Medical Certificate Anomalies: Analysis of Central Medical Inspection Missions and Medico-Legal Implications in Tunisia

Main Article Content

Fourati Hazem
Hanen Moussi
Maha Shimi
Elkhal Mohamed Cherif

Abstract

Introduction:
The medical certificate is a medico-legal document that fully engages the professional responsibility of the physician. Errors in its issuance, whether due to lack of knowledge of certification rules or acts of collusion, can have disciplinary, civil, and criminal consequences. The aim of this study was to analyze anomalies in medical certificates identified during the missions of the Central Medical Inspection and to evaluate their medico-legal implications.


Methods:
This was a retrospective descriptive study based on reports from medical inspection missions conducted in the Tunis region between January 1 and December 31, 2023. All reports concerning medical certificates issued by physicians that contained anomalies were included. Certificates falsified by non-physicians were excluded. Data collected included the source and reason for the complaint, type of certificate, physician’s practice sector, observed anomalies, and inspection conclusions.


Results:
A total of 149 inspection missions were analyzed, involving 160 medical certificates. Among these, 55 certificates issued by physicians contained anomalies. Complaints mainly concerned suspected collusive certificates (38 cases) or falsifications (17 cases). Certificates of sick leave accounted for the majority of affected documents (42 cases). Identified anomalies included formal defects (lack of physician or patient identification, missing signature or stamp), inconsistencies in clinical content, and administrative irregularities, particularly lack of traceability in some public institutions. Following the inspections, 38 certificates were classified as collusive, while 17 anomalies were attributed to lack of knowledge of certification rules.


Conclusion:
Anomalies in medical certificates remain frequent and expose physicians to significant medico-legal risk. Strengthening training and awareness regarding proper certificate issuance is essential to improve the quality of these documents.

Article Details

How to Cite
Fourati Hazem, Hanen Moussi, Maha Shimi, and Elkhal Mohamed Cherif. 2026. “Medical Certificate Anomalies: Analysis of Central Medical Inspection Missions and Medico-Legal Implications in Tunisia”. International Journal of Medical Science and Clinical Research Studies 6 (05):852-56. https://doi.org/10.47191/ijmscrs/v6-i5-08.
Section
Articles

References

I. Code de Déontologie Médicale tunisien. Décret n° 93-1155 du 17 mai 1993, portant code de déontologie médicale. J.O.R.T n° 40 des 28 mai et 1er juin 1993 page 764.

II. Epain D. Certificats médicaux et urgence-certificats de coups et blessures. EMC-Médecine. 2005;2(4):448–467.

III. Nseme E, Eone DH, Sando Z, Ngankol VM, Sosso MA, Ashuntantang G. Mise au Point sur la Rédaction des Certificats Médicaux et Médico-légaux. Health sciences and diseases. 2018;19(2).

IV. Khalfallah M. Responsabilité déontologique du médecin certificateur: Analyse des plaintes déposées au conseil régional de l’ordre des médecins de Tunis.2017.

V. Sharma, N., Singh, M., Bahurupi, Y. et al. Analysis of errors in medical certificates of cause of death (MCCD) at a tertiary care institute in 2022. Discov Public Health 21, 85 (2024).

https://doi.org/10.1186/s12982-024-00209-7

VI. Agyekum F, Asamoah IE, Bashir M, Asante NA, Ganatra K, Duodu F, Akumiah FK, Brodie-Mends D, Asamoah KT, Ampofo EB, Doku A. Assessment of errors in death certification and mortality patterns and trends among medical patients at Korle Bu Teaching Hospital, 2019-2023. Ghana Med J. 2025 Sep;59(3):111-120. doi: 10.4314/gmj.v59i3.2. PMID: 41122261; PMCID: PMC12536572.

VII. Quatrehomme G, Alunni V, Martrille L. Item no 9. Certificats médicaux. La Revue de Médecine Légale. 2018

VIII. Boissin H, Rougemont D. Les certificats médicaux– Règles générales d’établissement. CNO; 2006.

IX. Ministère de la Santé publique. Circulaire n° 71/2000 du 11 septembre 2000 relative à la délivrance du CMI en cas d’accidents du travail et maladies professionnelles.

X. Décret N0 81-1634 du 30 Novembre 1981, portant règlement général intérieur des Hôpitaux, Instituts et Centres Spécialisés relevant du Ministère de la Santé Publique.

XI. Code_des_obligations_et_des_contrats.pdf [Internet]. [16 Jan 2019]. Disponible à l'URL:

http://www.e-justice.tn/fileadmin/fichiers_site_francais/codes juridiques/ Code_des_obligations_et_des_contrats.pdf

XII. Code_penal_12_07_2010_fr.pdf. [16 Jan 2019]. Disponible à l'URL: http://www.e-justice.tn/fileadmin/fichiers_site_francais/ codes juridiques/ Code_penal_12_07_2010_fr.pdf

XIII. Abeygunasekara A, Ramasundara M. Evaluation of errors in death certification by medical officers in an acute hospital. Australas J Ageing. 2023 Dec;42(4):786-790. doi: 10.1111/ajag.13207. Epub 2023 May 1. PMID: 37127432.

XIV. Hart, J.D., Sorchik, R., Bo, K.S. et al. Improving medical certification of cause of death: effective strategies and approaches based on experiences from the Data for Health Initiative. BMC Med 18, 74 (2020).https://doi.org/10.1186/s12916-020-01519-8