. In morocco, it happens frequently and this is due to several causes which are: errors during the diagnostic, lack of communication, lack of materials, overcrowded hospitals, and lack of competent and experienced doctors.

Errors during the diagnostic are due to another cause which is lack of communication between doctors and patients. Normally, during consultation doctors look upon the sickness that the patient suffers from, and the allergies he or she has, in order to avoid bad reactions while giving the treatment or carrying out surgery. In Morocco, doctors do not pay attention to these details. They just want to treat the patient without knowing which his or her real problems are and without looking for his or her allergies in the case he or she has some. For example, a patient in a private Clinique in Casablanca had an operation and the doctor gave him a shot of penicillin, what he would not have done if he was doing his job properly since the patient was allergic to that substance. This patient’s operation was supposed to remove a small piece of his stomach. But now, he is paralyzed for life because of the shot of penicillin. The patient did not manage to pursue the doctor since the Clinique has as argument the fact that he did not inform the doctor about his allergy (Siham Ali).

As we have previously said, medical mistakes can be the result of a failure to diagnose or a misdiagnosis of the patient’s medical condition due to a lack of communication between doctors and patients. Unfortunately, these are not the only issues that result in medical malpractice. The lack of materials - surgical instruments, ambulances - and of qualified staff are also some significant problems that a lot of Morocco’s hospitals face. Moreover, the budget has also something to do with the omnipresence of medical errors in Morocco since only 5% of the general state budget is assigned by Moroccan health ministry to the hospitals. With low funds at disposition of hospitals, staff responsibles are obliged to adapt to the situation. In other words, they buy less materials of quality and do not maintain them properly (Mustapha Bourakkadi).

Overcrowded hospitals in Morocco are also a serious issue that triggers medical errors. The CHU IbnSina in Rabat is one of the best examples we can take to illustrate this problem. Indeed, there are so many demands that people are very bad treated. They come with serious injuries and are obliged to fill in administrative paper even for urgent cases. Every patient has to pay or get payment guarantees before being cured. Moreover, there are much private clinics than public hospitals. Because of the higher cost of private clinics and Morocco’s underdevelopment, a large majority of citizens are obliged to go to public hospitals in order to get cured. This creates a high density of people that leads to overcrowded hospitals (Sara Badi).

The problem we have just mentioned may be seen from another perspective. In fact, hospitals may not be overcrowded but problem may rather be the lack of doctors in Morocco. According to the minister of health Yasmina Baddou, the government is trying very hard to remedy the shortage of hospital stuff, especially in public hospitals where patients fall over each other. In fact, Only 17.000 Moroccan doctors are available and they work more than fifteen hours per day which affects their vigilance and yield (Siham Ali). Also, according to Dr. Sbioui, in the city of Casablanca, there is only one single doctor per day for every 250 patients. So, doctors are clearly overtaken by events (Sara Badi). According to Dr. Belahmer Mohamed Fouad, due to this lack of stuff, usually, healthcare providers have to ensure more than one role during the same day which can be very dangerous as. It is dangerous since in this kind of cases, healthcare providers are exhausted and they may end up botching their original tasks, which could have extremely serious issues on the patients’ health conditions. Finally, a considerable issue that must be solved urgently is the incompetence of doctors who have been trained in Morocco. In fact, the auditorium of the medical school of Casablanca used to have a capacity of 170 students in the past. Now, it can receive up to 240 students, which means the double. There are clearly some efforts that are being made by the government but they are still insufficient. Therefore, in order to keep improving the field of medicine in Morocco, the government must try really hard to overcome the problem of education and hence afford the best conditions possible for students who plan to devote to medicine (Dr Belahmer Mohamed Fouad).

Effects of medical malpractice:
When a healthcare professional – a doctor, a nurse, a hospital worker, a surgeon – fails to provide his or her patient with a standard quality of care, it usually triggers several detrimental effects on the physical, emotional, and on the financial aspects of the victim.
In fact, any negligence from a medical practitioner can lead to pain and suffering of the victim. This was the case for a woman in her fifties from Fez. According to Lematin, the woman was suffering from cervical cancer and decided to have a surgery in a private hospital in Fez with the hope of leaving the hospital healed. However, instead of leaving it in a better alleviated condition, she left it with an agonizing pain that lasted two endless months and with a wound that did not heal even after all that wait. After a second surgery, at the same private hospital, surgeons found a towel they had forgotten in her stomach after the first surgery she had. This ridiculous and outrageous medical error shows to what extent healthcare providers can be irresponsible toward their patients (M. Akisra).

In spite of this painful and traumatic experience she went through, that woman is lucky compared to other people who’s pain caused by medical mistakes was not temporary. In fact, according to L’economiste magazine, there is an endless number of outrageous medical malpractice cases that result in irreparable damages from which we can cite doctors who operate on the wrong patient due to the mix-up of medical files and those who amputate a limb instead of another. These errors that change the victims’ lives forever illustrate again health care provider’s irresponsibility and their lack of commitment to their patients’ health. A famous case Moroccans have heard a lot about is the case of a woman who ended up with a disastrous result after an unsuccessful nose surgery also called rhinoplasty (N. Lamlili). So is the doctors’ role still to heal patients and contribute to the improvement of their healthy living conditions?

Even though the case we have just mentioned seems to be one of the worst cases of medical malpractice, there is, unfortunately, a worse effect to that kind of unforgivable error which is death. During our research, we have found several websites describing stories of patients who passed away because of healthcare providers’ mistakes and one of these websites is Le matin. Mr. Mustapha is one of those who decided to share his own experience or his relatives’ experiences. His unfortunate sister lost her baby during the delivery because of a deep wound in the baby’s skull due to the midwife’s long nails. This error is so shameful we cannot even dare imagine the psychological state of the mother when she has been told the reason behind her baby’s death (M. Akisra). And many are the cases similar to that one. Once again, medical malpractice is clearly a serious issue that often has irreversible consequences on patients’ lives. Dying because of a ridiculous long nail should not be something for people to worry about, but unfortunately, it is in our country.

In the case of people with severe and irreversible physical damages like in the case of amputating a limb from the wrong patient for instance, the victim will not only have to live his/her life deprived of one of his/her limbs by mistake, but he/she will also have to spend the rest of his/her life suffering from that outrageous mistake. Some medical mistakes can completely throw away a patient’s life. The victim may become unable to keep working and hence, live autonomously and provide for his/her needs anymore which may probably result in psychological side effects such as depression for the victims as well as for their close relatives.

Leila Hiwass has become a widow because of a medical malpractice. Her husband, Habib Hiwass, was admitted to a hospital in Casablanca in order to have a gallbladder surgery which is supposed to be a common surgery. Leila did not suspect at all that a common surgery would change her life into a nightmare. In fact, after he had the surgery, Habib’s situation got complicated and he had to get a head scan but since there was neither a scanner nor a call doctor in the hospital where he was admitted, he had to be transferred urgently to better-equipped hospital. Instead of transferring him immediately, the hospital preferred to wait for Leila to arrive and pay 30,000 DHS before doing it. Two days later, Habib Hawiss died (N. Lamlili). Leila Hawiss did not only lose her husband because of the hospital’s negligence, but she also lost a considerable amout of money. It may not be the case of Leila, but some people may be extremely affected by losing as much money.

Therefore, as we have just seen, medical mistakes do not only dreadfully affect the physical and psychological aspects of the victims, but they also have a significant impact on their financial aspect. In fact, Medical errors result in serious economic damages for the patients and their relatives. In fact, losing someone or having a disabled person to take care of because of a medical error, like a husband for instance, involves many costs– the costs of home care, the costs of a long-term treatment, the loss of an income – that are not supposed to be incurred and that are not easily recovered for the majority of the Morocco’s population. And, even if sometimes the victims are compensated, only the economic damages are recovered but never the physical or the psychological damages. The 850,000 DHS that received Leila is certainly an important amount of money that will help her. However, it will never make her forget a much more important thing she lost: her children’s father and beloved husband.

Solutions to medical malpractice in Morocco:
As we have already mentioned, medical malpractice is an undesirable result of an unsuccessful surgery or treatment. This result might be due to the inconvenience of the medicine taken or due to the wrong analyze of the patient's sickness. Sometimes, the mistake could be corrected and sometimes it is irremediable. Moreover, medical errors are in most cases deadly. Usually, things get complicated and sometimes even cause the patient’s death even though he is told; in the first place, by the health providers that everything is going well. The relationship between doctors and patients should be based on sincerity. Therefore, doctors must keep their patients informed about each step they follow in order to cure them. Also, doctors must let their patients know if any kind of error has been made in case patients do not feel secure anymore and prefer to go to another hospital or see another doctor. Liam Donaldson, the president of the World Alliance for Patient Safety, which is sponsored by the World Health Organization and the Chief Medical Officer for England, declared that some actions considered as solutions to medical malpractice have proven their effectiveness in reducing the numbers of medical injuries which are increasing in many parts of the world. Also, he revealed that most of the prestigious hospitals that are trying to avoid medical errors did not succeed (M.Fadada).

To reduce the rate of medical errors we must recognize the existence of the problem and do not hide it or cover it up. Medical malpractice is neither a taboo nor a natural disaster but a result of human negligence and irresponsibility. In order to avoid this phenomenon, the ministry of health in Morocco has provided some significant solutions that must urgently be taken into consideration.

As a first step, we should encourage staff and patients to report any kind of medical errors and solve them within the place they occurred to avoid scaring people by the judicial laws and their complexity. Here is a famous story of a woman, who was show in 2M TV news in 2008. The woman was left after she had surgery without care until she died in the operating block. The family sued the hospital which has finally been closed by the government. As a second step, hospitals should find an easy mean of reporting medical errors such as the internet. Third, working hours should be reduced, the system of custody re-examined, and the number of patients per doctor taken into consideration.
Today, there are nearly 300 anesthetists in Morocco, the density or number of physician anesthetists per 100,000 inhabitants is 1/100.000. 70% of physicians anesthetists are concentrated in the center and 30% in the rest of the country. Over 40% of doctors who are specialized in anesthesia practise in the city of Casablanca. Therefore, in Morocco, the number of anaesthesiologists should be multiplied by 12 to meet the international standards of anesthesia safety (Abdelaziz Ouardighi).

Fourth, develop an appropriate system to determine whether the treatments administered to patients suits them or not. Fifth, the cooperation between the various health facilities should be facilitated in order to manage reducing medical errors, developping plans of action, and exchanging medical information. Last but not least, patients should always ask their doctors about the treatment they administer them, the doses prescribed, the frequency at which the treatment must be taken. In short, patients must feel comfortable while asking for information related to their health situation.

Conclusion:
Through the main points we covered in this research paper which are the causes, effects, and solutions of medical malpractice in Morocco, we aimed to highlight the harm of medical malpractice and show how much its serious negatuve consequences require an urgent government intervention to diminish the damages caused to both patients and hospitals. Obviously, many efforts are made by the government over both public and private sectors consisting in providing hospitals with sufficient materials of good quality, improving the training of future doctors, and finally acknowledging Moroccan citizens that, in case they have suffered malpractice, they have the right to claim damages by taking some specific steps also that they should be aware of the fact that doctors must take full responsibility and pay for their lack of responsibily and commitment. Nevertheless, many lacks still exist. In fact,nowadays, hospitals are still facing scarcity of materials and a lack of adequately trained healthcare providers what triggers irreversible physical, psychological, and economic damages on patients as illustrated with the cases of medical malpractice we provided throughout our research paper.

Today, as it has been confirmed through our research paper, Morocco is in an alarming situation regarding medicine. In order to address this issue, Morocco has to go through crucial modifications. Something must urgently be done before going to a hospital or seeing a doctor becomes one of people’s worst nightmares.

Annotated bibliography:
Source 1:
Akisra, Mohamed. "Victimes, bienvenues en enfer". Le matin.ma. Jouahri, Mohamed. , 16 Jan. 2008. Web. 09 Dec 2010.
Mohamed’s article « Victimes, bienvenues en enfer » is from Le Matin, a daily francophone Moroccan newspaper known for its royalist stances. In this article, the author talks about some causes and also some negative effects of medical malpractice through testimonies of people who decided to share their experiences and their pain with the general public. Furthermore, the article provides some reasons behind the lack of support faced by the victims of medical malpractice. According to Mohamed Akisra, Medical malpractice is a serious issue in Morocco due to several factors such as a lack of communication between doctors and patients and the lack of experts specialized in the study of the files concerning medical malpractice.

In this article, the author Mohamed Akisra provides information about some important issues related to our topic which is medical malpractice. In fact, he starts by providing some scandalous cases of medical malpractice among which we have cited 2 cases, in order to emphasize the existence of the problem in our country. Then, the author explains why the victims usually face a lack of support in these cases, and finally, he gives some solutions so that the victims become able to assert their rights. This article seems to be reliable since it was published recently in 2008 and last updated in December 2010. Moreover, in order to provide all these useful information, Mohamed Akisra had interviews with people who are strongly concerned by this issue such as doctors and the head of the national doctors’ syndicate. Finally, the website provides enough information about people who are in charge of it such as the phone numbers and email addresses of the general manager of publication and the responsible of the website updating. Overall, this article provides interesting information and good examples that we included in our paper. Even though there are several citations from people who are specialized in the field, the article does not seem to be addressing a specialized audience since there are very little technical words and the vocabulary employed is easily understood. Therefore, this source is exactly the sort of sources we need for our paper.

Source 2:
Ali, Siham. « Le Maroc face à une pénurie de médecins ». Magharebia. n.p. 05/14/10. Web. 08 /10/10.
This article is titled “Le Maroc face à une pénurie de médecins” written by Siham Ali. This means Morocco faces a lack of doctors. This source explains a cause of medical malpractice. The article did an interesting investigation about what happens in hospitals especially after midnight. The research shows that because of a lack of materials and health providers. They used an example of a doctor from a hospital in Rabat where his average of abortions a day is four to five. He explained that he must be excused if he made a mistake during the surgery. After all he is a human and by nature we can make mistakes. In brief, this article highlights for the first time that there is an implicit criminal behind medical malpractice which is the secretary of health.

The article is written by an official journalist in the national Moroccan journal Magharebia. Even if the writer doesn’t have enough information about her qualifications, the journal is supported by an accurate political party which is the Party of Justice and Development. Concerning the accuracy of the information, the writer cited the date of the interview with the secretary of the health department and the website has as first aim inform people not advertise object. The article post the date of publishing, this one may indicate when the material was first placed on the Web. Concerning the coverage, the article discusses the malpractice in morocco courageously. She made fun of the irresponsibility of the doctors and the health care providers.

Source 3:
Badi, Sara. "Les erreurs médicales, encore trop taboues." L’Economiste Magazine. n.p. 05 Oct. 2008. Web. 11 Nov. 2010.
Sara’s article “Les erreurs médicales, encore trop taboues” is from a monthly French magazine called L’Economiste Magazine. In this article, the author emphasizes some main causes behind medical errors in Morocco, and she also explains the reason why statistics related to medical malpractice in Morocco are usually not available. Although to err is human, medical errors are still a considerable taboo in Morocco. In fact, only few medical errors give rise to litigation because of patients’ ignorance, for instance, and also because there are no institutions that list cases of medical errors. Medical malpractice is a considerable issue in Morocco, but it is unfair to blame doctors for that since they work in extremely crude conditions. When victims of medical errors want to sue doctors, there is a specific procedure to follow.

In her article, Badi Sara tries to cover many different aspects of our topic which is medical malpractice. In fact, she gives information about some main reasons behind medical errors. She gives some specific and serious cases of medical errors, and finally she talks about procedures that are followed when patients decide to sue their doctors. Almost all paragraphs in this article give information that could easily be included in our research paper. Badi gives interesting information that seems to be reliable since this article was published recently in 2008. She quotes some Moroccan doctors, and she also gives some considerable cases of medical errors that we found also in other sources. She gives precise information about doctors’ punishment (amounts of money to pay and prison sentences). She reinforces her credibility when she says that she does not include statistics not because she does not find that it is necessary, but because there is a lack of statistics and she explains why. Finally, Badi does not seem to be addressing a specialized audience since she does not use any technical words, so the source is just right to our needs.

Source 4:
Dr. Belahmer, Mohamed Fouad. Personal interview. 07 Dec. 2010.

Source 5:
Bourrakadi, Mustapha. "Une nuit aux urgences de Rabat ". Maghress. Abdelatif Mansour. 09 Nov 2007. Web. 09 Dec 2010.
Bourkadi’s article “Une nuit aux urgences de Rabat” is from an Arabic website that contains all the Moroccans periodicals, and this article is from a journal titled MarocHebdo. In this article, the author highlights some causes that are due to medical malpractice in Morocco and he also gives some cases of medical errors that took place in Ibn Sina Hospital in Rabat. Moreover, he describes the structure of the hospital throughout his article and also the way patients are treated in this same hospital in order to demonstrate that these two factors play an important role in the commitment of medical errors.

The article “Une nuit aux urgences de Rabat” is written by Mustapha Bourrakadi, an official journalist and one of the chief editors of MaroHebdo which is a national Moroccan journal. The author cited the date of the day he made a visit to the hospital Ibn Sina in order to interview some patients. In addition, his article appears to be reliable since it has been published recently in 2007. Concerning the coverage, the article discusses without any taboo medical malpractice in Morocco. Finally, the content of the article is not hard to understand since Mustapha Bourrakadi do not use scientific or specific terms which made the incorporation of the information he provided easy for us.

Source 6:
El Fadada , Mohamed. “Medical errors in hospitals: crimes without evidence." Aman. n.p. 2008. Web. 10 Dec 2010.
El Fadada’s article “Medical errors in hospitals: crimes without evidence” is from an Arabic website titled Aman. In this article, the writer talks about all the issues related to medical malpractice. He begins by telling some dramatic stories that show doctors like businessmen who look only for money. Besides, he discusses the cases of medical errors that are ignored instead of being taken into consideration. Furthermore, the author provides information concerning the judicial laws related to medical malpractice in the Arab world and the changes that need to be made.
In his article, El Fadada Mohamed covers several main points of our topic. In fact, he made interviews with famous doctors in Palestine like Mrs. Tijani to discuss the main causes of medical malpractice and also to determine who are the people to blame for these medical errors. The author specified the date and the place of the interview which, we think, enhances his credibility. Also, he quoted some laws from the Moroccan judicial book and also some Moroccan lawyers specialized in medical malpractice probably to reassure the readers of his information. He also gave information about the compensations that victims get, and the health’s ministry control of private hospitals. In short, El Fadad seems to be touched by the victims of medical errors since he mainly focuses on what those victims could do to get compensation.

Source 7:
Khabouze, Rabie. “Anesthésie-réanimation : Réalités et perspectives". Maroc info.
n.p. 06-02-2006. Web. 10 Dec 2010.
Khabouze's article talks mainly about the shortage of doctors in Morocco especially anesthetists. In general he did not talk about medical malpractice as a main topic; in contrast, he discussed the lack of professionalism in anesthesia field, which is an implicit cause of medical errors.
The article is rich in terms of the statistic used to highlight the need of anesthetists. In fact, these numbers are taken from Register 2005 of the Moroccan's health ministry concerning health statistics. This source gives to the article both reliability and accuracy. Concerning the coverage, it is about anesthetists in Morocco which may seem not related to our topic. However, since it explains that there is a lack of anesthetist in Morocco, the article is linked to our topic and especially the first part concerning the causes of medical malpractice in Morocco.

Source 8:
Lamlili, Nadia. "Erreurs médicales. La loi du silence". Tel Quel Online. n.p. 15 June 2007. Web. 10 Dec 2010.
In her article, the author, Nadia Lamlili, begins by giving a case of medical malpractice that we used in the second part of our paper. After explaining what happened to the victims, she gave some information about medical errors from a legal perspective. In fact, she defines “a medical error” according to the law and she also explains doctors’ role. Then, Nadia provided additional cases of medical errors but only cases where the victims sued their doctors, claimed their damaged and managed to obtain them. In short, in this article, Nadia gives information from two different perspectives: the one from which doctors look at things and the one from which experts in law look at things.

Nadia’s article was published only three years ago, in 2007. The case of medical malpractice that we used from it is a case that we have already heard about. Furthermore, we found many other websites relating this specific case. We chose to take it from this article in particular since it provides much more details than the other articles from other websites which, for us, was a sign of reliability. Moreover, we did some research on its author Nadia Lamlili and, we found an interview with her on La Marocaine.com. Nadia first became a journalist in 1998 for the daily magazine L’Economiste. In 2005, she got the prize for the best African journalist of the francophone press concerning an investigation about illegal immigration. Nadia joined the editorial stuff of the magazine Tel Quel in 2006 and in 2008 she has been appointed chief editor of Economie&Entreprises. After we found out about Nadia’s career path, we considered that we could judge her article as reliable source of information.

Source 9:
Mark Slay “Medical Malpractice”. The Canadian Bar Association . Stephen G McPhee. April 2010. Web. 10 Dec 2010.
Mark slay’s article “Medical Malpractice” is an article from a Canadian website which is the Canadian Bar Association. In this article the author gives a clear and developed definition of medical malpractice. In fact, he discusses different types of medical errors and explains the steps that should be taken by every person who suffers these medical mistakes.
The article titled “Medical Malpractice” is written by Mark Slay who is an official writer for the Canadian bar association who graduated from the University of Victoria Law School. This article appears to be reliable since we have a lot of information about the author, the date of publication, and the president of the website. Concerning the coverage, the author gives an obvious definition of medical malpractice which we considered significant for our introduction.