Ammon – Interviewed by Mohammad Jamil Khadr – Lawyer and researcher Dr. Nasser Abu Roman believes that Jordan has made significant progress in the field of legal accountability. He asserts that bridging some gaps in legislative policy will position us at the forefront of countries in the region, and possibly the world, concerning issues of legal accountability and its branches.

He typically links this accountability to the development of the medical tourism sector, arguing that Jordan, by legalizing the tools for developing this sector, can make it a vital contributor to the national economy, a source of jobs and prosperity, and one of the effective levers for sustainable development.

Abu Roman is a legal lecturer specializing in medical law. He obtained his PhD from Cairo University in the field of medical liability for the actions of assistants. He recently published a book titled “The Physician’s Responsibility for the Actions of Assistants,” released by Zain Legal in Beirut, which addresses the legal challenges associated with medical errors and the role of healthcare staff in reducing risks and improving healthcare. Since 2021, he has been a member of MPL Medical Professional Liability in Virginia, USA, representing countries in the Middle East and West Asia. Additionally, Abu Roman is the founder and CEO of West Asia Medical Liability Company (WACML) based in Istanbul, a company specializing in medical liability. It offers various services, such as raising awareness of medical liability to enhance patient safety and reduce medical errors.

The company’s areas of work include education and training, arbitration services, litigation, medical legal research, organizing specialized conferences, and hosting international exhibitions to connect and elevate the level of healthcare services and medical tourism, along with other regulatory services.

He is in the process of organizing a conference in Jordan for most West Asian countries on international medical liability, and arranging the (WACML) exhibition for medical tourism.

Regarding his field of specialization and his visions for enhancing medical accountability and developing medical tourism, “Ammon” had this interview with Dr. Nasser Abu Roman.

How far has Jordan progressed in adapting civil liability laws and regulations to address the issue of delegation and responsibilities arising from the actions of others? This question is divided into three parts:

• Adaptation of medical liability law.

• The issue of medical delegation.

• Liability for the actions of others.

Adapting local laws and regulations requires a precise understanding of Jordanian laws governing medical liability, which may differ in details and application from those of other countries. Regarding the determination of liability, it is essential to distinguish between delegation and liability for the actions of others. In delegation, the responsibility falls on the delegating person who has assigned a task to others to perform, and it remains under their supervision and responsibility. As for liability for the actions of others, it is primarily governed by the provisions of civil law, specifically the liability of a superior for the actions of subordinates.

Regarding the legal procedures followed: the application of laws and regulations in Jordanian courts, and the steps taken to resolve civil liability cases, both types of liability are governed by the rules of contractual liability.

In this context, under Jordanian law, any person can delegate their authority to others to act on their behalf.

In this context, civil liability falls on the person delegated (the agent) if any harm arises from their actions, provided that these actions are within the scope of the authority granted by the delegating person. For example, a specialist doctor might delegate a procedure within their specialty to an assistant or resident doctor. If the agent performs actions that contradict instructions or exceed the granted authority, the delegating doctor may be held civilly responsible for the damages caused by the agent. In cases of disputes related to liability towards the affected parties or the accused party causing the harm, courts can be approached to issue a judgment determining responsibility and appropriate compensation.

Generally, within the scope of delegation, the powers of the delegate must be within the boundaries of the granted authority. If the agent exceeds these powers and commits acts beyond the scope of the delegation, the delegator (the person who delegated) may be held civilly liable for the damages resulting from those acts.

In the case of gaps and the absence of a specific legislative policy on medical liability in Jordan and other West Asian countries, is this related to the legislator, the surrounding circumstances, or a lack of adaptability and adjustment?

_ This issue can be the result of a combination of the factors mentioned.

Firstly, legislation: There is a noticeable lack of clear legislative policies on medical liability in West Asian countries. This absence manifests as delayed legislation and insufficient serious engagement with these issues by legislative authorities. The delay in adopting necessary laws and policies to define and regulate medical liability can lead to legal gaps or lack of clarity regarding rights and obligations.

Secondly, the surrounding social, economic, and cultural conditions in these countries can affect the legal system’s ability to adapt and evolve. For example, societal culture might play a role in how people address legal issues and personal responsibility.

Thirdly, a lack of adaptability and adjustment can occur when the legal system itself is weak in responding to new challenges or societal developments. There may be difficulties in effectively applying laws, or a shortage of judges and lawyers trained in such issues, leading to improper or inconsistent enforcement of the laws.

We should also not forget the lack of legal awareness regarding the importance of regulating medical liability and its impact on society and medical practitioners. This can result in insufficient public pressure to enact strict and effective laws.

All of this, among other factors, will inevitably lead to a reduced ability to adapt, given the deficiencies in legal infrastructure or the necessary training for judges and lawyers to handle complex medical liability cases. This will contribute to challenges in the effective implementation of laws and result in ongoing gaps in protecting patients’ rights and determining liability.

Honestly and clearly, what are your reservations about the Medical Accountability Law No. 25 of 2018? Given that you have stated in several interviews and through various platforms that Jordan has taken an important step in the right direction with this law, considering that our country is one of six countries in West Asia out of a total of 16 that have legislated medical accountability through regulations or by establishing mutual insurance funds?

_ My first reservation is about the implementation mechanisms and effectiveness of the law. While the law is fundamentally good and represents a positive step toward enhancing accountability in healthcare, the challenge lies in how it is implemented and its actual effectiveness on the ground. Generally, we assess any law based on the tangible improvements it brings in accountability and quality of healthcare, which, to date, have not been clearly realized.

My second reservation concerns the lack of resources and infrastructure. There is a noticeable shortage of adequate human and financial resources, as well as weaknesses in the essential infrastructure needed to support accountability processes.

My third reservation targets the lack of transparency and disclosure. The law should encourage transparency and disclosure within the healthcare system, which would facilitate investigations and accountability.
Overall, I view the law as a positive step forward in enhancing medical accountability in Jordan. However, the actual challenges lie in how effectively it is implemented to ensure that the desired goals are achieved without infringing on the rights of doctors, nurses, patients, and healthcare workers in general. The law must address the complexities in legal and administrative procedures related to filing complaints and following up on medical accountability cases. Ideally, the system should be clear and straightforward, ensuring fair and effective accountability without unnecessary complications.

One of my observations and reservations is the lack of sufficient committees to review and adjudicate the cases presented to them. This leads to delays in determining whether there has been a medical error or not.

Another reservation I have relates to a prevailing culture among some doctors and healthcare practitioners that resists change and views accountability as a threat to their traditional practices.

The law should also include comprehensive strategies for dealing with medical errors, including reducing recurrent errors and continuously improving the quality of healthcare. It should clearly ensure comprehensive accountability for all healthcare parties, including doctors, nurses, and healthcare institutions, in a fair and inclusive manner. Additionally, the law should incorporate preventive measures to enhance quality, such as promoting continuous training for healthcare practitioners and improving administrative procedures to minimize medical errors. It should lead to an overall enhancement of healthcare quality and foster a health culture and legal awareness among both patients and healthcare practitioners. This can be achieved through ongoing training and awareness programs regarding patients’ rights and the legal obligations of healthcare practitioners.

From the above, we can conclude that implementing the Medical Accountability Law in Jordan presents a multi-faceted challenge. This requires considering various aspects to ensure it has a positive and sustainable impact on the healthcare system and the health community as a whole.

In your opinion, do strict laws limit investment in medical tourism, or is the opposite true?
_ The opposite is true. Strict laws in healthcare and medical tourism contribute to providing a reliable and high-quality environment for international patients. For example, stringent regulations may ensure high medical standards and safety measures, which enhances trust among travelers seeking treatment abroad. Such laws may only become a hindrance if they are overly complex or impose high costs on healthcare providers or the medical tourism industry. On the other hand, excessive bureaucracy or financial constraints might reduce investment attractiveness, such as imposing restrictions on incoming patients, like security clearances and other approvals.

Generally, strict laws affect medical tourism investments in the following ways:

• Quality of Healthcare: By imposing high standards on healthcare providers, these laws ensure that facilities and institutions offering medical tourism services must adhere to stringent health standards, such as international accreditations, which enhances the overall attractiveness of healthcare destinations.

• Trust and Credibility: When patients know that a destination follows recognized international health standards, their confidence in choosing that location for treatment increases, boosting the likelihood of medical tourism.

• Innovation and Diversification: Strict laws can stimulate innovation and diversity in the healthcare services offered to medical tourists. For instance, policies may encourage the adoption of the latest medical technologies or the development of advanced treatment programs, which enhances the variety and excellence of the services provided.

Strict laws often include additional requirements such as medical translation and cultural communication, which providers must adapt to ensure a smooth experience for international patients. In summary, strict laws play a crucial role in enhancing trust and quality in medical tourism. However, they must be balanced to avoid stifling innovation and economic growth in this vital sector.

To clarify this, we can point out that:

1- Strict laws often impose precise standards on healthcare and patient safety. This includes medical institutions being equipped with modern technologies and adhering to strict hygiene and safety procedures, which enhances the credibility of medical destinations and attracts international patients seeking high-quality care.

 

2- Strict laws may require complex health and financial licenses for healthcare providers, which can be a barrier for small or new companies entering the medical tourism market.

 

3- Strict laws may mandate high levels of insurance and coverage for international patients, protecting them from potential risks and enhancing trust in the local healthcare system.

4- Medical destinations must adhere to local and international laws and regulations in marketing their services, which can be a challenge in creating effective and appealing marketing campaigns for the international market.

 

Finally, entities that adopt strict laws in a way that enhances quality and safety may be in a better position to compete in global markets. This helps attract more international patients and strengthens the reputation of the destination as a leading player in medical tourism.

 

 

* Your career record highlights notable achievements and significant transitions across various legal and rights fields. Are there specific or personal motivations that led you to the field of medical liability and the associated legal and civil accountability?

 

In fact, I hold a master’s degree in medical liability and a PhD from Cairo University in physician liability for the actions of assistants. Additionally, I have extensive practical experience in the healthcare field, working as a researcher in medical liability since 2000, which means I have been in this field for 25 years. I also represent West Asia and the Middle East in the Medical Professional Liability Association in the USA and have been serving as a Defense Affiliate Partner in this field since 2021.

 

* What you have achieved regionally is a remarkable and responsible accomplishment that the entire nation, its people, and its leadership can take pride in. Being the CEO of West Asia Medical Consultancy and Research, based in Istanbul, reflects your success and dedication in this field. Could you share the details of this achievement and the significance of the moment that led you to embark on this journey?

Certainly, I am happy to discuss the achievements of West Asia Medical Consultancy and Research and the pivotal moment that led me to join it as CEO and founder. West Asia Medical Consultancy and Research is a beacon in the field of medical research and consultancy in the region, distinguished by its dedication and uniqueness in providing medical and educational services. The regional achievements include:

 

1. Leadership in Medical Research: The organization has made significant contributions to medical research.

2. Strategic Consulting: Providing exceptional consulting services in the field of healthcare.

3. Education and Training: Organizing specialized training programs for professionals in the medical field.

4. International Partnerships: Enhancing collaboration with international organizations and global research centers, leading to the exchange of advanced medical knowledge and technologies..

 

The pivotal moment that led me to establish West Asia Medical Consultancy and Research stemmed from its forward-looking vision and commitment to providing exceptional medical services and improving healthcare across the region. As CEO, I see a unique opportunity to contribute to advancing medical research and healthcare in West Asia, which makes me proud of this role and the team that works diligently and passionately to achieve these goals. We aim to: Enhance Regional Collaboration, Develop Medical Infrastructure, Contribute to Health Advancements, Support Innovation and Scientific Research and Develop Sustainable Health Policies that serve the interests of member countries

 

At West Asia, we also strive to establish strategic partnerships with research centers, universities, and hospitals in the region to develop health policies that contribute to improving healthcare and enhancing public health across the area.

 

Insurance as a solution for managing compensation costs in the event of damage or harm has various effectiveness levers, but don’t you think that cultural, religious, and value-based heritage may reduce the likelihood of adopting this option/solution, which is actually the most logical?

 

Insurance as a solution for compensation in the event of damage is a logical and economically effective solution, but there are cultural, religious, and value-based factors that may influence individuals’ decision to choose this option. For example, cultural and religious heritage may play a role; in some cultures and religions, reliance on insurance might be associated with specific views on money or social solidarity. Some individuals might view insurance as an excessive financial burden or see it as conflicting with concepts of reliance on God or divine destiny.

 

However, there are alternatives such as Takaful funds, as seen in Saudi Arabia, where social values encourage reliance on mutual support and social solidarity rather than on commercial insurance services. In advanced economies, reliance on insurance might be more common and accepted, while in emerging economies, the situation might be different due to economic and cultural challenges.

 

Overall, insurance companies and communities should pay attention to the interplay between these factors and how they impact financial decision-making. Understanding these factors can help in developing insurance products that better align with the cultural and religious needs and expectations of individuals and communities.

 

Beyond legal responsibilities and its various complexities, to what extent can medical tourism in Jordan be moved from the realm of vision to actual horizons?

This can be achieved through effective promotion and marketing, targeting both international and local markets with compelling campaigns to attract more medical tourists. Additionally, collaboration with the private sector is crucial, as it plays a vital role in developing healthcare infrastructure. Governments can also play an important role by facilitating administrative and regulatory processes, making it easier for medical tourists to access healthcare and tourism services, so coordination with them is essential.

 

We should also offer a variety of treatment and healthcare options that meet the needs of tourists from different countries. Quality and reliability in healthcare and tourism services must be prioritized, as these are essential for elevating medical tourism to a level that meets tourists’ expectations. We should establish partnerships with prestigious academic and professional institutions in the field, such as Johns Hopkins and Cleveland Clinic, among others. Additionally, collaborating with major insurance companies to cover treatment-related errors and provide appropriate insurance for medical tourists is essential.

In this context, Jordan is known for its strong reputation in providing high-quality medical services and is a vital center for advanced treatments such as oncology, cardiac surgery, ophthalmology, and other specialties. It must maintain this medical excellence by attracting more experts and specialists to offer unique and advanced treatments. Furthermore, Jordan should continue to develop its healthcare infrastructure, including hospitals and medical centers, equipping them with the latest medical technologies and devices to ensure effective and safe medical care for medical tourists.

 

Among the drivers for moving medical tourism from the realm of vision to the realm of reality is investing in hotel facilities and developing hospitals and medical clinics to improve the quality of medical services provided. Additionally, the infrastructure should be enhanced to make it more attractive to foreign patients by developing and updating hotels to meet the needs of medical tourists, and providing facilities such as spas and health centers in popular tourist locations.

 

In the context of striving to enhance our position on the global medical tourism map, it is essential to implement training programs and workshops for medical personnel and those working in the tourism sector to improve their skills in serving medical tourists. Furthermore, strengthening medical education, continuing medical education, and advanced research in medical specialties contribute to attracting more medical experts and researchers to Jordan. Simplifying legal and administrative procedures, providing visas for medical tourists, and offering financial and tax incentives for companies and institutions operating in the medical tourism sector are also crucial factors in developing this vital sector.

 

Finally, implementing these measures and focusing on infrastructure development and service quality will enable Jordan to achieve a significant transformation in the medical tourism sector. This will enhance opportunities to attract tourists, contribute to the local economy, and strengthen our international standing as a distinguished medical center.

 

News Source: Amoon