In healthcare, it's not enough to do things right: you must be able to prove it. Medical liability is defined long before litigation. Disputes rarely turn solely on the clinical act. They are often decided by the quality of the process, the traceability of the medical record, and how care was documented.
Risk also appears in late consent, an incomplete clinical note, a complication managed via messaging, or a psychiatric crisis without sufficient documentation. This guide compiles the most critical points according to Dominican case law and best practices to safeguard medical practice.
Three Principles of Evidentiary Management
I. INFORMED CONSENT
For surgical and invasive procedures, informed consent must be documented in writing and individualized. The judge also weighs clinical notes, statements, and elements consistent with the informational process.
II. MEDICAL RECORD
Date, time, progress notes, orders, warning signs, and response to adverse events are probative pieces. What is not documented remains vulnerable to adverse reconstructions.
III. DIGITAL
WhatsApp, audio messages, clinical images, and social media can become judicial evidence. Relevant content must be preserved and formally incorporated into the medical record.
Regulatory Framework
CONSTITUTIONAL
- Art. 38 – Human dignity
- Art. 42 No. 3 – Personal integrity
- Art. 53 – Consumer rights
- Art. 61 – Right to health
STATUTORY
- Law 42-01 General Health Law
- Law 358-05 Consumer Protection
- Law 12-06 Mental Health
- Law 172-13 Data Protection
- Law 74-25 Criminal Code (effective 2026)
REGULATORY
- Decree 1138-03 Licensing
- MSP Resolution 000001/2017
- MISPAS Regulation 2024
- Resolution 0013-2023 Medical Record
8 Scenarios That Most Expose the Professional
| # | Situation | Recommended Documentary Defense |
|---|---|---|
| 01 | Late consent Signing under pressure minutes before the procedure. | Individualized form, advance delivery, note of the informational process, emergency record. |
| 02 | Postoperative complication Notice by call/message; claim of lack of follow-up. | Written warning signs, prudent instructions, referral to emergency department, integrate messages into the record. |
| 03 | Healthcare-associated infection Wound infection or HAI. | Sterilization protocols, supply traceability, equipment logs, epidemiological surveillance. |
| 04 | ICU and critical monitoring Sedated patient, risk of fall/elopement. | Verified physical measures, nursing notes, risk assessment, incident reports. |
| 05 | Psychiatric crisis Suicidal ideation, psychosis, refusal of transfer. | Applied risk scale, family contact (time recorded), reasoned clinical decision, signed informed refusal. |
| 06 | Misleading clinical advertising "Before/after", "risk-free". | Eliminate absolutes, warn of variability, image consent, review campaigns. |
| 07 | Images and sensitive data Photos on personal cell phone. | Express authorization (Law 172-13), defined purpose, anonymization, secure storage. |
| 08 | Care without written consent Emergency / incapacity. | Document severity, impossibility of consent, contact with representative, reasoned clinical decision. |
High-Impact Internal Adjustments
Eight focus areas to close evidentiary gaps before a claim:
Case Law Criteria of Practical Impact
Supreme Court of Justice · Dominican Republic
Internal Evidentiary Risk Checklist
Ten questions · each “no” identifies a point of exposure
- Is informed consent provided sufficiently in advance (ideally 24h) and does it contain personalized risks?
- Does the medical record include date, time, and professional for each entry?
- Are warning signs provided in writing upon discharge?
- Are documented infection prevention protocols in place?
- For patients at psychiatric risk, is a validated scale applied and family contacted?
- Are WhatsApp messages containing clinical content transcribed into the medical record?
- Does advertising avoid absolute terms (“guaranteed”, “risk-free”)?
- Do clinical images have express authorization and are they stored securely?
- In emergencies without written consent, is there a record of the impossibility and the medical decision?
- Do contracts with the facility clearly define responsibilities?