SIN Nederland

Stop Medical Errors NOW!

Important:

Black List
Physicians and Hospitals

Tell & Repair
Legal Proposal

For international developments
concerning medical
errors and patient
safety see:
www.ieu-alliance.eu

Please report
medical errors to:
info@sin-nl.org

Reports on patient safety

Eight Futures Forum
WHO 2005 Governance of Patient Safety (3.35mb)

When things go wrong, responding to adverse events
Harvard rapport 2006

International

International

SIN-NL partner with American organisation for patient safety, 25th January 2008

Tell and Repair proposal for legal provision, June 2007.

IEU-alliance Manifesto 2007 to improve the quality of healthcare in the EU, march 25th 2007

Physicians indeed refuse medical care to patients, USA and New-Zealand 2006

Harvard Consensus Report, March 2006.

Physicians exclude litigious patients from medical care, JAMA 2005.

WHO report on Patient Safety

IEU-Alliance

The IEU-Alliance, the Declaration and SIN-NL

Declaration IEU-Alliance

SIN-NL partner with American organisation for patient safety, 25th January 2008

25th January 2008:

SIN-NL establishes partnership with American organisation for patient safety:
zie Patient Safety.com.

Tell and Repair proposal for legal provision, June 2007.

Tell and Repair provision as extension of Laws on Medical Treatment Agreement.
June 2007, to be implemented as soon as possible.
Based on Harvard Consensus Report(2006) When Things Go wrong: Responding to Adverse
Events, discussed at workshop Position of the Patient by Sophie Hankes SIN-NL/IEU-alliance
Congress Blamefree Reporting, KNMG Utrecht, 24 November 2006.

What is the wish of a patient when he/she is damaged by a medical error? Put yourself in
his/her place: what would I want if I were hurt by treatment? What is the right thing to do?
Guiding principles concerning disclosure directly after the medical error:
1.Report only the facts of the error, what happened.
2.Give reliable information as soon as this is available.
3.Explain which follow-up diagnostics and remedial medical care are recommended.
4.Explain the implications for the prognosis

Open and full disclosure:
1.Tell the patient and family what happened.
2.Take responsibility.
3.Apologize.
4.Explain that the error will be examined.
5.Explain what will be done to prevent recurrence of the error.

Who and how to communicate:
1.A trusted caregiver should lead the initial communication.
2.The person responsible for next steps in care should lead subsequent communication,
possible in presence of person of choice of patient/family.
3.Include primary nurse in communication, if this is the wish of the patient/family.
4.Include member of staff with special communicaton skills.
5.Choose a quiet, neutral area for communication, not the room of the CEO.

Follow-up communication:
1.Conduct follow-up sessions promptly. Apologize in case of delay.
2.Physician who is responsible for care should lead sessions. Involve CEO in case first
communication was not successful.

Support and follow-up medical care for the patient, family and caregiver:
1.Take each patient/family concerns serious and be respectful.
2.Maintain the therapeutic relationship, provide appointments. Do not abandon the patient.
3.Put all billing on hold pending analysis of the event.
4.Investigate possible means for providing financial support and provide if necessary financial
compensation.
5.Provide if necessary psychological and social support.
.Provide if necessary psychological counselling for the physician/nurse who caused the error.

After the medical error the following is essential:
-honest and open information : what happened.
-follow-up diagnostics to determine the damage and follow-up remedial medical care to
mitigate or repair the damage.
-registration and examination of the error to prevent recurrence and to learn from errors.

IEU-alliance Manifesto 2007 to improve the quality of healthcare in the EU, march 25th 2007

Iatrogenic Europe Unite -Alliance www.ieu-alliance.eu

Manifesto 2007 Year of and for Victims of Medical Errors published on the occasion of the 50th anniversary of the European Union 25th of March 2007

In order to improve transparency and the quality of healthcare:
* Introduction of the �Tell and Repair� protocol based on the Harvard Consensus Report March 2006 to the benefit of victims of medical errors.

* Introduction of �Tell and Repair� protocol as well and patient safety in medical education as well as introduction of obligation for yearly attendance of post-graduate training for qualified physicians and healthcare professionals.

* Introduction of positive incentives for physicians, nurses and other healthcare professional to report medical errors to the national authorities and to inform patients about medical errors. Likewise introduction of sanctions against those who do not report nor inform the patients. Introduction of statutory reporting system, analysis and prevention system.

* Introduction of a National Reporting Center for victims of medical errors in combination with the installment of a National Independent Mediator who is qualified to interfere immediately on behalf and to the benefit of the victims of medical errors.

* Statutory obligation: medical records are only valid after written authorization of the patient.
* Sanctions for not providing full and correct medical records to patients at first request.
* Statutory obligation for healthcare insurers and physicians to provide the patients with the ICD-10 codes of their illness and to provide copies of all bills of physicians and hospitals.

* Statutory obligation to include representatives of victims of medical errors in discussions and decisions on medical errors, the victims and patient safety.

* Statutory obligation to offer mediation for medical errors in stead of legal procedures.
* Statutory obligation to offer no-fault system in stead of tort-system.

* Statutory obligation for the national Health Care Inspectorates in all EU-countries to record the status of doctors in EU-countries concerning verdicts of professional dysfunctioning and to make that information available for EU-citizens.

* Installment of truth commissions to investigate medical errors and the position of victims.

* Installment of national parliamentary inquiry per country as well inquiry of European Parliament to examine medical errors, the position of victims and patient safety in general.

- May these innovations improve the quality of healthcare to the benefit of all those involved -
office@ieu-alliance.eu www.ieu-alliance.eu

Physicians indeed refuse medical care to patients, USA and New-Zealand 2006

Comment SIN-NL:
These two articles on New Zealand and the USA describe the refusal of medical care -in terms of avoidance or withdrawal- to litigious patients of ao victims of medical errors.
Physicians in the Netherlands have confirmed to SIN-NL that refusal of medical care to litigious patients also occurs in the Netherlands.
Some physcians do not appreciate assertive patients and regard them as potential adversaries. This is certainly a negative development.
SIN-NL pleads for mutual honesty, transparancy and evidence-based medicine, in order to develop and maintain a positive physician-patient relation.

N Z Med J. 2006 Oct 27;119(1244):U2283
Defensive changes in medical practice and the complaints process: a qualitative study of New Zealand doctors.
Cunningham W, and Dovey S. Department of General Practice, Dunedin School of Medicine, Dunedin. wayne.cunningham@stonebow.otago.ac.nz

AIM: To characterise doctors' responses to complaints.
METHOD: Survey of a systematic sample of New Zealand doctors, and indepth interviews with 12 doctors who recently received complaints.
RESULTS: 714 written survey responses and 12 indepth interviews revealed changes consistent with positive and negative defensive medicine as well as changes in the direction of "good practice". Positive defensive medicine changes were increased investigation and referral rates, active identification of potential problem patients, over-documentation and consenting, and altered approaches to time and workload. Negative defensive medicine changes involved withdrawal from the doctor-patient relationship and particular fields of practice. Good practice changes included reflective practice, greater sensitivity to societal and professional expectations, and initiating systemic change.
CONCLUSIONS: The complaints process in New Zealand has the potential to improve healthcare delivery at a systemic level and to reinforce appropriate standards of professional behaviour, but it may cause individual doctors to practice defensively. Unless an appropriate educational process is allied to the complaints process, defensive medicine may compromise patient care and constrain potential improvements in healthcare delivery overall.
PMID: 17072358 Pub Med

The doctor-patient relationship: A casualty of the medical liability crisis
By Stuart L. Weinstein, MD
Bulletin American Academy of Orthopedic Surgeons, December 2006.
Important parts of the text are printed in bold.

The orthopaedic profession exists for the primary purpose of caring for the patient. The physician-patient relationship is the central focus of all ethical concerns,� reads the AAOS Code of Medical Ethics and Professionalism for Orthopaedic Surgeons.1 But the current medical liability crisis is jeopardizing that relationship on several levels.

The current medical liability crisis has been ongoing for the past five years. Although there has been some progress in passing tort reform on the state level, a federal solution remains elusive. The success of California�s Medical Injury Compensation Reform Act (MICRA) legislation over the past 30 years, and the more recent constitutionally sustained reforms in Texas in 2003, give objective evidence that meaningful liability reform can bring common-sense resolution to the crisis.2 Medical liability insurance premiums may have stabilized, but they remain exorbitant in most states.

National debate on tort reform centers on the two main effects of the crisis�decreasing access to care and increasing health care costs. But the most important aspect of medicine and the delivery of health care�the doctor-patient relationship�is also one of the unintended casualties of the crisis. The evolution of this relationship�a direct result of the current crisis�will affect all aspects of health care for a generation to come. This article briefly addresses the changing doctor-patient relationship and its impact on other aspects of the medical liability crisis.

Turning patients into adversaries
The AAOS Code of Medical Ethics and Professionalism states that: �The physician-patient relationship has a contractual basis and is based on confidentiality, trust, and honesty�The orthopaedist shall not decline to accept patients solely on the basis of race, color, gender, sexual orientation, religion, or national origin or on any basis that would constitute illegal discrimination.� But can a physician decline to accept trauma patients, who evidence suggests are more litigious than other patients, or patients that the physician �perceives� to be litigious? In fact, an increasing number of physicians are doing just that.3,4

Recent articles on the doctor-patient relationship in the current medical liability crisis indicate that physicians are increasingly viewing patients as potential adversaries. This has profound effects on physician behavior, on health care costs (resulting from defensive medicine expenditures), on the distribution of physicians and on the career choices of medical students.

In a 2004 study, researchers reported that 40 percent of Pennsylvania specialist physicians surveyed were dissatisfied with the practice of medicine as a result of the medical liability crisis, and many said that they viewed every patient as a potential lawsuit.5

Residents�regardless of medical discipline�are beginning to reflect similar attitudes. One study examined the effects of the liability crisis on residents who took their training in Pennsylvania. Of 360 residents in anesthesiology, emergency medicine, general surgery, orthopaedic surgery and radiology, 80 percent stated that they viewed every patient as a potential malpractice lawsuit. One-third stated that they were less candid with patients because of medical liability concerns. Sadly, two out of three said they were less eager to practice medicine than they had once been, and nearly 28 percent regretted choosing medicine as a career.6

The impact of the crisis even reaches medical students; according to statistics from the American Medical Association, 95 percent of medical students are aware of the current crisis and almost half say that it played a part in their career choices. Because of the high liability risks associated with the practice of obstetrics and gynecology (Ob-Gyn), approximately one-third of U.S. Ob-Gyn residency slots went unfilled during the last few years.7

The Common Good Web site quotes one emergency physician as saying, �I now view every patient I see as a potential lawsuit� and �The threat of lawsuit is hovering out there, hovering somewhere in the air between me and the patient on the stretcher, invisible but with a presence as strong as a third person sitting and listening to the conversation waiting for the right time to simply come out in the open.� These attitudes profoundly affect the doctor-patient relationship and upset the entire health care dynamic. They also result in increased health care spending and decreased access to care.

Practicing defensive medicine
Doctors who view patients as potential adversaries can contribute to increasing health care costs by practicing defensive medicine. A survey of specialists in Pennsylvania found that 93 percent reported practicing defensive medicine, and 92 percent reported �assurance behavior.�4

Assurance behavior can be defined as �supplying additional services of marginal or no medical value with the aim of reducing adverse outcomes, deterring patients from filing malpractice claims or persuading the legal system that the standard of care was met.� It includes ordering tests (particularly imaging tests), performing diagnostic procedures and referring patients for consultation. Other assurance behaviors include ordering more medications than medically necessary, particularly antibiotics; suggesting invasive procedures�such as breast biopsies�to confirm diagnoses; and performing extensive workups and requiring hospitalization for atypical chest pain in low-risk patients. As the study authors pointed out, the more this practice is perpetuated, the more likely it is to become the �standard of care.�4 Assurance behavior has also been documented in a recent study of emergency physicians.9

The Pennsylvania study also found that 42 percent of surveyed physicians reported �avoidance behavior.�4 Avoidance behaviors reflect physicians� efforts to distance themselves from sources of legal risk and may include restricting practice, eliminating high-risk procedures and procedures prone to complications (trauma surgery, pediatric surgery, vaginal deliveries, cancer surgery, spine surgery, cranial surgery, aneurysm surgery), and avoiding patients with complex problems or patients �perceived� as litigious. This profoundly affects access for patients in rural areas where alternative choices of care are limited.

In Pennsylvania, 42 percent of specialists have reduced or eliminated high-risk aspects of their practice and 50 percent are likely to do so over the next two years.11

Limiting access
The Institute of Medicine�s recent report on emergency care in the United States documented the critical shortage of specialists in certain areas of the country. As a result, many emergency rooms are closing and patients must travel long distances for basic care.3, 10 Access is also restricted because physicians change their practices, stop doing high-risk procedures, stop taking emergency room duty, and stop taking care of trauma patients.

A survey of AAOS members in four crisis states found that 58 percent have discontinued or limited their emergency room coverage, 33 percent have stopped doing spine surgery and 33 percent have eliminated other high-risk procedures or complicated trauma cases. At the same time, increased referrals to academic health centers placed greater pressure on these facilities.

Nationwide, the two groups most affected by the access issue are women and those who live in rural areas. Women are affected because one in seven Ob-Gyns no longer delivers babies. In some areas, such as Washington, D.C., that number is up to 40 percent. Of those who do deliveries, a significant number will not take any high-risk cases. Women are also affected because of the shortage of physicians willing to read mammograms. Rural residents are affected because of the lack of availability of on-call specialists, which contributes to the closure of emergency rooms and increases the distance patients must travel for basic care.

The U.S. House has repeatedly passed liability reform measures, but these have not passed the Senate, where Republicans have generally supported reform while Democrats have prevented the measure from even coming up for a vote. However, the effects of the crisis are now being recognized even by those senators who have voted against reform.12 During the summer of 2006, both chambers held hearings on medical liability reform.

Without prompt resolution of the current medical liability crisis, the change in the doctor-patient relationship may be irreparable. The practice of �defensive medicine� will establish standards of care that can only lead to continued increases in health care costs.

Stuart L. Weinstein, MD, is chair of the Orthopaedic Political Action Committee. He also serves on the AAOS Medical Liability Committee, representing Doctors for Medical Liability Reform.

References:

AAOS Code of Medical Ethics and Professionalism for Orthopaedic Surgeons
Hull MS, Cooper RB, Bailey CW, Wilcox DP, Gadberry GJ, Wallach MD. �House Bill 4 and Proposition 12: An Analysis with Legislative History.� Texas Tech Law Review. Special Supplement to Volume 36, 2005.
Institute of Medicine. Emergency Medical Services At the Crossroads. National Academy of Science, June, 2006.
Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293:2609-2617.
Mello MM, Studdert DM, DesRoches CM, et al. Caring for patients in a malpractice crisis: physician satisfaction and quality of care. Health Affairs. 2004;23:42 -53
Mello MM, Kelly, CN. Effects of a professional liability crisis on residents� practice decisions. Obstet Gynecol 2005;105:1287-1295
Personal communication, John Gibbons, MD, American College of Obstetrics and Gynecology.
Common Good Web site
Katz DA, Williams GC, Brown RL, et al. Emergency physicians� fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med: 2005;46:525�33
www.acep.org/webportal/Newsroom/NR/general/2006/050206.htm
Mello, MM, Studdert DM, DesRoches CM, et al. . Effects of a malpractice crisis on specialist supply and patient access to care. Ann Surg. 2005;242(5):621-628.
Clinton HR, Obama B. Making patient safety the centerpiece of medical liability reform. New Engl J Med. 2006;354:2205-2208
costs.

Harvard Consensus Report, March 2006.

A major breakthrough:
16 hospitals in and around the Boston area, USA adopted the goals of SIN-NL and the IEU-Alliance:
-full, open and honest disclosure to the patient on the medical error and the damage
-providing genuine follow-up diagnostics and remedial medical care to mitigate the damage
These goals should be implemented as soon as possible in the Netherlands, Europe and globally.

TO DOWNLOAD HARVARD CONSENSUS STATEMENT
When things go wrong: Responding to adverse events.

Physicians exclude litigious patients from medical care, JAMA 2005.

Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment

Research shows that physicians exclude patients who are medically complex and litigious patients e.g. victims of medical errors from medical care.

David M. Studdert, LLB, ScD, MPH; Michelle M. Mello, JD, PhD, MPhil; William M. Sage, MD, JD; Catherine M. DesRoches, DrPH; Jordon Peugh, MA; Kinga Zapert, PhD; Troyen A. Brennan, MD, JD, MPH
JAMA (Journal of American Medical Association). 2005;293:2609-2617.

Context How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate.

Objective To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment.
Design, Setting, and Participants Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003.

Main Outcome Measures Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior).
Results A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents� lack of confidence in their liability insurance and perceived burden of insurance premiums.

Conclusion Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.

Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health (Drs Studdert, Mello, DesRoches, and Brennan), Department of Medicine, Harvard Medical School (Dr Brennan), and Department of Medicine, Brigham and Women�s Hospital (Dr Brennan), Boston, Mass; Columbia Law School, New York, NY (Dr Sage); and Harris Interactive Inc, Rochester, NY (Mr Peugh and Dr Zapert).

WHO report on Patient Safety

WHO developments

The WHO acknowledges the necessity of:
political will, professional will and moral leadership to improve patient safety.
See: Eight Futures Forum WHO report on Governance of Patient Safety
Erpendorf, Austria 2005
click here

The chance to die in an air crash is one in three million.
The change to be subject of a serious medical error is one in three hundred according to the WHO.
Various prestigious researchers conclude that one in six patients in hospitals are subjected to medical errors.
In more than 30 public researches on fatal medical errors within the National Health Service, the same causes were mentioned: isolation, inefficient systems and processes, poor communication and inadequate management/leadership.
The WHO report on the Futures Forum 2005 describes the following seven major sins in dealing with patients and their safety:
1.arrogance
2.denial
3.blaming others
4.attacking the messenger
5.to turn away/ not willing to see
6.inability to think about systems
7.passive learning

Co-operation and systematic evaluation
WHO-Europe concludes that in order to achieve solutions for more patient safety the following items are essential:
Political will, professional will, leadership, trustworthy data, patient empowerment.
Also a change of culture is necessary ,which implies more teamwork. As communication is vital for teamwork it will have a preventive influence. Last but not least systematic evaluation is necessary a.o. via the development of quality-indicators.

IEU-Alliance

It is clear that the experiences of victims of medical errors are unfortunately universal, especially the prevalence of the interests of the colleague-physician over the interests of the damaged patients. Physicians retreat from their responsibility towards iatrogenic patients to inform them about the occurrence of the medical error and the extent of the damage, and to provide genuine diagnostics and remedial medical care.
The Iatrogenic Europe Unite-Alliance has been founded to improve the position of iatrogenic patients , victims of medical errors and patient safety in general.

Iatrogenic means caused by medical treatment. The name is chosen on one hand to call upon patients-victims to unite their forces and on the other hand to call upon dialogue between physicians and iatrogenic patients.

The website of this alliance can be found on this URL: www.ieu-alliance.eu
Participants are:
SIN Sufferers of Iatrogenic Neglect, England
DPSB Deutsche Patienten Schutz Bund, Germany
Notgemeinschaft Medizingeschaedigten Bayern, Bavaria Germany
Patientforeningen Danmark, Denmark
Patient Focus, Ireland
AMNA Action against Medical Neglicence Association, North Ireland
SIN - NL Slachtoffers Iatrogene Nalatigheid, The Netherlands

The IEU-Alliance, the Declaration and SIN-NL

Since the first meeting of the IEU-Alliance on the 17th of November 2004 in Dormagen, Germany SIN-NL functions as co-ordinator of this European organisation. The aim is to improve the patient safety and the quality of the healthcare, especially the position of the iatrogenic patients, on a national and international level.

July 2005 the second convention of the IEU-Alliance took place in Utrecht. The Declaration of the IEU-Alliance describing the position of iatrogenic patients and necessary improvements ao statutory obligations of honest and open disclosure and registration of medical errors as well as the obligation to provide genuine follow-up diagnostics and remedial medical care was signed by the participating members.

In November 2005, during the third convention of the IEU-Alliance in London, the declaration was presented to Martin Fletcher and Susan Sheridan of the World Alliance Patients for Patient Safety of the WHO.

On the 28th of November 2005 the Declaration was presented to a representative of Tony Blair at Downing Street 10, as well as a representative of Sir Liam Donaldson Chief Medical Officer of the Department of Health in the UK and the Chair of the World Alliance for Patient Safety WHO.

In January 2006 SIN-NL had a meeting with Mr G. Schmetz of the regional office of the WHO in Copenhagen. Mr Schmetz also received the Declaration of the IEU-Alliance.

On the 13th of March 2006 the IEU-Alliance was received in Strasbourg by Alexander Vladychenko, Director General of the department Social Cohesion of the Council of Europe and presented its Declaration.
Mr John Bowis, former Minister of Healthcare in the UK and a member of the European Parliament met the IEU-Alliance and received the Declaration prior to the plenary session of the European Parliament, March 13th. In his speech to the European Parliament he made clear mentioning of the plight of iatrogenic patients.

On the 22th of March 2006 in Brussels Karl-Heinz Florenz, Chair of the Commission of Public Health, Environment and Foodprotection of the European Parliament discussed the position of iatrogenic patients as described in the IEU-Declaration and clearly stated his support to the delegation of the IEU-Alliance.

On the 5th of April 2006 SIN-NL presented as co-ordinator of the IEU-alliance the IEU-Declaration to Mr Hoogervorst, Minister of Health in the Netherlands during the conference �faster better� at the Academic Hospital of the Free University in Amsterdam.

On the 9th of May 2006 Dr. H. Molendijk, Chair of the Platform for Patient Safety of the Netherlands received the IEU-Declaration. He would discuss participation of SIN-NL with the Royal Dutch Medical Association.

On the 22nd of May 2006 SIN-NL presented the IEU-Declaration to Mrs. I. van Bennekom, director of the National Patient Consumers Federation. Both organisations agreed to start cooperation, a very positive development.

In the period of June 2006 till January 2007 SIN-NL/the IEU Alliance attended many congresses. Several meetings on toplevel have been arranged at which the IEU-Declaration was presented and discussed.
We will keep you informed on the developments.

On behalf of SIN-NL and the IEU-Alliance all efforts will be made to improve Patient Safety and the position of the iatrogenic patients.

Declaration IEU-Alliance

On Sunday morning, 21st. November 2004, in north Germany at a small town of Dormagen a momentous meeting took place of the First European Convention of patient support groups for the innocent victims of medical errors. It was an historic moment. In all, seven organisations were represented from six European countries. On the 3rd of July 2005 the second IEU-Alliance took place in Utrecht, Netherlnads and on the 27th of November 2005 the patient support groups met at the third Convention in London, England. The 12th of March 2006 the IEU-Alliance met for the fourth Convention in Strasbourg, France.

All groups present emphasised that medical care for the majority in Europe is very good, but inevitably mistakes occur and some of these have serious consequences to the patient. Recent research in the USA, UK and Australia show that about 10% of patients are harmed by medical errors. Of these approximately 1% have very grave consequences causing deaths and serious permanent injury. This means that medical errors have caused the deaths and serious disability of thousands of patients throughout Europe. These patients are left with a very poor quality of life and many are deprived of their means of economic livelihood. In addition, such medical mistakes cause enormous costs to European social systems.

During the meeting information was exchanged on the trauma and problems that were experienced by the victims of medical errors throughout the European countries represented. There was a remarkable unity of purpose and empathy between the member groups of the Convention as it became apparent that iatrogenic patients throughout Europe were facing similar problems.

The victim/relatives of serious medical errors can experience:

Deaths due to medical errors are seldom disclosed honestly to the grieving relatives who are then left in trauma and unable to obtain closure.
Denial of truthful information about the nature and extent of the iatrogenic medical condition. Evasive health professionals give misleading information because they have difficulty in coping with the results of the error. Also, they are often forbidden by their employer and/or medical insurers from disclosing evidence of damage. This develops into a conspiracy of silence known as a 'cover up'. No injury = no lawsuit..
Great difficulty in obtaining a full set of correct medical documents: the critical ones are often missing and some, to the patient's knowledge, have been falsified, in some cases no records are available.
Derogatory remarks with unfounded 'psychiatric' labelling are discovered in medical records.. This results in a character assassination with the sole purpose of discrediting the patient, and can be catastrophic, making it almost impossible for the patient to access much needed genuine diagnostic and remedial medical care. This destroys the patient's well being and in the worse cases puts the patient's life at risk.
Denial of genuine diagnostics and treatment effectively blacklists the patient, for to give remedial care would be to acknowledge that damage has occurred.
Difficulty or denial of genuine second opinions - the professional 'closing of ranks' apparently is an international phenomenon.
Great difficulty in pursuing the legal route to claim for justifiable compensation because of the excessive costs; the refusal of most medical experts, save for the dedicated few, to speak out against their colleagues; and the difficulty in finding competent medico-legal lawyers. This effectively sabotages any financial redress.
Iatrogenic patients are perceived as being potential litigants - personae non gratae - and therefore to give them the truth about the medical damage suffered is seen as giving them valuable information that would allow them to win a law suit. Therefore the barriers come down.
The professional allegiance appears to be stronger than allegiance to the vulnerable and innocent patient for whom both physicians and surgeons have an ethical, moral and legal commitment to provide genuine medical care.

The 'Hit and Run' analogy of the car accident best describes the medical error situation in which most seriously damaged patients find themselves. Health professionals, unlike car drivers who accidentally have an accident resulting in the death and serious maiming of other road users, have the option of not reporting that a serious medical accident and death has occurred. In fact they may ignore their moral and legal obligation to organise genuine remedial care for the injured victim, so denying that damage has occurred. Any car driver being so irresponsible would receive a prosecution. The denial of information and the refusal of genuine remedial care after the occurrence of a medical error is a tragic, unfortunate, but exact analogic example of the 'hit and run' phenomenon after a car accident. The groups represented below believe that the above constitutes medical abuse of damaged patients and contravenes Article 25 Universal Declaration of Human Rights United Nations 10/12/48. The Issue of European Human Rights for Patients should also be addressed.

There should be serious national and international meetings for dialogue with damaged patients and their support groups concerning the unnecessary problems facing the iatrogenic patient, the most immediate one being that of arranging genuine remedial specialist care. The present culture of 'denial and cover-up' needs to be changed to one of 'openness and honesty' when health professionals are able to be truthful with their damaged patients.

The Convention demands that patients should be fully protected and their rights be put in statute:
- Statutory obligation for health professionals to disclose & report all medical errors and in particular any medical error that has harmed a patient.
- Statutory obligation to give an open, full and honest disclosure of the occurrence of the medical error, and the extent of damage sustained by the patient - to the patient and his/her family,
- Statutory obligation to provide genuine remedial medical care for the iatrogenic victim.
- Statutory obligation to provide fair compensation in case of serious iatrogenic damage - a Victim's Compensation Fund.
- Full access and control over medical records, checked by the patient for accuracy before release onto any Electronic Data Base, including rights to full copies of all manual and computer coded records.
- Developing national and international systems of recording medical errors with their route cause analysis and a statutory obligation to include the patient's experience.
- Developing national and international systems of improvements of healthcare by preventing medical errors.
National Governments & Health Authorities European Institutions The World Health Organization (WHO) in addition to National, European and International Medical Organizations ( Physicians & Surgeons )

�to fulfill their moral, ethical and legal responsibilities towards the iatrogenic patient.
This IEU Convention is calling for a culture change that would be of mutual benefit to both doctor and patient producing a true healing relationship between the physician and patient.

IEU Convention Declaration supported by the following Patient Support Groups:
Action on Medical Negligence Association (AMNA Northern Ireland)
Deutscher Patienten Schutz Bund e.V. (DPSB N. Germany);
BAG-Notgemeinschaft Medizinigeschaedigter Bayern ( Bavaria S. Germany)
Patientforeningen Danmark (Denmark)
Sufferers of Iatrogenic Neglect (SIN Great Britain)
Patient Focus (Ireland)
Slachtoffers Iatrogene Nalatigheid-Nederland (SIN - Netherlands)