Parliament Diaries| The dented victory of the medical liability law

In the dimly lit corridors of the House of Representatives, on Tuesday March 25th, I walked into Dr. Osama Abdel Hai as he was about to head for the Doctors Syndicate's headquarters at Dar Al-Hikma, a calm in his step that belied the storm still swirling around the newly approved Medical Liability and Patient Safety Law.

Though not all of his proposed amendments survived the legislative mill, Abdel Hai seemed to carry some reserved optimism. "It’s better than nothing," he told me with a weary pragmatism, still clinging to the hope that the law might retroactively extend relief to doctors still languishing in jail for medical errors—cases so shrouded in bureaucratic murk that not even the syndicate could say how many are jailed.

This is the same Abdel Hai who, back in January, canceled an emergency general assembly meant to confront the law's initial version—a move that some saw as strategic retreat, others as surrender. Since then, the pressure from doctors has been relentless, their frustration boiling over in comments beneath the explanatory video he posted after the law's revision.

Somewhere between social media’s exaggerated concerns and the glowing endorsements from the pro-government majority in parliament, lies the story I share with you today: not just of a law passed, but of the long negotiations, the reluctant concessions, and the uneven victories that mark its path. Let’s take a moment to examine the finer details of the scene—what was fight about, what was gained, and what remains unresolved.

A long journey

The journey of the medical liability bill has spanned years. Multiple attempts by MPs and successive syndicate leaders were stalled due to widespread concerns about regulating the complex relationship between doctors and patients—a subject long deemed politically explosive. Accordingly, many versions of the draft spent years collecting dust.

When the government’s bill was first taken up in the Senate, it passed with limited objections. The Doctors’ Syndicate, however, rejected it outright. But by the time it reached the House of Representatives, channels of dialogue had opened between the syndicate, parliament, and the government—offering a pathway to compromise.

I shared with you earlier, two months ago, about the rounds of negotiations that led to substantial revisions during deliberations in the Health Committee. But continued talks yielded even more gains for doctors during the final general session.

Medical error: Who decides?

Under the new law, liability is assigned for any medical error that causes harm to a patient, unless the harm results from a known risk or complication scientifically recognized in standard medical practice, or stems from the patient’s own action, like refusal of treatment or failure to follow medical instructions.

The law defines a medical error as any action—or failure to act—by a healthcare provider that violates this legislation, existing healthcare laws, established medical norms, or professional codes of ethics issued by the relevant syndicates or by the Egyptian Health Council.

Crucially, neither prosecutors nor judges can determine a medical error without guidance. A high-level committee will now be formed to receive complaints and determine whether harm resulted from a foreseeable complication or from an actual medical error.

Even in confirmed cases of error, the punishment no longer includes imprisonment. Parliament amended the maximum financial penalty, lowering it from EGP 1 million to EGP 100,000 (around $2,000 USD).

Is the committee’s decision binding?

The head of the Doctors’ Syndicate together with the opposition bloc tried to introduce amendments mandating that courts adhere to the committee’s findings. Abdel Hai also lobbied for a clause requiring prosecutors to delay investigations until the committee had issued its technical report determining whether an error occurred.

But the government and ruling coalition rejected such proposals submitted by MPs Maha Abdel Nasser, Atef Maghawry, Mohamed Ezzat Arafat, Talaat Abdel Qawi, and Ahmed Hamdy Khattab.

Minister of Parliamentary Affairs Mahmoud Fawzy responded to their demands saying “The committee’s opinion is advisory. The judge’s opinion is binding and enforceable.”

MP Talaat Abdel Qawi of the Nation’s Future Party insisted the committee’s report should be a prerequisite for trial. “This is the heart of the issue. I demand that, in all cases, a doctor cannot be summoned, investigated, or referred to court until the committee's report is issued.”

But MP Ashraf Hatem offered an "outside the box" alternative suggesting that the public prosecutor issues a circular memo instructing prosecutors to await the committee’s findings before proceeding with investigations.

This led MP Ahmed Hamdy Khattab to question the usefulness of advisory committees if their opinions are non-binding. Fawzy then replied “The technical report is submitted to the court. In practice, the judiciary rarely contradicts these reports—unless there’s a stronger one. Ignoring it would make the ruling vulnerable to appeal.”

Fawzy sought to reassure the syndicate and parliament “In practice, courts rely on these committee findings. They are taken seriously.”

Gross negligence and the return of jail time

While non-intentional errors are no longer punishable by prison, the bill retains imprisonment in cases of gross negligence. During deliberations, parliament redefined the term following a proposal by the Health Committee secretary-general Karim Badr Helmy.

The final definition specifies gross negligence as any action of such severity that the resulting harm is certain. It includes, for instance, working under the influence of alcohol, drugs, or mind-altering substances; failing to assist a harmed patient; ignoring a request for help despite being capable of responding; or intentionally practicing outside one’s medical specialty in non-emergency situations.

Parliament also removed vague terms such as “negligence,” “carelessness,” and “recklessness,” and rejected a proposal to list specific cases, arguing that doing so would be limiting. “If we list 10 examples and an 11th arises, the committee won't be able to address it,” the Health Committee chair said.

The committee will determine whether an error constitutes gross negligence and submit a report detailing its classification. If gross negligence is confirmed, penalties include imprisonment for one to five years, and a fine ranging from EGP 500,000 to 2 million (roughly $10,700 to $43,000), or both.

Who foots the bill?

Abdel Hai proposed replacing fines with civil compensation for patients, but the government and majority bloc refused. He then suggested scaling fines from one to four months’ salary—merely as a guarantee of patients’ rights before they file for damages.

“It’s not logical to impose heavy fines for errors that could happen in any medical context,” he said. “Globally, civil compensation is used to address harm. Excessive fines will only drive young doctors away.”

This proposal didn’t gain traction with the majority, though majority leader Abdel Hadi El-Kasaby did offer a compromise to reduce the fine specifically for medical errors. Parliament ultimately approved Article 20, which establishes a government fund to cover liabilities resulting from medical errors. The fund may operate directly or through insurance firms approved by Egypt’s Financial Regulatory Authority. It can also help cover additional damages based on actuarial assessments.

In other words, the fund will help doctors pay these fines.

Before errors happen

The bill obligates healthcare providers to follow key procedures before treating patients. These include applying established scientific and professional standards, documenting patients’ medical and family history, using functioning and appropriate medical equipment, informing patients of potential risks, and recording all actions in the patient’s file.

It also prohibits refusing treatment in emergencies or life-threatening situations. If a procedure falls outside a provider’s specialty, they must stabilize the patient and refer them to a specialist or nearby facility—providing a brief report on initial findings.

In short, administering CPR in an emergency won’t expose a GP to liability simply because a colleague from the needed specialty wasn’t available.

Patient examination rules

The law sets new ground rules for physical examinations in non-emergency cases. It prohibits clinical exams on patients of a different gender without their consent or without a relative, escort, or medical team member present—except in emergencies.

Although prior committee discussions praised this as a safeguard for both doctors and patients, MP Irene Saeed proposed an amendment requiring the accompanying team member to be of the patient's gender. Parliament rejected her proposal.

Saeed argued “If a woman sees a male doctor without an escort, what’s the point of him bringing another man into the exam room? That defeats the purpose. This amendment is about protecting women’s dignity.”

Health Minister Khaled Abdel Ghaffar replied “The goal is to avoid leaving the patient alone. Whether it’s a male or female doctor, the goal is served. This amendment introduces unnecessary constraints.”

Prison terms for other violations

Beyond medical error, the law sets out other violations that carry up to one year in prison, a fine of up to EGP 100,000, or both.

These include exceeding the scope of one’s license; treating patients without consent except in emergencies or when the disease poses a public health risk; refusing treatment in life-threatening situations; using unauthorized tools; or disclosing patient information obtained while practicing medicine.

Patient accountability

To protect healthcare workers from assaults inside medical facilities, the law also outlines penalties for patients who attack them.

Anyone who insults a provider with gestures, words, or threats while they are performing their duties faces up to six months in jail or a fine of up to EGP 10,000. Intentional damage to medical facilities or physical assault on staff during work may result in up to one year in jail or a fine of up to EGP 50,000.

A proposal by MP Alaa Abed of the Nation’s Future Party introduced new penalties for malicious complaints, aiming to curb false reports that tarnish doctors’ reputations. These carry a penalty of up to three months in jail, fines of up to EGP 30,000, or both. 

A difficult victory

This is where the story ends—for now. Not in a blaze of triumph, but in a quiet nod to compromise. The law that began its journey stripped of safeguards for doctors has emerged—scuffed, dented, but standing—as something far closer to justice than where it started.

I will spare you the details of every fiery exchange between MPs, every subtle standoff between the government and dissenting voices. For what matters now is, in a legislative landscape where laws seem frozen in time and immune to reform, this one moved. It shifted. It bent toward the possible.

True, it’s not the ideal many dreamed of. But in the world of policy and politics, especially in a chamber dominated by a pro-government majority bloc, the ideal is often sacrificed on the altar of the doable.

The hope, now, is that these pages of legislation translate into safety—for patients, for doctors, and for the strained institutions caught between them.

Perhaps, if the law is applied wisely and the fund functions well, fewer doctors will feel the need to pack their degrees and dreams into a suitcase and board flights toward more dignified work environments.

Let us set aside our cynicism and call this what it is: a rare, hard-won success. And in the Egypt of today, that is no small thing.

A version of this article first appeared in Arabic on March 27, 2025