Israeli doctors angry at change to complaints' proceduresBMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7261.592/b (Published 09 September 2000) Cite this as: BMJ 2000;321:592
Responsibility for investigating Israelis' complaints against doctors will be shifted from committees appointed by the health ministry to a special justice ministry panel, Israel's new health minister, Roni Milo, announced less than three weeks after he took office.
Mr Milo, a lawyer by training, did not consult with officials in the Israel Medical Association before making his decision, and informed the justice minister only 10 minutes before his announcement.
The new panel will not only investigate complaints but will also decide if a doctor has been negligent and whether he or she should be punished.
Until now, the health minister has had the sole responsibility for deciding the professional fate of doctors accused of negligence, and could take decisions completely at variance with disciplinary boards' recommendations. An appeal against the minister's decision could be made only before Israel's Supreme Court.
The health ministry's committees have a record of dismissing a high proportion of patients' complaints. In 1999 the ministry's committees dismissed 765 out of 792 complaints. The comparable figures for 1997 and 1998 were 602/615 and 700/715 respectively.
When Mr Milo served as police minister several years ago, he ordered that investigations of complaints against policemen be handled by the justice ministry, and not by an internal committee of the Israel police. This decision was welcomed by the public, who regarded the new system as more transparent and fair. Now as health minister, he has decided to adopt the same technique for complaints against doctors.
As the health ministry owns and operates dozens of government run general, geriatric, and psychiatric hospitals and employs thousands of doctors, the health minister felt that conflicting interests would prevent justice from being done and seen to be done.
Although changes would require legislation to be pushed through the Knesset (parliament), Mr Milo said that he would immediately refuse to change the recommendations of doctors' committees that investigated complaints.
Lawyers representing patients have repeatedly complained that senior doctors are reluctant to testify as experts to protect colleagues under investigation or merely as a collegial courtesy. Under Mr Milo's proposal a committee of two retired doctors and one retired judge would decide the cases.
In the current system, complaints against doctors are sent to the health ministry's medical ombudsman, who considers the complaints and then decides whether there is enough merit to bring it to an investigation committee.
If the ministry's director general agrees that there is solid evidence of negligence, the legal department prepares a case, which is sent for hearing by a disciplinary board of practising doctors. These boards recommend whether the doctor should be found innocent, reprimanded, suspended, or have his medical licence withdrawn. This process usually takes years, by which time witnesses have forgotten details or even died.
The minister's announcement shocked and amazed doctors' groups. “It's unthinkable that such reform can be carried out by shooting from the hip,” commented the Israel Medical Association's chairman, Dr Yoram Blachar. “He decided without consulting professionals about a difficult subject that many of his predecessors wrangled with.”
Dr Blachar admitted that reform was needed. “But it must be done carefully and with consideration,” he said.
Other doctors, however, argued that the association's recent commitment to not to strike in exchange for a long term wage contract and mediation committee on future wage disputes made it impossible for doctors to put up a fight against Mr Milo's proposals.
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