1 00:00:00,240 --> 00:00:05,360 We saw Dr Peñaló, as his colleagues call him, so is the schoolmate, 2 00:00:05,879 --> 00:00:08,519 but it is Dr César Rivera who calls the people who check them. 3 00:00:08,839 --> 00:00:14,119 One was given all the jurologist glaudio. And here we also have the lawyer, 4 00:00:14,359 --> 00:00:18,320 the lawyer who talks about the castilla that I consume very often for the 5 00:00:18,440 --> 00:00:22,320 stomach and said the effects. I stopped seeing traspati and now I' m 6 00:00:22,359 --> 00:00:28,160 living water or AIDS, like he calls me to himself, because it can 7 00:00:28,160 --> 00:00:32,439 be taken. And the doctor explained it, but not continuously. If there 8 00:00:32,479 --> 00:00:36,479 are many pods and one provokes the fierce to see correct me to me told 9 00:00:36,560 --> 00:00:42,200 me one person, a doctor told me a long time ago that the continuous 10 00:00:42,240 --> 00:00:45,920 consumption of that medication, of that sheath also put a home me tutu of 11 00:00:45,920 --> 00:00:49,840 the caco. With the passage of time you start to forget the thing and 12 00:00:49,880 --> 00:00:54,479 the sheath and said that you have to take it, but under supervision and 13 00:00:54,600 --> 00:00:59,520 strict medical prescription. Actually yes, there are some other days arts that every 14 00:00:59,520 --> 00:01:03,799 doctor closes s good morning the doctor of the plane. There are some studies 15 00:01:03,880 --> 00:01:07,319 that talk about how the prolonged use of these medications can cause some degree of 16 00:01:07,480 --> 00:01:12,680 dementia cini senile, yes, well, just like other medicines, such as 17 00:01:12,719 --> 00:01:17,599 the old carinics, are also. There are some studies that say that prolonged 18 00:01:17,719 --> 00:01:23,480 and indiscriminate use of these medications can lead to dementia. I still run out 19 00:01:23,480 --> 00:01:26,680 of water. Now to see if I' ll get rid of all those 20 00:01:26,680 --> 00:01:27,760 really messed up drugs. Really the grandfather who' s going to be commenting 21 00:01:27,760 --> 00:01:33,439 on diuresis. If diuresis increases, there will be a lower plasma concentration of 22 00:01:33,519 --> 00:01:38,040 the medicine. I mean, God said send a lot of urine. High 23 00:01:38,200 --> 00:01:46,799 term you all die I also have John Arthur with us here. The doctor 24 00:01:46,840 --> 00:01:49,799 wanted to touch on the medical claims that have been made and made public and 25 00:01:49,879 --> 00:01:55,959 that have had as sentences to hospitals and doctors, and wanted us to invite 26 00:01:56,000 --> 00:02:01,799 Juan Arturo to also give a legal perspective to this issue that they had. 27 00:02:05,480 --> 00:02:10,080 Today I saw in the newspaper list a note written by the president of a 28 00:02:10,120 --> 00:02:14,960 foundation that the doctor' s name seeks his name so as not to stay 29 00:02:14,960 --> 00:02:17,560 with him, that he had been a long time and it is true I 30 00:02:17,639 --> 00:02:24,120 came to read in the two thousand fifteen that this kind of sentence would arrive 31 00:02:24,199 --> 00:02:27,080 and that the doctors had to prepare for this which we are seeing now. 32 00:02:28,120 --> 00:02:31,520 Well, I really do demand American From my point of view, I understand 33 00:02:31,560 --> 00:02:37,759 it' s a right that the patient has. If we work from the 34 00:02:37,800 --> 00:02:43,639 scientific method, the scientific method is supposed to allow anyone who undergoes a medical 35 00:02:43,719 --> 00:02:49,120 treatment to actually verify their treatment, because we also know that not in all 36 00:02:49,199 --> 00:02:55,719 individuals a treatment can work the same. And that' s why in some 37 00:02:55,759 --> 00:03:02,919 countries then there are therapeutic protocols that if you follow those therapeutic protocols, then 38 00:03:04,000 --> 00:03:08,759 the verification part. There is automatically nullified that happens in countries like Ours, 39 00:03:09,080 --> 00:03:15,599 that therapeutic protocols are adjusted to the year two thousand a year, one thousand 40 00:03:15,599 --> 00:03:20,520 ninety- six, and some of those of medical treatments and some of the 41 00:03:20,560 --> 00:03:24,520 surgical treatments, which are even stipulated in our law, are subject to the 42 00:03:24,560 --> 00:03:28,960 year two thousand, when the law was made forty- two one. And 43 00:03:29,080 --> 00:03:32,400 if we look at any of these treatments today, in the 2, 000 44 00:03:32,479 --> 00:03:38,039 twenty- four, none are standard for the treatment of many diseases, even 45 00:03:38,120 --> 00:03:44,879 at the time of the patient, to seek medication coverage, procedure coverage, 46 00:03:44,879 --> 00:03:49,479 treatment coverage. Many times they receive the refusal of the insurers, because what 47 00:03:49,560 --> 00:03:53,240 is the standard today was not the standard in the year two thousand twenty, 48 00:03:53,039 --> 00:04:00,400 In the year two thousand pardons And right now, many patients are demanding their 49 00:04:00,479 --> 00:04:05,400 right to be verified and to be given a seclusion, either out of the 50 00:04:05,439 --> 00:04:11,280 doctors, out of the technical, but a legal solution. What happens also 51 00:04:11,319 --> 00:04:15,600 in our country that, unlike other parts of the world, we also do 52 00:04:15,639 --> 00:04:23,920 not have a specialized stay for this type of problems, of these types of 53 00:04:23,959 --> 00:04:28,800 legal problems, And much of what we ask as a specialist is that it 54 00:04:28,879 --> 00:04:31,879 is removed as decriminalization, but it is good. Yes, sue me, 55 00:04:32,879 --> 00:04:39,079 sue me in the civil court that you can, for example, have an 56 00:04:39,399 --> 00:04:45,040 economic sanction or a sanction, let' s say so, a suspension of 57 00:04:45,439 --> 00:04:47,759 the license, a suspension of the license, what' s going on in 58 00:04:47,839 --> 00:04:53,560 other parts of the world. The criminal is what I was reading exactly that 59 00:04:53,560 --> 00:04:57,959 and that' s what Ashley Cowboy, president of the Otor Cowboy Foundation, 60 00:04:58,279 --> 00:05:00,759 was talking about, was the one who wrote and wrote about this in the 61 00:05:00,879 --> 00:05:05,120 year two thousand fifteen backwards, warning that this could happen. So the criminal 62 00:05:05,199 --> 00:05:09,399 issue is what you, as a doctor, understand should be what should be 63 00:05:09,439 --> 00:05:15,600 really discussed. It is the most shameful thing for us to be treated in 64 00:05:15,680 --> 00:05:23,199 a criminal way. We' re all going to be sued somewhere at some 65 00:05:23,240 --> 00:05:29,079 point in our career, that for civilian, because it' s going to 66 00:05:29,160 --> 00:05:32,360 be for abuse. I don' t expect it to be given to me, 67 00:05:32,480 --> 00:05:36,560 but we' re all going to be subjected to some kind of research 68 00:05:36,560 --> 00:05:40,639 at some stage of our career. I think we are all prepared and some, 69 00:05:40,879 --> 00:05:46,360 for example, in private practice we have American protocols, we follow European 70 00:05:46,480 --> 00:05:49,879 protocols to try to have our practice. Let' s say the most strictly 71 00:05:50,079 --> 00:05:56,040 organized. The problem is that in a Dominican court the American protocol to me 72 00:05:56,040 --> 00:06:00,000 is of no use to me. The European protocol to me is of no 73 00:06:00,040 --> 00:06:03,560 use. I can have it as an example. But when they' re 74 00:06:03,639 --> 00:06:06,399 going to judge me, they' re going to judge me by an obsolete 75 00:06:06,399 --> 00:06:12,000 protocol. I' m not going to offer an obsolete treatment. In the 76 00:06:12,079 --> 00:06:14,560 twenty- four thousand I' m going to try to offer a treatment. 77 00:06:14,560 --> 00:06:16,839 For example, here we already have, thank God, Robot surgery. We 78 00:06:16,879 --> 00:06:20,720 already see a group of doctors who are making the effort to prepare ourselves, 79 00:06:21,839 --> 00:06:28,680 certify ourselves and have international certifications to use that device. But if we have 80 00:06:28,720 --> 00:06:35,240 an inconvenience, the Dominican legislation may not contemplate that type of surgery and that 81 00:06:35,279 --> 00:06:41,600 complicates everything, complicates everything and everything goes well. Maybe we don' t 82 00:06:41,600 --> 00:06:46,240 have a problem. When something goes wrong, then maybe we have that weakness. 83 00:06:46,839 --> 00:06:49,800 Although, for example, in eighty- ninety percent of international medical associations 84 00:06:49,800 --> 00:06:54,920 already surgery with jrobot is accepted, for example, for the treatment of many 85 00:06:54,920 --> 00:07:01,000 diseases. The medical school is right now, I think it' s developing 86 00:07:01,040 --> 00:07:11,439 the best strategy by asking the state, asking the Supreme Court of Justice to 87 00:07:12,160 --> 00:07:16,199 design a specialized court to deal with these cases, because it' s not 88 00:07:16,240 --> 00:07:18,680 that we don' t want it to be dealt with, it' s 89 00:07:19,360 --> 00:07:26,600 not that we don' t want to be sued, but rather that we 90 00:07:26,759 --> 00:07:32,360 submit that lawsuit process within a group of people who understand what are the concepts 91 00:07:32,959 --> 00:07:39,439 that will develop in each type of pathology and that it won' t be 92 00:07:40,399 --> 00:07:46,199 understood that a complication or an unwanted result is a bad person, malpractice lawyer 93 00:07:46,319 --> 00:07:48,800 looks at the main problem that doctors face today. When we go to both 94 00:07:48,800 --> 00:07:53,920 the civil code and the penal code on these issues of liability, both civil 95 00:07:53,920 --> 00:07:57,680 and criminal, it is the own wording that brings each of the codifications. 96 00:07:58,199 --> 00:08:01,839 Or do not remember that both the civil code and the penal code that we 97 00:08:01,879 --> 00:08:05,600 have in force in the Dominican Republic, regardless of all the laws that have 98 00:08:05,680 --> 00:08:11,240 modified it over time. They are 19th- century codifications that came to Dominican 99 00:08:11,279 --> 00:08:16,040 Republic from ninety- nine percent of what today medicine touches did not exist. 100 00:08:16,600 --> 00:08:20,800 There wasn' t, I mean, all these specialties, the scientific advances, 101 00:08:22,079 --> 00:08:28,000 not even the antibiotics yet I think they were discovered. This codifications arrive 102 00:08:28,000 --> 00:08:33,679 in one thousand eight hundred twenty- two to the Dominican Republic with the Haitian 103 00:08:33,720 --> 00:08:37,559 occupation and are then translated into Spanish, when, therefore, the country becomes 104 00:08:37,600 --> 00:08:39,559 independent in one thousand eight hundred forty- four. When you then go to 105 00:08:39,600 --> 00:08:43,679 the writing, you see that the writing is extremely closed in the case of 106 00:08:43,720 --> 00:08:48,519 civil matter, it establishes that everyone who causes harm to another has to repair 107 00:08:48,919 --> 00:08:54,519 it point. That is to say, basically that is the basis of civil 108 00:08:54,559 --> 00:09:00,440 liability in the Dominican Republic, although later, since the code itself and the 109 00:09:00,480 --> 00:09:05,200 laws that have emerged over time, are shaping a little bit this topic of 110 00:09:05,320 --> 00:09:07,799 civil and criminal responsibility, which is what affects doctors in most cases, since 111 00:09:07,840 --> 00:09:13,159 the crime that is being prosecuted is manslaughter in almost all of them that is 112 00:09:13,559 --> 00:09:18,960 contemplated in the three hundred and nineteen and establishes to read it textually. Anyone 113 00:09:20,000 --> 00:09:26,559 who, for recklessness, inadvertentness, negligence or inadmissibility of regulations, commits manslaughter 114 00:09:26,559 --> 00:09:31,360 or is an involuntary cause of manslaughter shall be punished by a three- month 115 00:09:31,360 --> 00:09:39,159 to two- year prison term and a fine. Obviously, there, within 116 00:09:39,200 --> 00:09:43,960 that group also fall the errors in observance that is mentioned, but it could 117 00:09:43,159 --> 00:09:50,240 be interpreted as the doctor very well points out that the use of protocols that 118 00:09:50,320 --> 00:09:56,240 are outdated so are those approved by law, because they fall within the scope 119 00:09:56,559 --> 00:10:03,159 of involuntary homicide, a little you are not using in principle the modern guidelines, 120 00:10:03,240 --> 00:10:07,600 in force and accepted internationally in the field of medicine. So this complicates 121 00:10:07,720 --> 00:10:15,399 a defense for the doctor, because, regardless of whether they can fully verify 122 00:10:15,440 --> 00:10:18,399 that they followed the protocols that are standing and that not only followed those, 123 00:10:18,759 --> 00:10:24,639 they followed those that are set out, for in Dominican legislations regulations at the 124 00:10:24,720 --> 00:10:30,360 time when the argument comes out, but that is that those are regulations or 125 00:10:30,720 --> 00:10:35,879 are guidelines of the year two thousand. The judge is in criminal proceedings bound 126 00:10:37,000 --> 00:10:41,120 by his hands to rule only on the basis of the evidence submitted to him 127 00:10:41,200 --> 00:10:46,159 and the law. There' s no room in that sense. The judge, 128 00:10:46,200 --> 00:10:48,360 in order to maneuver, he' s gonna have to convict the doctor. 129 00:10:50,039 --> 00:10:54,480 So, the doctor has followed the right protocol and the result, unfortunately, 130 00:10:54,519 --> 00:11:00,000 that adverse result for the doctor now too and that is one of the 131 00:11:00,080 --> 00:11:03,840 criticisms I think should be made and that is that at all times we have 132 00:11:03,840 --> 00:11:11,440 to remember the mistakes. Neglect and fair observance are indicting or are the genesis 133 00:11:11,720 --> 00:11:16,240 of liability, i e, regardless of whether you have followed the entire protocol. 134 00:11:16,679 --> 00:11:20,360 Yeah, in that protocol. You make a mistake, you are responsible, 135 00:11:20,840 --> 00:11:24,240 it is possible to be persecuted and the discussion has to be there. 136 00:11:26,080 --> 00:11:31,000 I hear that, because the Dominican medical school and the doctor and you too 137 00:11:31,200 --> 00:11:35,639 when we were talking out of the air, they support the creation of a 138 00:11:35,639 --> 00:11:41,519 special jurisdiction to know, because of medical cases. I am not so sure 139 00:11:41,919 --> 00:11:48,440 what kind of judges could make up that special jurisdiction, because special jurisdiction is 140 00:11:48,519 --> 00:11:52,519 sometimes counterproductive. And I bring the example of the military courts that existed in 141 00:11:52,639 --> 00:11:58,320 the Dominican Republic, where the military ended up judging military and, as I 142 00:11:58,320 --> 00:12:03,720 forget, they say, between bombs or they don' t step on the 143 00:12:03,919 --> 00:12:07,399 hose many times, because those soldiers did not fulfill the responsibilities that the law 144 00:12:07,399 --> 00:12:13,320 determined those cases. Then I advocate more than the creation of a special jurisdiction 145 00:12:13,399 --> 00:12:18,960 for the preparation of the justice agents, that there are agreements between the Dominican 146 00:12:18,000 --> 00:12:24,000 medical school and the National School of the Judiciary to prepare better judges, that 147 00:12:24,000 --> 00:12:31,759 there are agreements between the Dominican medical school and the School of the Public Ministry 148 00:12:31,840 --> 00:12:37,759 to prepare also prosecutors, that they have knowledge of these aspects of medical responsibility 149 00:12:37,919 --> 00:12:43,639 and thus start to create jurisprudence and start to have actors who know what they 150 00:12:43,639 --> 00:12:48,279 are talking about. In addition, I believe that there needs to be a 151 00:12:48,320 --> 00:12:54,679 major medical certification campaign so that they can be experts in court. The worst 152 00:12:54,840 --> 00:13:00,559 mistake doctors can make is to get away from justice, get the experts out 153 00:13:00,639 --> 00:13:03,679 there. Obviously, out of the doctors' solidarity, we' re not 154 00:13:03,639 --> 00:13:07,039 going to help hide other doctors. That would be a mistake, because they 155 00:13:07,120 --> 00:13:13,759 are losing the only voice they have in the judicial proceedings then and they could 156 00:13:13,840 --> 00:13:20,159 prevent the judge from unfairly, for lack of understanding by the judge, reaching 157 00:13:20,799 --> 00:13:24,759 a conclusion or a sentence that, in case it is, that the person 158 00:13:24,879 --> 00:13:28,480 is not responsible, the judge ends up saying that I will not complirate goleto 159 00:13:28,919 --> 00:13:33,320 pepapan were sometimes convicted even for lack of the judge not understanding it. It 160 00:13:33,360 --> 00:13:37,679 ' s just that sometimes the times are tied up with mach Yes, exactly, 161 00:13:37,960 --> 00:13:41,480 but you know that Thursdays, just like everyone and all of us, 162 00:13:41,759 --> 00:13:43,960 are clear human beings and can be possible to make a mistake. That' 163 00:13:43,960 --> 00:13:48,080 s why when the code was approved to pre- empt the penalty that we 164 00:13:48,080 --> 00:13:52,279 have in force, the judge' s intimate conviction was eliminated for exactly that. 165 00:13:52,600 --> 00:13:56,000 That is not part of the process and the judge, as I said 166 00:13:56,000 --> 00:13:58,360 earlier, is obliged to rule on the basis of evidence and is obliged to 167 00:13:58,440 --> 00:14:03,159 pass judgement on the basis of the arguments that have been given to the Tribunal 168 00:14:03,279 --> 00:14:05,080 and what the law establishes on what is being discussed. Dr César Rivera, 169 00:14:05,960 --> 00:14:09,720 okay. Right now, what we have is, as you recommend us, 170 00:14:09,759 --> 00:14:16,240 even set out to create that group of colleagues and colleagues who work in medical 171 00:14:16,279 --> 00:14:20,519 expertise. I understand that the number of medical experts we have at the moment 172 00:14:20,639 --> 00:14:28,960 very few certificates to also give an adequate response to many cases. Also right 173 00:14:28,000 --> 00:14:33,639 now there is a great wave of doctors who have dedicated themselves to studying law 174 00:14:33,679 --> 00:14:39,000 and I understand that the medical school should also gather those doctors almost as we 175 00:14:39,000 --> 00:14:43,960 meet the jurislogists, the surgeons meet, the doctors meet lawyers and also help 176 00:14:45,080 --> 00:14:50,080 design the strategy, not only to benefit the doctor, but also to protect 177 00:14:50,159 --> 00:14:56,279 the patient, because really our raw material, our quarry, are the patients, 178 00:14:56,360 --> 00:15:01,879 and we cannot create a barrier between patients and make us enemies of patients, 179 00:15:01,399 --> 00:15:05,120 make us enemies of the lawyers, but see how we can these three 180 00:15:05,200 --> 00:15:11,720 groups of human beings meet, speak the same language, establish review mechanisms, 181 00:15:13,039 --> 00:15:18,960 because I do not want to do an irregular practice or do a practice that 182 00:15:18,440 --> 00:15:26,559 is not subject to scrutiny. Of course, I also want it to be 183 00:15:26,679 --> 00:15:30,720 understood that I can make a decision. Even now the patient is given more 184 00:15:30,840 --> 00:15:35,879 participation in choosing certain treatments and starting from what the patient chooses, we, 185 00:15:35,279 --> 00:15:39,159 as a doctor, then have to follow certain guidelines and explain to the patient 186 00:15:39,200 --> 00:15:46,000 also each treatment that is chosen what its chances of success are, what its 187 00:15:46,000 --> 00:15:48,879 chances of failure are. What to do if there is a failure? What 188 00:15:50,000 --> 00:15:54,519 other alternatives we have, because also communication with the patient has been lost. 189 00:15:56,440 --> 00:16:00,759 Many of us have lost communication with the patient, we have lost communication with 190 00:16:00,799 --> 00:16:07,000 relatives and many times perhaps what triggers bad taste in the family, which then 191 00:16:07,080 --> 00:16:11,559 ends in an act of demand, is that we do not have a fluid 192 00:16:11,720 --> 00:16:18,279 and adequate communication. And the family then, based on what the lawyers explain 193 00:16:18,320 --> 00:16:22,960 to him, it' s going to be that the lawyer founded or designed 194 00:16:22,039 --> 00:16:27,200 a defense strategy for that family that was wronged and in many cases, maybe 195 00:16:27,200 --> 00:16:33,360 we, as a doctor, do miss because we' re not human beings, 196 00:16:33,399 --> 00:16:36,320 we' re going to be wrong. But I also understand that in 197 00:16:36,360 --> 00:16:41,799 some of the cases, some of the comrades were unfairly judged with situations that 198 00:16:42,279 --> 00:16:47,279 even literature, what happens is that they are not Dominican literatures, of course 199 00:16:47,399 --> 00:16:51,919 they will not fail against him, but are situations that are favorable to him, 200 00:16:52,600 --> 00:16:56,600 that he did what he had to do. I want to touch on 201 00:16:56,679 --> 00:17:02,039 one aspect of what you mention author on that subject. Of the thing the 202 00:17:02,320 --> 00:17:07,200 informed consents that basically because once already the patient, his family have been explained 203 00:17:07,200 --> 00:17:14,400 all the possible consequences or benefits of following a medical treatment they to give their 204 00:17:14,799 --> 00:17:18,000 adqhacence of ok We accept it, because they have to sign that informed consent 205 00:17:18,039 --> 00:17:26,400 In the light of the courts. Only the fact of your signing the informed 206 00:17:26,440 --> 00:17:30,720 consent is not going. Why. Because in the case of many professionals, 207 00:17:30,839 --> 00:17:38,440 especially doctors, in the contractual relationship between the physician and the patient. There 208 00:17:38,640 --> 00:17:45,160 are additional obligations that the physician, as the expert in the field and has 209 00:17:45,319 --> 00:17:52,559 knowledge that the ordinary person will not have about medical aspects. Each element that 210 00:17:52,640 --> 00:18:00,000 is part of a medical treatment should be not only correctly explained, but correctly 211 00:18:00,400 --> 00:18:03,839 understood by the patient. That' s very important. It' s not 212 00:18:03,880 --> 00:18:07,359 just you telling him look, you broke a bone, we' re gonna 213 00:18:07,400 --> 00:18:11,599 stick a metal plate in you, we' re gonna move that arm, 214 00:18:11,839 --> 00:18:14,359 a two- year treatment, we' re gonna follow you up or two 215 00:18:14,359 --> 00:18:15,079 years we' re gonna get the plate out. It' s not just 216 00:18:15,079 --> 00:18:18,160 that. And if the guy who puts his badge on it is raining it 217 00:18:18,240 --> 00:18:22,680 and pulls lightning and kills it, the doctor is responsible no, because that 218 00:18:22,799 --> 00:18:30,519 ' s an unforeseen, it' s impossible, it' s a possible 219 00:18:30,640 --> 00:18:36,200 crazy price that poque is going to die, he goes away illegitimate doctor, 220 00:18:36,400 --> 00:18:37,680 that the family can say for that madman we fell. No. No, 221 00:18:37,519 --> 00:18:41,279 no, already, that' s a house of force majeure, impossible, 222 00:18:41,160 --> 00:18:48,319 exact camulas bastard, all bad, bad, understood there if I am if 223 00:18:48,359 --> 00:18:52,599 not by the doctor in that case, because obviously that completely escapes control of 224 00:18:52,640 --> 00:18:56,519 the responsibility of the doctors, although we have to see if the clinic in 225 00:18:56,559 --> 00:19:02,759 a bad installation or a suitcase outside. No, but that' s already 226 00:19:02,839 --> 00:19:07,440 a layer of doctors' control. But yes. It is important to tell 227 00:19:07,480 --> 00:19:11,359 them who is listening to us and they are seeing us that in the medical 228 00:19:11,400 --> 00:19:15,880 case, it is not only the fact of you explaining to the patient what 229 00:19:15,039 --> 00:19:21,240 it is, the procedure, the treatment that is going to follow, but 230 00:19:21,640 --> 00:19:25,200 to be absolutely sure that that patient understands what you are telling him. There 231 00:19:25,240 --> 00:19:29,640 comes into play many issues such as the ability of a people to understand, 232 00:19:29,839 --> 00:19:34,559 academic preparation, but unfortunately, that is the standard against which professionals face people 233 00:19:34,720 --> 00:19:41,599 who do not practice that profession. The same obligation is required of lawyers in 234 00:19:41,680 --> 00:19:45,359 many minimal details exact, not only applied, but you understand me what the 235 00:19:45,440 --> 00:19:49,839 procedure is, and that is extremely important when it comes to creating a defense 236 00:19:49,920 --> 00:20:00,519 when you go to court for this kind of patient cases. There' s 237 00:20:00,519 --> 00:20:03,480 a question for me and it goes for both of us. I mean, 238 00:20:03,759 --> 00:20:08,039 you got a case and you tell him and you' re as a lawyer, 239 00:20:08,559 --> 00:20:12,039 you understand that this guy is responsible for what they' re accusing him 240 00:20:12,039 --> 00:20:15,160 of and you tell him, look, they' re gonna convict you because 241 00:20:15,160 --> 00:20:18,839 you' re responsible. So your job is to try to hurt him to 242 00:20:18,880 --> 00:20:22,359 the least conviction possible, because they' re going to convict him. Then 243 00:20:22,400 --> 00:20:26,960 you have a responsibility to tell him that Stop saying that if you report it, 244 00:20:26,599 --> 00:20:30,799 he' s failing your right duty. The same happens when you receive 245 00:20:30,839 --> 00:20:33,720 a patient and the patient you know that you have a disease that doesn' 246 00:20:33,720 --> 00:20:38,359 t go out and there that you' re not alive or you' re 247 00:20:38,400 --> 00:20:41,839 how you tell people to look, you' re going to die of that 248 00:20:41,839 --> 00:20:45,640 cancer. My job is to alleviate the disease process, but you have a 249 00:20:45,680 --> 00:20:51,079 disease that is no way. They have that really moral and ethical responsibility, 250 00:20:51,559 --> 00:20:55,759 the doctor to inform you or you can sell you if you sell life expectancy 251 00:20:55,759 --> 00:21:00,960 to that person, knowing that obviously, sometimes there are things that mysteriously work 252 00:21:00,039 --> 00:21:04,160 and there are people who heal themselves, but there is that obligation the medium. 253 00:21:04,400 --> 00:21:08,559 We are obliged in culture like our own, for example. Usually that 254 00:21:08,599 --> 00:21:11,599 ' s what we talk about with the family. The patient is not directly 255 00:21:11,640 --> 00:21:15,720 told that it is a mistake for me. It' s a mistake because 256 00:21:15,839 --> 00:21:22,440 it' s supposed to know what the real problem is with the patient. 257 00:21:23,319 --> 00:21:29,279 But we often agree that the children tell us no. Please don' t 258 00:21:29,359 --> 00:21:32,559 treat him before dad explains he doesn' t come to us. And if 259 00:21:33,039 --> 00:21:36,559 there are patients who have to tell them they' re going to die, 260 00:21:36,799 --> 00:21:41,680 the issue of death in the clinic is perhaps the most difficult issue for all 261 00:21:41,720 --> 00:21:47,839 doctors, but there are some treatments that have high mortality. There' s 262 00:21:47,920 --> 00:21:51,119 another treatment that has low mortality, but because of the fact that you have 263 00:21:51,200 --> 00:21:52,519 low mortality, you don' t want to. He said that, for 264 00:21:52,519 --> 00:21:55,279 example, in circumcision, three percent of what they submit to is going to 265 00:21:55,279 --> 00:22:00,680 die, that this is something that is not yet misunderstood. I saw someone 266 00:22:00,720 --> 00:22:04,119 is not happening person what they cut was the foreskin and that didn' t 267 00:22:04,160 --> 00:22:10,119 die and I saw a doctor say it' s a mistake to talk about 268 00:22:10,160 --> 00:22:15,519 that low risk says everything or has the human body at risk of death. 269 00:22:17,880 --> 00:22:22,240 Well, there' s one bigger or smaller cup in another. That gives 270 00:22:22,359 --> 00:22:25,839 an idea that you' re playing a lottery, but don' t sell 271 00:22:25,880 --> 00:22:29,759 yourself the idea that I put a lot of this on the throne a simple 272 00:22:29,759 --> 00:22:32,000 surgery and it came out. It came out like a white sheet up there. 273 00:22:32,599 --> 00:22:37,880 No surgical act is simple. No surgical act is simple and I' 274 00:22:37,880 --> 00:22:41,400 m going to repeat it three times. No surgical act is simple. There 275 00:22:41,440 --> 00:22:44,880 are surgical acts, such as cardiovascular ones, which have a higher mortality rate. 276 00:22:45,200 --> 00:22:51,000 There are surgical acts, for example, such as dermatological ones, which 277 00:22:51,079 --> 00:22:55,039 have a lower mortality rate. Ti Len two copies, they don' t 278 00:22:55,119 --> 00:22:59,200 have endoscopy have their mortality rate. I am not a gastroenterologist, but it 279 00:22:59,319 --> 00:23:03,680 has its fatal index of perforations of the intestine, that is, there are 280 00:23:03,839 --> 00:23:08,119 a number of complications until leading to the death of the patient than in the 281 00:23:08,119 --> 00:23:11,880 scientific method. When that study was approved, they were identified. Over time, 282 00:23:12,160 --> 00:23:17,680 we have been improving technology, We have applied other kinds of energies, 283 00:23:18,079 --> 00:23:22,920 even to work within the body, to reduce risks and reduce mortality. But 284 00:23:23,079 --> 00:23:29,079 every surgical act, every medical act, even because there are medications that have 285 00:23:29,079 --> 00:23:33,759 side effects that we have determined and that can also cause death. We are 286 00:23:33,759 --> 00:23:37,400 talking at the beginning of what was to be eaten for the stomach and which 287 00:23:37,480 --> 00:23:44,759 is not recommended to be consumed intensively and not consumed outside medical supervision. And 288 00:23:44,799 --> 00:23:48,920 there are people who get all that stuff out of that sidekick. For example, 289 00:23:48,000 --> 00:23:52,880 about four or five years ago ranitydine, which was used more than homeprazo, 290 00:23:52,960 --> 00:23:56,799 even in countries such as this one is totally discontinued by side effects. 291 00:23:57,000 --> 00:24:02,720 There are no more, and perhaps countries like this still suit you because of 292 00:24:02,920 --> 00:24:06,640 a cost issue to continue using the Ranity DI because if you start to see 293 00:24:06,759 --> 00:24:11,119 the rate of complications for how much cost it could produce, perhaps in some 294 00:24:11,200 --> 00:24:12,400 parts of the country you might not want to have a rank DE. But 295 00:24:12,799 --> 00:24:18,440 the state made the decision to take them out radically, like other medicines, 296 00:24:18,440 --> 00:24:21,079 because of the side effects. But it' s not that anything we' 297 00:24:21,200 --> 00:24:25,599 re going to do in a patient is harmless. Everything can cause death. 298 00:24:26,519 --> 00:24:32,119 How it is determined, for example, in a surgical case and to establish 299 00:24:32,440 --> 00:24:37,720 legal responsibilities as it is being discussed, how it is determined then who had 300 00:24:37,759 --> 00:24:42,200 the responsibility to make a claim when it is a case that is unique, 301 00:24:45,599 --> 00:24:48,519 an anesthesis, there are several, there are several doctors involved in a problem 302 00:24:48,640 --> 00:24:55,920 buy that chergic exactly then how that responsibility is taken when a patient wants to 303 00:24:56,000 --> 00:25:00,680 sue a me stalantecist. It' s the one that cracks you, the 304 00:25:00,680 --> 00:25:04,880 one that passes instruments, the nurse nurse who dries your sweat, and it 305 00:25:04,920 --> 00:25:08,720 goes exactly to establish. That' s why you don' t see it 306 00:25:08,759 --> 00:25:11,440 in the film fas bad and in a fatal case, for example, that 307 00:25:11,440 --> 00:25:17,400 the patient dies. They always say mean negligence, medical negligence. Sometimes where 308 00:25:17,599 --> 00:25:21,160 the exact net arose to cite a recent case of an eighteen- year- 309 00:25:21,240 --> 00:25:27,480 old boy who went to take out some pieces to do an 18- and 310 00:25:29,200 --> 00:25:32,400 19- year- old orthodox work and died of a heart attack from anesthesia. 311 00:25:33,279 --> 00:25:36,720 So there' s a problem there, because the doctor who' s 312 00:25:36,759 --> 00:25:37,839 supposed to do the surgery is one and the one who' s going to 313 00:25:37,920 --> 00:25:41,680 nettify you is another. And in that particular case, there we speak of 314 00:25:42,319 --> 00:25:45,599 dentistry Rome speaks in his case, a urologist has to operate a prosto, 315 00:25:47,240 --> 00:25:51,599 for example, by ros, the primary physician is the one who bears the 316 00:25:51,720 --> 00:25:56,640 full responsibility first. I, as a surgeon who brings a patient to the 317 00:25:57,079 --> 00:26:00,279 O R, have all the responsibility for the passage. I' m supposed 318 00:26:02,400 --> 00:26:06,200 to certify that the anesthesiologist there is certified, that my assistant is certified, 319 00:26:06,920 --> 00:26:10,720 that the center where I' m going to operate also has all the certifications. 320 00:26:10,759 --> 00:26:15,640 I, as a GP, am primarily responsible for what happens in that 321 00:26:15,680 --> 00:26:18,279 act. So r they' re there in even reported. Residents are not 322 00:26:18,319 --> 00:26:22,200 responsible. They' re coming like a waterfall. At the time of submission, 323 00:26:22,359 --> 00:26:26,400 you were first, then the medical center and then you are going to 324 00:26:26,440 --> 00:26:30,519 split up, when then here, in the first instance, the patient goes 325 00:26:30,519 --> 00:26:36,559 there Nazif z does the first expertise, which is to do the autopsy. 326 00:26:38,039 --> 00:26:41,440 After that then the medical record is sought, an optosia is also done to 327 00:26:41,519 --> 00:26:47,079 the medical network Cold. That' s where the medical school experts come in, 328 00:26:48,240 --> 00:26:52,680 and between the part that Linazif delivers and what the medical experts do. 329 00:26:52,680 --> 00:26:57,880 Then responsibilities begin to be established in our country. Residents have no responsibility. 330 00:27:00,640 --> 00:27:04,359 Residents are in training, they have to depend on me in every act that 331 00:27:04,480 --> 00:27:10,160 a resident is. For example, I am a resident coordinator and no resident 332 00:27:10,279 --> 00:27:17,279 of my residence operates alone or does anything. Only if he went crazy and 333 00:27:17,400 --> 00:27:22,759 went out there and if any good supervision of my super already, he has 334 00:27:22,839 --> 00:27:26,880 to something that excited right now. The graduate was very good, and we 335 00:27:26,920 --> 00:27:30,759 have to get out of the head that that four gives us authority to do 336 00:27:30,799 --> 00:27:36,200 everything. In nineteen hundred that four allowed me, as a doctor, to 337 00:27:36,200 --> 00:27:38,720 give birth, perhaps me for my basic training. If there' s an 338 00:27:40,079 --> 00:27:42,680 emergency, I can act on the lemeniza, but if it got to a 339 00:27:42,720 --> 00:27:47,440 gynecologist, I have to let that gynecologist do his job. If you have 340 00:27:47,480 --> 00:27:51,039 an emergency situation and I can diagnose an infant, because I know chest pain 341 00:27:51,119 --> 00:27:56,039 or its duration, that state of agitation is the bras parrot removed. I 342 00:27:56,079 --> 00:28:00,440 have to taste good for the arm hurts the left. I have to know 343 00:28:00,480 --> 00:28:04,640 that his heart attack was already a nemotemia that was cute, where one had 344 00:28:04,720 --> 00:28:07,920 also the monkey or one didn' t know what the treatment was, and 345 00:28:07,960 --> 00:28:11,720 I can start it. Now having I' m going to go out there 346 00:28:11,799 --> 00:28:18,240 I' m a durologist, cardiologist, gin costotra, pulmonologist and to do 347 00:28:18,279 --> 00:28:22,279 everything I understand that I can do the table already we have to get that 348 00:28:22,480 --> 00:28:26,839 out of our heads and finally, to see the legal part of the question 349 00:28:26,000 --> 00:28:30,400 of tea, following what very well the doctor indicates once the processes have finished, 350 00:28:30,640 --> 00:28:36,599 already of the autopsy and the expert that is carried out, to determine 351 00:28:37,279 --> 00:28:42,920 exactly where the failure occurs, the negligence or that that simple person simply had 352 00:28:42,960 --> 00:28:49,440 bad luck at that time. That' s where we lawyers come in and 353 00:28:49,519 --> 00:28:53,720 determine who we' re going to sue, because many times in court what 354 00:28:53,720 --> 00:28:59,839 you do is a discard. Suppose that in the process one cannot directly point 355 00:29:00,039 --> 00:29:06,359 out any of the doctors or medical personnel who was involved in the surgical procedure. 356 00:29:06,960 --> 00:29:11,640 So my irresponsibility as a lawyer is to sue everyone the devil I sue 357 00:29:11,720 --> 00:29:15,319 the clinician or the hospital, you, I command the doctor of pru te, 358 00:29:17,039 --> 00:29:19,559 I command the residents who were there under his supervision, I sue the 359 00:29:19,559 --> 00:29:25,279 anesthesiologist of command to the nurse, I demand even the people who clean the 360 00:29:25,279 --> 00:29:27,119 room, the one who brought him breakfast, Jedda, who could not have 361 00:29:27,200 --> 00:29:30,920 breakfast, died with the do and I present then themselves. So, I 362 00:29:32,000 --> 00:29:36,720 don' t know that this I present the facts and my evidence of what 363 00:29:36,720 --> 00:29:41,000 happened. Why I point out that they are all jointly responsible. So they 364 00:29:41,079 --> 00:29:45,319 are equally responsible and then they have the technical defense in the doctors' courts, 365 00:29:45,440 --> 00:29:49,680 to end who is the possible responsibility or to defend that no one was 366 00:29:49,799 --> 00:29:56,079 responsible in that case. So there the judges, which is the importance of 367 00:29:56,119 --> 00:30:00,000 the experts, because they are the doggies that the judges will illustrate. What 368 00:30:00,039 --> 00:30:03,640 ' s the situation? The expert is going to take the judge, to 369 00:30:03,759 --> 00:30:07,200 be inside that surgical room, where procedure is being done and he will explain, 370 00:30:07,599 --> 00:30:11,240 step by step, what the procedure is and where the errors might have 371 00:30:11,279 --> 00:30:15,839 been or if there was no error. That' s why I said right 372 00:30:15,839 --> 00:30:18,920 now. It' s a mistake to pretend now that medical experts are taking 373 00:30:18,960 --> 00:30:26,680 out of the media in solidarity with doctors because they share that view, because 374 00:30:26,039 --> 00:30:30,000 you' re getting your voice out of the judicial process and you' re 375 00:30:30,079 --> 00:30:34,160 letting it be the judge, who' s not an expert in medicine, 376 00:30:34,279 --> 00:30:40,200 who makes the decision based on what' s being presented to him alone and 377 00:30:40,279 --> 00:30:41,319 essentially using the law and applying it exactly as it is written. Then. 378 00:30:41,599 --> 00:30:47,279 That' s why the lawyer' s role has to be there in that 379 00:30:47,279 --> 00:30:49,119 case. If I' m representing the plaintiff, I' m going to 380 00:30:49,160 --> 00:30:52,359 hold everyone responsible so that it' s the judge who, through his decision, 381 00:30:52,400 --> 00:31:00,720 says look. The doctor Cabecera was not responsible because he followed the protocols 382 00:31:00,720 --> 00:31:03,920 of the place. The residents were not responsible because I never laid hands on 383 00:31:03,960 --> 00:31:08,480 the patient. The anesthesiologist was responsible because he passed to the extent of the 384 00:31:08,519 --> 00:31:12,160 anesthesia he had, since he had to inject it. Then download everyone and 385 00:31:12,160 --> 00:31:18,640 the anesthesiologist is held responsible and is the possible convicted in that case. Or 386 00:31:18,720 --> 00:31:22,119 it could be that the doctor who is operating makes a deeper cut than was 387 00:31:22,119 --> 00:31:26,079 initially thought a mistake. Or whatever the carota is and where the croons are 388 00:31:27,039 --> 00:31:32,720 The neck happens, that is, mistakes happen, unfortunately, and the judge 389 00:31:32,799 --> 00:31:37,559 understands that none of us are responsible. It is responsible for the doctor who 390 00:31:37,559 --> 00:31:42,200 was, therefore, caring for that person who we are operating on the residents 391 00:31:44,279 --> 00:31:48,200 quickly, as you describe it, between the residents and the doctor who is 392 00:31:48,240 --> 00:31:55,400 in charge of them there is a preposed committeeing relationship We have talked here that 393 00:31:55,480 --> 00:31:56,720 this is a relationship that is similar to that of the artisans with their apprentices. 394 00:31:57,680 --> 00:32:05,240 He' s going to be responsible for what residents do based on his 395 00:32:05,279 --> 00:32:10,839 instructions. If that resident goes out operating people out there and the doctor doesn 396 00:32:10,920 --> 00:32:14,720 ' t know it until a mess explodes, he can' t be responsible 397 00:32:14,759 --> 00:32:17,200 for that ever or ever, but what happens in that hospital, in that 398 00:32:17,279 --> 00:32:22,279 clinic, under the supervision of the crag, the head of the residents, 399 00:32:22,039 --> 00:32:25,759 who heads them, who determines what their duties are going to be over the 400 00:32:27,200 --> 00:32:31,640 course of a day the mistakes they make. He' s going to answer 401 00:32:31,680 --> 00:32:37,880 that that' s what breaks the criterion that you' re going to pay 402 00:32:37,160 --> 00:32:39,759 for the responsibility for what you do. That' s one of the exceptions 403 00:32:39,799 --> 00:32:43,960 we' ve talked about here some juantos, parents with minor designs, animal 404 00:32:44,279 --> 00:32:47,839 owners know animals, they hurt other people. In the case of parkers who 405 00:32:49,839 --> 00:32:54,359 are employees of restaurants or super treated companies to provide that service, we have 406 00:32:54,480 --> 00:33:00,880 mentioned it here on several occasions. Then that relationship with the chief doctors and 407 00:33:00,920 --> 00:33:05,559 their residents, because it also falls, falls within those exceptions. There' 408 00:33:05,920 --> 00:33:07,680 s a date, there' s a little thing and it' s a 409 00:33:07,680 --> 00:33:14,720 lot. This and it is our daily bread. For example, where would 410 00:33:14,799 --> 00:33:20,839 the medical diligence enter this question of demand, which is why there are people 411 00:33:20,880 --> 00:33:25,880 who take a sick patient to an emergency, but then they find the picture 412 00:33:25,920 --> 00:33:31,000 that always presents the nurse drinking coffee over there the guy the doctor, when 413 00:33:31,000 --> 00:33:35,359 it appears that you have to make a deposit and if you don' t 414 00:33:35,440 --> 00:33:40,319 get it exactly happens the patient dies. In what is presented the case that 415 00:33:40,359 --> 00:33:45,119 the guy grabs and deposits the money that has to be deposited in the box 416 00:33:45,160 --> 00:33:49,480 to be cared for that the nurse finishes seeing that his coffee, that the 417 00:33:49,480 --> 00:33:52,880 resident doctor pairs that it is that I that thing that you have to bring 418 00:33:52,880 --> 00:33:59,480 him a receipt certifying that you deposited that money, the patient dies waiting for 419 00:33:59,480 --> 00:34:06,119 attention. Attention then how to proceed. There' s medical negligence. That 420 00:34:06,200 --> 00:34:08,400 ' s where the entire clinic is demanded with the entire doctor up to the 421 00:34:08,400 --> 00:34:14,039 trucker. As the good law says in that case, for example, there 422 00:34:14,280 --> 00:34:19,400 is already non- observance. That is negligence and if that usually happens the 423 00:34:19,480 --> 00:34:24,000 times that has happened, the center is always sued with all the actors. 424 00:34:24,119 --> 00:34:28,639 It' s a practice that I understand has declined a lot in the Dominican 425 00:34:28,639 --> 00:34:36,480 Republic. Here too, we have to understand that bureaucratic procedures also often complicate 426 00:34:36,519 --> 00:34:42,480 emergency care, because we have sometimes oversaturated emergencies with patients who do not want 427 00:34:42,679 --> 00:34:47,719 to go to the clinic, and that oversaturation makes it many times when a 428 00:34:47,840 --> 00:34:52,320 real emergency arrives. If I am already taking care of you and I see 429 00:34:52,320 --> 00:34:53,559 that there is very missing, you are not going to want me to go 430 00:34:53,559 --> 00:34:58,800 well, because you understand that your problem is more serious than King two. 431 00:34:59,039 --> 00:35:01,039 And that' s what happens in eighty or ninety percent of the misunderstandings you 432 00:35:01,159 --> 00:35:06,920 see in those situations. Many times immenence has an internist, they have a 433 00:35:06,960 --> 00:35:09,599 pediatrician and a general practitioner. The piatrata with children, the internetta with adults 434 00:35:09,639 --> 00:35:15,760 or the emergenciologist. Thank God, we already have the medicologist in our country 435 00:35:15,800 --> 00:35:20,840 and we often waste more time on the emergency with situations that are not emergency, 436 00:35:20,960 --> 00:35:24,239 for example Mitaliti. Mentrual pains are fading. That' s what' 437 00:35:24,280 --> 00:35:27,960 s in the emergency. It' s here right now and really when a 438 00:35:28,400 --> 00:35:31,440 real emergency patient arrives, we have to divert all the time. Sometimes in 439 00:35:31,480 --> 00:35:35,800 an ambitalid and you will understand proximism you have ambita Liti and I will help 440 00:35:35,800 --> 00:35:39,039 you of the night I attend. I have insurance first. I got here 441 00:35:39,039 --> 00:35:44,920 first. But we have to start making proper use of the emergency. For 442 00:35:44,920 --> 00:35:46,519 example, in another part of the world, the use of the emergency is 443 00:35:46,599 --> 00:35:50,719 paid by the patient. Here, unfortunately, the use of emelence is paid 444 00:35:50,840 --> 00:35:58,159 for by insurance and all the emergency so full the scoundrel already finally with you 445 00:35:58,159 --> 00:36:04,880 exactly. It will seem that if bureaucratic processes are so unreasonable with regard to 446 00:36:05,159 --> 00:36:09,960 other hospitals or other clinics in the same situation. That, then, creates 447 00:36:10,000 --> 00:36:15,440 responsibility for the medical center. I mean, that' s the first thing 448 00:36:15,800 --> 00:36:20,360 you see if all the bureaucratic processes you have are exactly the same as those 449 00:36:20,400 --> 00:36:23,559 of MEDIA or if they' re more complicated, longer and more tedious, 450 00:36:24,000 --> 00:36:30,760 because that could create responsibility for the clinic of the medical center in general. 451 00:36:30,199 --> 00:36:34,559 And so, as the doctor put it right, the case of non- 452 00:36:34,719 --> 00:36:36,920 observance of the doctors of the sick woman said check it out. Now, 453 00:36:36,880 --> 00:36:39,800 since I' m seeing a coffee or whatever time of Almo lady almo, 454 00:36:39,920 --> 00:36:44,440 it' s done, give me a second, I' m going and 455 00:36:44,440 --> 00:36:49,440 you twisted a whole pain there' s until you die, because then that 456 00:36:49,480 --> 00:36:51,440 too could generate responsibility for everyone who' s that amargent. I went in 457 00:36:51,440 --> 00:36:52,280 exchange for a jeck and the one who got it to me went to comay. 458 00:36:52,400 --> 00:36:55,920 He didn' t tell me anything and the check in another box and 459 00:36:55,960 --> 00:37:00,000 an hour I' m waiting for my check to be changed had confirmed it. 460 00:37:00,159 --> 00:37:04,400 Thank you, Dr César Rivera, thanks to Von Arturo, he' 461 00:37:04,440 --> 00:37:06,280 s going to apologize to Dr Fo who asked you to come, but you 462 00:37:06,280 --> 00:37:07,559 have to come tomorrow. We need to talk about NBA. All right, 463 00:37:07,480 --> 00:37:12,079 we need to talk about never- ending problems, but we always thank you 464 00:37:12,119 --> 00:37:15,119 for the availability. I think the audience is pretty clear about what' s 465 00:37:15,119 --> 00:37:21,199 going on. I myself was in error in many concepts. I' m 466 00:37:21,239 --> 00:37:22,079 not a doctor, I' m not a lawyer. I now have a 467 00:37:22,159 --> 00:37:24,920 clearer idea of this issue. That' s why I haven' t talked 468 00:37:25,440 --> 00:37:29,119 about him much, because I didn' t. I think that the criteria 469 00:37:29,119 --> 00:37:31,480 are enough to give me a clear view of what is going on. And 470 00:37:31,599 --> 00:37:37,360 I do agree with what the doctor is proposing and I fully support that here 471 00:37:37,400 --> 00:37:45,199 we have to review from the protocols to how these kinds of actions are being 472 00:37:45,280 --> 00:37:49,960 pursued and punished, which I think are excessive and should only be admissible in 473 00:37:50,000 --> 00:37:55,320 exceptions, exceptions where the intention I know exactly is to harm, because no 474 00:37:55,400 --> 00:38:00,159 doctor. I have a lot of medical friends and we see ros with it 475 00:38:00,440 --> 00:38:05,599 and I share and know that they are all good people. No doctor studies 476 00:38:06,639 --> 00:38:09,880 this career with the intention of taking life, but of giving it and helping 477 00:38:09,920 --> 00:38:14,559 to improve it. Then it' ll be the doctor' s feeling. 478 00:38:14,559 --> 00:38:17,119 And for any nonsense and you' re going pana hayo I imagine it' 479 00:38:17,159 --> 00:38:21,519 s a face on your back as professionals as well and in your conscience you 480 00:38:21,519 --> 00:38:23,679 pussy. But it' s just that I feel like I' m stealing, 481 00:38:23,760 --> 00:38:25,599 that I feel like a pussy, and that I was a potential criminal. 482 00:38:25,800 --> 00:38:27,920 And it' s not like that. It' s not like that. 483 00:38:28,159 --> 00:38:30,480 So, doctor, thank you, Juan Arturo, thank you. We 484 00:38:30,719 --> 00:38:34,800 ' re gonna put this on YouTube. We were discussing the issue of medical 485 00:38:34,880 --> 00:38:37,280 demands here at the rhythm of the morning, with Dr César Rivera, urologist 486 00:38:37,360 --> 00:38:42,000 and Juan Alturo, his lawyer, who is the doctor. The doctor' 487 00:38:42,039 --> 00:38:44,719 s going on a trip again, but you' re going to a doctor. 488 00:38:45,000 --> 00:38:46,000 We' re going to San Antonio, Texas. Look at me, 489 00:38:46,599 --> 00:38:50,400 but for God' s sake, my God, this year he' s 490 00:38:50,400 --> 00:38:53,519 traveled you more than I have. I haven' t gone out twice We 491 00:38:52,199 --> 00:38:53,519 ' re already here.