In Sweden 99 % of all complaints against doctors are handled by a public authority, The Medical Responsibility Board (HSAN). This way it is very rare fore a medical complaint to reach the judicial courts in Sweden. HSAN is a national authority that assesses medical negligence. If health care staff is at fault, the Board can take disciplinary action against them.

The Board is made up of nine members. The chairman is a lawyer with judicial experience and the other members have experience from various sectors of the health services. Anyone who is or has been a patient can file a complaint to HSAN. The National Board of Health and Welfare, the Parliamentary Ombudsman and the Chancellor of Justice can also file complaints to HSAN. The complaint must contain details of the actual examination, care or treatment referred to, when and where it took place and, if possible, who was at fault and what the fault is considered to be. HSAN must be informed of the subject of complaint within two years of the incident’s occurrence. If this is not the case, disciplinary responsibility will have lapsed.

HSAN’s decisions are always public. A case is prepared by getting the opinion of the accused doctor and a copy of the patient records.

When a case has been prepared medical experts with links to HSAN review it. HSAN subsequently examines the case and arrives at a decision. The chairman alone examines certain cases following a review by medical experts. Copies of the decision are sent both to the person who filed the complaint and those to the person(s) cited.

If the person filing the complaint is not happy with the decision, it may be appealed. The appeal must be lodged within three weeks from the date the decision is made public. The court of appeal is the county administrative court.

HSAN does not handle requests for economical compensation. If the plaintiff wants money he/she has to go to court. This happens extremely seldom.

HSAN handles about 3000 cases a year and in less that 6–10 % a decision against the accused is made. 70 % of the cases concern doctors and 30 % dentists, nurses and others. The number of orthopaedics cases is about 300 per year and a ruling against the surgeon happens in less than 10 %. The complaints in orthopaedics concern clinical examination, faulty diagnostics (usually that x-rays were not taken), faulty treatment and misconduct. Most of the cases in orthopaedics originate in the emergency department.