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if they cause damage, it means that we completely forbid them from is he like the woman who mistakenly poured kerosine into the mouth #
practicing their profession in the future, even for free. of an unconscious woman. While perhaps the woman was not careful
So do we revoke a physician’s license if he was negligent? It de- enough, in this case, any other physician would have done just what
pends: According to the Shulchan Aruch, one can revoke his license this physician did. Therefore, he does not need kapparah at all, and by
even if he was negligent only one time, if he is salaried by the city to imposing it on him we will be deterring future rescuers.
work for the public. According to the Rama, we can revoke his license 
only if he was negligent three times, and even if he is self-employed.
However, I heard from my father-in-law, Rav Y. S. Elyashiv, that
one should not learn from the words of the Shulchan Aruch and the 1 SuMMaRy and Conclusions
Sema in the case where the physician erroneously prescribed a tox-
ic medication and the patient took it and died. It seems likely that 1. If a surgeon cut an organ or blood vessel because of inadequate
the words of Shulchan Aruch and Sema were said only in regard to a care and attention, and the patient dies, he must be exiled.
bloodletter who was negligent, such as if he let more blood than nec- 2. If a physician switched medications in an urgent case and the
essary, in which case he literally caused damage with his own hands. patient died, he is exempt from exile. He requires some kappa-
If he did not damage with his own hands, such as if he wrote out a rah for his act since bad happenings come about through the
prescription for a harmful drug or a beneficial drug without checking guilty.
whether it could be poisonous to the patient, then we have not heard 3. If a physician did not diagnose an illness correctly, and as a result 20818_efi-ab - 20818_efi-ab | 5 - A | 18-08-20 | 13:29:01 | SR:-- | Magenta
that he is to be removed from his profession. the patient died, if the error was not due to negligence and there #20818_efi-ab - 20818_efi-ab | 5 - A | 18-08-20 | 13:29:01 | SR:-- | Yellow 20818_efi-ab - 20818_efi-ab | 5 - A | 18-08-20 | 13:29:01 | SR:-- | Black 20818_efi-ab - 20818_efi-ab | 5 - A | 18-08-20 | 13:29:01 | SR:
On the other hand, I heard from my revered father-in-law that was no greater physician with whom to consult, he is exempt
under all circumstances, a physician is viewed as salaried by the city from exile because he is viewed as an anuss. He requires some
since he has permission to heal all its inhabitants. Thus, if they do kapparah for his act since bad happenings come about through
not revoke his license for negligence, he will cause damage to many the guilty.
more patients. In this case our Sages look out for the public welfare.
Therefore, under all circumstances, a physician is halchically viewed 4. If a physician is caring for someone injured in his abdomen who
as an employee of the people of the city, even if he is self-employed. requires immediate surgery and the patient dies due to an aller-
Since there is doubt about the halachic ruling, for according to the gy to the anesthetic, since the surgeon made no mistake, and any
Shulchan Aruch he is fired from his job and he is also fined immedi- other physician in his place would have done the same thing,
ately even after one incident of negligence, but according to the Rama, he is not exiled nor do we impose any means of kapparah upon
only after three times, we do not fine him after one time. him, so as not to deter future rescuers. (This applies if there was
Thus, if the physician is generally a responsible person and works no time before the surgery to clarify whether the patient had an
diligently and meticulously, but it happened that he once made a allergy to anesthetic agents.)
mistake, it is likely that we cannot fire him or even fine him. (But 5. An ambulance driver who rushed to bring a patient to the hos-
one should give the case over to a beis din who will warn him not to pital and hit a pedestrian and killed him is exempt from exile,
repeat his mistake.) However, if, in general, the quality of his work but he probably needs atonement. However, if his speed while
is low and he takes his responsibilities lightly, it is likely that one can driving was within the acceptable range for an emergency vehi-

146 1 Medical-HalacHic Responsa of Rav ZilbeRstein Do they require exile? 2 131