Ban on Assistant Surgeon Performing Surgery... Alone
- The necessity of linking surgical procedures to the physician’s field of specialization, their license, and their approved professional privileges.
- Scheduled elective procedures must be approved by a physician at the specialist level or higher.
- Mandatory requirement to obtain informed consent from the patient or their legal representative prior to performing the procedure.
- Prohibition of a surgeon performing more than one procedure simultaneously or leaving the operating room unless under extreme necessity.
- Physicians are permitted to perform procedures in other government hospitals when necessary, after obtaining the required approvals.
Minister of Health Dr. Ahmed Al-Awadi issued Ministerial Decision No. 220 of 2026, concerning the conditions, regulations, and standards to be adhered to when performing surgical operations or medical interventions in both the public and private sectors. The decision stipulates that a physician at the level of registered assistant or trainee in a specific medical specialty is not permitted to perform a surgical procedure independently. It also prohibits performing any procedure without the consent of the patient or their legal representative.
The decision assigns the responsibility of granting and approving privileges for performing surgical operations and medical interventions to departmental councils. This is achieved by classifying approved procedures for each specialty according to the job title in the professional license, specialization, experience, and the nature of the intervention. Additionally, it mandates the establishment of specific conditions, regulations, and standards for each specialty, with periodic review and updates in line with the latest medical developments.
In this context, the decision reinforces the supervisory and regulatory role of the Undersecretary of the Ministry of Health. It stipulates the approval of procedure classifications, conditions, regulations, and standards submitted by departmental councils. Each council must submit a list of classified surgical procedures specific to its specialty to the Undersecretary within three months of the decision’s publication for approval. Furthermore, the decision empowers the Undersecretary or their authorized delegate, following the administrative hierarchy, to temporarily suspend the privilege to perform procedures or medical interventions when medical necessity dictates. It also mandates the review of requests concerning overlapping authorities among different medical specialties within three months of the decision’s publication.
The decision emphasizes the necessity of linking the performance of procedures and medical interventions to the physician’s specialization, license, and approved professional privileges. It requires that scheduled elective procedures be approved by a physician at the specialist level or higher. It defines the required levels of supervision for physicians based on their job titles, including the prohibition of a physician at the level of registered assistant or trainee in a specific medical specialty performing a surgical procedure or medical intervention independently. It also regulates exceptions regarding minor procedures, in accordance with the classification, approval, and direct supervision specified in the decision.
The decision strengthens patients’ rights by obligating the attending physician or a member of the medical team at the specified job level to obtain informed consent from the patient or their legal representative before performing the procedure or medical intervention, and to document it in the medical file. It also requires disclosing the identity of the medical team that will perform the procedure or intervention to the patient, and prohibits delegating the procedure to another physician without the patient’s or their representative’s consent, provided that the substitute physician holds the necessary authority.
The decision also regulated the handling of cases requiring additional expertise during surgical procedures, obligating the physician encountering difficulties or challenges during an intervention to seek assistance from experienced colleagues before changing the type of surgery or halting it, provided the patient’s condition permits. It prohibited surgeons from performing multiple surgical procedures simultaneously or leaving the operating room during an intervention except in cases of extreme necessity, and only after ensuring the patient’s complete safety, with such instances documented in the medical record.
Regarding the management of emergency and urgent cases, the decision authorized physicians working in the public sector, within the scope of their license and specified regulations, to perform surgeries and medical interventions in other government hospitals when necessary and after obtaining the required approvals. This was conditional upon the hosting hospital’s readiness and the availability of a qualified medical team to monitor potential complications. Furthermore, in emergency or urgent cases aimed at preserving the patient’s life or preventing serious harm, the decision permitted assigning surgeons employed by the Ministry of Health to provide surgical care in private healthcare facilities, in accordance with the approvals and procedures outlined in the decision.
The decision emphasized the continuity of medical care, obligating on-duty physicians to report to the operating department whenever requested, prioritizing this duty over outpatient clinic duties or scheduled surgeries. It also mandated that the on-duty team, including specialists, senior specialists, and consultants, review new admissions and patients who underwent surgery on the same day. Additionally, it organized the daily rounds of physicians at specified levels through all patients in surgical wards.
To strengthen the culture of quality and institutional learning, the decision required heads of surgical departments to hold regular meetings on complications and mortality, no less than once a month, to review cases, analyze their causes, and assess deficiencies or observations related to care quality and patient safety. These meetings were to establish necessary recommendations and corrective actions to prevent recurrence, with reports submitted to the facility’s quality management department through the head of the medical board.
The decision mandated that healthcare facilities appoint a designated official, from the specified eligible professional categories, to organize surgical operating rooms. This official is responsible for overseeing their operation, readiness, and the efficiency of equipment, instruments, supplies, sterilization systems, and supply chain safety. The role also includes coordinating surgical schedules, allocating operating rooms and nursing staff, and preventing schedule conflicts or unauthorized simultaneous surgeries, thereby supporting optimal resource utilization and reinforcing the highest standards of surgical quality and safety.
The decision included additional controls to enhance patient safety and professional governance, such as prohibiting any additional interventions during surgery unless there is an urgent or necessary need, ensuring sufficient operating rooms are operational to accommodate time-sensitive emergency cases, and restricting clinical trials conducted through surgical procedures or medical interventions to those approved by the Standing Committee for Coordinating Medical and Health Research and the relevant departmental council.
The decision obligated the attending physician to follow up with the patient after surgery or medical intervention, or to delegate a qualified substitute physician in their absence, while documenting the follow-up, treatment plan, and review appointments. It also stressed the comprehensive recording of data related to surgeries and medical interventions in the medical record and the operating log, including patient details, diagnosis, procedure name, primary surgeon, assisting surgeons, and the nursing team.
The decision sets out specific regulations for cases involving the amputation of body parts or organs, as well as for excision procedures and tissue sampling, including the completion of approved forms, the submission of samples for examination or documentation of the reasons for not doing so, the follow-up of tissue examination results, the notification of patients of those results, and the documentation of such actions in their medical records.
