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if they cause damage, it means that we completely forbid them from
practicing their profession in the future, even for free.
So do we revoke a physician’s license if he was negligent? It de-
pends: According to the Shulchan Aruch, one can revoke his license
even if he was negligent only one time, if he is salaried by the city to
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
Sema in the case where the physician erroneously prescribed a tox-
ic medication and the patient took it and died. It seems likely that
the words of Shulchan Aruch and Sema were said only in regard to a
bloodletter who was negligent, such as if he let more blood than nec-
essary, in which case he literally caused damage with his own hands.
If he did not damage with his own hands, such as if he wrote out a
prescription for a harmful drug or a beneficial drug without checking
whether it could be poisonous to the patient, then we have not heard
that he is to be removed from his profession.
On the other hand, I heard from my revered father-in-law that
under all circumstances, a physician is viewed as salaried by the city
since he has permission to heal all its inhabitants. Thus, if they do
not revoke his license for negligence, he will cause damage to many
more patients. In this case our Sages look out for the public welfare.
Therefore, under all circumstances, a physician is halchically viewed
as an employee of the people of the city, even if he is self-employed.
Since there is doubt about the halachic ruling, for according to the
Shulchan Aruch he is fired from his job and he is also fined immedi-
ately even after one incident of negligence, but according to the Rama,
only after three times, we do not fine him after one time.
Thus, if the physician is generally a responsible person and works
diligently and meticulously, but it happened that he once made a
mistake, it is likely that we cannot fire him or even fine him. (But
one should give the case over to a beis din who will warn him not to
repeat his mistake.) However, if, in general, the quality of his work
is low and he takes his responsibilities lightly, it is likely that one can
146 1 Medical-HalacHic Responsa of Rav ZilbeRstein
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is he like the woman who mistakenly poured kerosine into the mouth #
of an unconscious woman. While perhaps the woman was not careful
enough, in this case, any other physician would have done just what
this physician did. Therefore, he does not need kapparah at all, and by
imposing it on him we will be deterring future rescuers.

1 SuMMaRy and Conclusions
1. If a surgeon cut an organ or blood vessel because of inadequate
care and attention, and the patient dies, he must be exiled.
2. If a physician switched medications in an urgent case and the
patient died, he is exempt from exile. He requires some kappa-
rah for his act since bad happenings come about through the
guilty.
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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 2081
was no greater physician with whom to consult, he is exempt
from exile because he is viewed as an anuss. He requires some
kapparah for his act since bad happenings come about through
the guilty.
4. If a physician is caring for someone injured in his abdomen who
requires immediate surgery and the patient dies due to an aller-
gy to the anesthetic, since the surgeon made no mistake, and any
other physician in his place would have done the same thing,
he is not exiled nor do we impose any means of kapparah upon
him, so as not to deter future rescuers. (This applies if there was
no time before the surgery to clarify whether the patient had an
allergy to anesthetic agents.)
5. An ambulance driver who rushed to bring a patient to the hos-
pital and hit a pedestrian and killed him is exempt from exile,
but he probably needs atonement. However, if his speed while
driving was within the acceptable range for an emergency vehi-
Do they require exile? 2 131