From the unbelievable to the ultra-ridiculous in Costa Rica, Doctors who commit mala praxis – malpractice – are exposed to a suspension, yes, a suspension and a ¢200 colones fine, due to an obsolete law dating back to 1962.
If the Ethics Tribunal of the College of Physicians (Tribunal de Ética del Colegio de Médicos) or Medical Association determines the liability of one of its members in a case of malpractice, it only has the power to suspend the medical doctor for a period of 4 months.
In addition, as there is a principle of innocence, medical professionals suspected of negligent injury can continue to practice their profession, despite the suspension.
The debate on this issue has resurfaced with the death of a 41-year-old woman, identified publicly only by her last name Méndez, on November 3, who underwent a liposuction and was-apparently-sedated by a general practitioner, and not an anesthesiologist.
The case is now being investigated by the Ministerio Público (Public Prosecutor’s Office) for the alleged crime of negligent injuries in the form of malpractice.
Authorities raided the Clínica Costarricense de Medicina Estética, located in Rohrmoser, where the operation was allegedly carried out.
The raid also included the offices of the Emergencias Médicas company, which had transferred the victim to the San Juan de Dios hospital, after the complication.
In the clinic, a cell phone, a computer and the medical file of the deceased woman were confiscated; while at the transport company the call sheet was sequestered and the testimonies of those who were responsible for attending to the patient were taken.
Mauricio Guardia, a prosecutor of the College of Physicians said that at the level of the Code of Ethics of the entity and judicial level the principle of innocence is maintained until it is proven otherwise, so, while the process is carried out, there is no suspension of license.
“When there are wrongful injuries or there is intent, an attempt on the life of the patient, then the case goes to the courts and they are the ones who can order preventive detention (remand) or other sanction. At the College level, it is obvious that as long as it is not possible to verify, we cannot suspend the practitioner. Unfortunately this is the law that governs us,” he explained.
The prosecutor described the law as “ridiculous and obsolete” because the economic fine in that law in case of finding the doctor guilty of malpractice is ¢200 – two hundred – colones. That is 31 US cents at today’s exchange rate or about two US dollars when the law went into effect.
As to the suspension, the maximum the College can levy on a member is 120 days and that is for a ‘very serious’ infraction.
“The Ethics Tribunal will decide whether to consider it (the infraction) serious, very serious or a minor offense. The maximum sanction we can give is 120 days for what the law says. That’s ridiculous! (…) they (the doctors) know that the law is so weak, they do not care (…),” explained Guardia.
In recent years aesthetic clinics have proliferated and are promoted with “combos” (multiple procedures) at ridiculous prices, where general practitioners perform the techniques.
For its part, the Ministry of Health says it does not correspond to them to establish limits to the medical function, because that is the task of the College and that its function is reduced to grant operating permits to establishments: that is, permits for the compliance with the infrastructure standards (ie building and sanitary conditions), the documentation for same is up-to-date and that human resources (doctors) are duly integrated in the College of Physicians.